Political Factors Affecting Public Expenditure on Health Promotion and Disease Prevention in Thailand, 2002-2023
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Abstract
The allocation of public expenditure for health promotion and disease prevention represents a crucial mechanism reflecting the state's commitment to sustainable health system development, particularly as Thailand transitions into an aging society and confronts epidemiological shifts from acute communicable diseases to chronic non-communicable diseases. However, governmental budgetary decisions are not solely predicated upon health principles or public demands, but rather depend on multidimensional determinants of public spending, particularly political factors that play a pivotal role in shaping public policy directions. This study aims to 1) examine political factors influencing the determination of public expenditure on health promotion and disease prevention, and 2) propose policy recommendations for enhancing the efficiency of public expenditure allocation for health promotion and disease prevention. The research employed a quantitative approach utilizing time series data from 2002 - 2023 and multiple regression analysis techniques, integrating public finance theory, political economy theory, and public expenditure determination theory. The study period encompasses several significant political transitions in Thailand, including military coups, governmental changes, and health system reforms. Regarding the first objective, the findings reveal that the model explains 91.9% of the variance in the dependent variable (R² = 0.919), with governmental democracy (β = -1.352, p = 0.001) and fiscal decentralization (β = -1.037, p < 0.001) demonstrating statistically significant negative effects on disease prevention expenditure, while the previous year's expenditure (β = 0.040, p = 0.005) exhibits a positive effect, reflecting incremental budgeting characteristics. Regarding the second objective, the study presents five critical policy recommendations: establishing mechanisms to prevent political interference, developing evidence-based communication systems, improving health sector decentralization systems, enhancing evaluation systems, and refining budget allocation mechanisms. These results contradict traditional democratic theory and support public choice theory, which postulates that politicians in democratic regimes tend to prioritize policies that yield short-term political returns. This study has significant implications for developing mechanisms to prevent political interference, improving health sector decentralization systems, developing evidence-based communication systems, and ensuring continuity of disease prevention investments for the long-term health of the Thai population.
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- เนื้อหาและข้อมูลที่ลงตีพิมพ์ในวารสารรัฐศาสตร์และรัฐประศาสนศาสตร์ถือเป็นข้อคิดเห็นและความรับผิดชอบของผู้เขียนบทความโดยตรง ซึ่งกองบรรณาธิการวารสารรัฐศาสตร์และรัฐประศาสนศาสตร์ ไม่จำเป็นต้องเห็นด้วย หรือร่วมรับผิดชอบใดๆ
- บทความและข้อมูล ที่ได้รับการตีพิมพ์ในวารสารรัฐศาสตร์และรัฐประศาสนศาสตร์ ถือเป็นลิขสิทธิ์ของวารสาร หากบุคคลหรือหน่วยงานใดต้องการนำข้อมูลไปใช้ประโยชน์ในทางวิชาการ ขอให้อ้างอิงแหล่งที่มาด้วย
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