Economic Implications of Advance Care Planning and Living Will (Article 12) Implementation in Thailand: A State-of-the-Art Narrative Review

Abstract

This study examines the economic implications of implementing Advance Care Planning (ACP) and Article 12 of Thailand’s National Health Act within the healthcare system. As Thailand faces an aged population and rising non-communication disease rates, understanding the economic aspects of these end-of-life care initiatives is essential for effective policymaking. Through a state-of-the-art narrative review (without a formal meta-analysis or pooled economic model) of existing research, the study describes implementation costs, including provider training, infrastructure development, and public education. It also frames potential benefits such as reduced unnecessary treatments, improved care quality, and more efficient resource utilisation. Limited available evidence suggests potential long-term cost savings, though significant implementation costs and data gaps remain. Major challenges include limited Thai-specific economic data, cultural barriers to end-of-life discussions, and the absence of standardized cost-effectiveness evaluation methods. This review’s contribution is threefold: 1) it maps the economic components of ACP and Article 12 in the Thai context (direct, non-medical, caregiver, and intangible costs), 2) it synthesises sparse Thai evidence with international insights to propose a context-appropriate evaluation framework, and 3) it identifies priority data gaps and a staged research agenda (pilot implementation with prospective costing, goal-concordant outcomes, and valuation of informal care). This review does not call for new methods or pilot trials; instead, it underscores the need to specify and routinely measure Thai-relevant variables that determine both the costs and the benefits of end-of-life care. The research emphasises balancing economic considerations with cultural sensitivity and patient autonomy, concluding with pragmatic considerations for cost-conscious implementation strategies and identifying areas for future research to better characterise economic impacts in Thailand’s healthcare system.