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Dialysis and kidney transplant practices and challenges in Thailand

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Thailand is a country in the heart of mainland Southeast Asia (SEA), divided into 5 regions (north, northeastern, south, eastern and central) and 77 provinces. As of 2023, the Thai population is estimated to be 70 million, with a population density of 137 habitants/km~2 and a median age of 40 years. Half and one-sixth of the population live in urban areas and Bangkok (the capital city), respectively. According to World Bank records, Thailand is classified as an upper-middle-income country that has spent 6.5 of its gross domestic product on health. Since 2008, kidney failure has been recognized as a 'catastrophic disease' by the government, meaning all kidney replacement therapy (KRT) costs related to kidney failure are covered by the Thai state. This kidney failure coverage includes active and passive workers contributing to the social insurance system, representing 20 of the Thai population. These patients attend The Social Security System (SSS) Office for treatment. Those who do not have a formal job and who do not contribute to social insurance, representing 68 of the population, receive Universal Health Coverage (UC) from the National Health Security Office (NHSO). The government officers receive health coverage from the Civil Servant Medical Beneficiary System (CSMBS), which covers, free of charge, all kidney failure expenses. This article aims to describe the current status of dialysis and kidney transplantation service deliveries in Thailand, reviewing the barriers to effective dialysis management and highlighting opportunities for improvement.

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