Three dimensions of service delivery can help compare the performance of public services across different countries and sectors: 1) accessibility refers to people’s ability to obtain appropriate services; 2) responsiveness refers to how quickly and well public organisations respond to people’s needs; and 3) quality is the degree to which services meet desired outcomes. The accessibility, responsiveness and quality of healthcare systems are crucial for ensuring the well-being of citizens. Among many other factors, human-centric health services must ensure the availability of skilled professionals, manageable out-of-pocket (OOP) expenses, and high-quality delivery.
Accessibility encompasses people's ability to obtain timely, appropriate and affordable healthcare services when needed. Accessibility means that geographical, financial or systemic barriers do not prevent individuals from receiving necessary care. The availability of doctors is a critical component in the accessibility of healthcare, as shortages can mean longer waiting times or patients having to travel for care. Seven of eight SEA countries have increased physician-population ratios since 2010 (Figure 6.4). The largest improvements occurred in Singapore (+0.8 p.p.) and Thailand (+0.6 p.p.). However, SEA countries may still have scope for improvement in access to physicians. On average, the number of doctors is 1 per 1 000 people in SEA countries, with wide regional variation. This is below the average ratio of 3.8 doctors per 1 000 people in OECD countries. As of 2021, Singapore had the most physicians per person among SEA countries (2.6 per 1 000 people).
OOP healthcare spending refers to payments made by households for healthcare goods and services. High OOP expenditures may also be a barrier to access to health services, whereas lower OOP costs can help ensure that individuals are able to seek and obtain the care they need without financial hardship. OOP expenses are a significant portion of health expenditures in SEA countries (Figure 6.5). In the most recent years for which data are available, average OOP expenditure in SEA was 31% of total healthcare spending. This was higher than the average OOP expenditure across OECD countries in 2022, which was 19%. However, progress has been made in reducing OOP across the region. Between 2012 and 2022, seven of eight SEA countries reduced OOP expenditures. The largest reductions were in Indonesia (-22 p.p.), Lao PDR (-20 p.p.) and Singapore (-13 p.p.). Brunei Darussalam (8%) and Thailand (9%) have the lowest proportion of OOP expenses in the region.
The maternal mortality rate (MMR) can help to examine the quality of care. Within the SEA region, the average MMR has improved, falling from 107 per 100 000 births in 2013 to 75 in 2023 (
Figure 6.6). However, there is wide variation between SEA countries. Encouragingly, every country in the SEA region improved their MMR between 2013 and 2023. The largest improvement was in Lao PDR, where the rate decreased from 215 in 2013 to 112 in 2023. Substantial decreases were seen in Indonesia (down by 68, from 208 in 2013 to 140 in 2023) and in Cambodia (down by 45, from 182 to 137). Public services contribute to this. For example, Cambodia’s success is partly due to improved access to antenatal care and skilled birth attendance, driven by the increased number of midwives and facilities offering emergency obstetric care (WHO, 2015). A major achievement is the nationwide scale-up of the Early Essential Newborn Care programme, supported by the World Health Organization (WHO).
