Distribution Disparities Among Medical Specialists in Thailand: An Equity Analysis of the National Health Workforce Database (2015–2024)

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• Published article — doi:10.1136/bmjopen-2025-103021
• Analysis code and data — GitHub

Abstract

Objectives Ensuring equity in medical specialist distribution is essential for achieving universal health coverage (UHC). This study explored the changes in the availability and distribution of medical specialists in Thailand from 2015 to 2024 and assessed the equity impacts on workforce.

Design A retrospective longitudinal analysis of national administrative workforce data.

Setting Public and private hospitals across Thailand, covering 1471 facilities in 77 provinces.

Primary outcome and explanatory variables The primary outcomes were specialist-to-population ratios and geographical equity measured using the Gini coefficient (G), where values closer to 0 indicate greater equity. Explanatory variables included specialty type, geographical region, and the timing of major workforce policies, including mandatory service and specialty-specific legislative interventions.

Results Between 2015 and 2024, GPs and specialists in Thailand expanded significantly, with improvements in both density and distribution. The Gini coefficient for GPs showed the largest equity improvement (G=0.42 in 2015 and G=0.22 in 2024), reflecting the impact of mandatory service programmes and rural recruitment programmes. Among specialists, emergency and family medicine showed rapid growth and significant reductions in distribution inequity, reflecting the success of legislative policies. Sustainability of workforce policies was challenged by a "leaking stock" phenomenon driven by career opportunities and economic incentives.

Conclusion Workforce-targeted interventions have led to improvements in the availability and equitable distribution of GPs and medical specialists over the past decade. Further policy — such as retention incentives and assisted technology — is needed to achieve equitable distribution across all specialties, particularly in low-density fields. Thailand's experience offers lessons for other low- and middle-income countries pursuing evidence-based, equity-focused workforce policy for UHC advancement.

Strengths and limitations of this study

• Applies an equity-focused, longitudinal approach to workforce analysis in Thailand, demonstrating the practical use of real-world data to inform policy decision-making.
• Introduces a methodology to identify and impute human data-entry errors, enhancing data reliability.
• The 10-year period of analysis provides sufficient granularity to observe distinct trends and policy influences across each specialty area.
• Focuses solely on quantitative and retrospective policy analysis; the underlying policy agendas and implementation mechanisms were not explored through qualitative methods.