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Reviews of the Thai health care systems and knowledge gaps for health system
research
Phusit PrakongsaiSomsak Chunharas
International Health Policy Program (IHPP)Thai National Health Foundation (TNHF)
Presentation to the meeting on Health System Research Collaboration
Pan Pacific Hotel, Bangkok10 July 2009
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What are we trying to do?
• Build up (institutionalize) groups of researchers doing “health (services) system research” in Thailand
• Ensure continuous funding for research in areas of high priority
• Build network of researchers, users and funders
• Many groups already exist and work with certain degree of coordination and support => addressing high priority issues, linking to policy and decision making, involving the public, ensuring continuous funding and capacity building
2
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What are we talking about today?
• Health system research vs health services research?
• Health services “system” (design and organization/governance) vs health services/care (delivery).
• Health services system components (6 components as proposed by WHO)
• Implications (utilization of research results)– Policy development (financing, governance,
HRH, technology, HIS)– Health services delivery practices (model,
technology use,– Health services management ( HR management,
IT management)
3
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Outline of presentation
• The past decades of health system development and current context– The extension of social protection– Burden of disease (BOD) in 1999 and 2004– Economic crisis and pandemic of new emerging
diseases
• Health system building blocks framework– Health service delivery– Health workforce– Health information system– Medical products & technologies – Health care financing– Equity and efficiency
• Conclusions on knowledge gaps of health system research
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Health system development and the extension of
social protection • Almost three decades of the long march
through piecemeal social protection extensions: – 1975 Low income scheme 1990s social welfare +
elderly, children <12, disabled – tax financed supply side subsidies.
– 1980 CSMBS for public sector employee + dependants—tax financed non-contributory
– 1983 CBHI 1994 voluntary public subsidies insurance, 50/50
– 1991 SHI for private employee—pay roll tax financed tripartite, capitation contract model
– By 2001, 30% of 60m population still uninsured – By April 2002, fully achieved universal coverage
• All residual population--non-SHI and non-CSMBS were covered
5
1945
2000
2002
Informal user fee exemption
1980
1970
User fees
1-3rd NHP1962-76Provincial hospitals
Health Infrastructure extension--wide geographical coverage
Historical evolution: Infrastructure development + financial protection
extension
1975LIC
1990
Establishment of prepayment schemes
1983CBHI
1980CSMBS
1990SSS
Universal Coverage
CSMBS
2002 full achieve
Universal Coverage
SSS
LIC MWS 1994Pub VHI
CSMBS
SSS
Expansion consolidation of prepayment schemes
4th -5th NHP (1977-86) District hospitalsHealth centers
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Current context• Good news:
– Achieving universal coverage with improved financial risk protection and health equity,
– Achieving all MDG targets,– Establishment of a number of autonomous organizations
regarding health sector reform: HSRI, NHSO, THPF, NHCO, HISRO, HITAP, etc.
• Bad news:– Economic crisis and decrease in GDP of the country,– Political instability,– The pandemic of new emerging infectious diseases e.g.
SARS, H5N1, H1N1, – Unsuccessful containment of tuberculosis,– Poor governance of the health sector as well as other
sectors,• Lack of leadership since UC reform, MOPH leaders strongly
resist to reform, totally loss financial command to NHSO • Lack of strong units in PS Office/ Departments to generate
evidence • Lack of vision and no systematic training of new cadres of
qualified managers in long term
% of Total 52.6 42.8
Rank DiseaseDALY('000)
% %DALY('000)
Disease
1 HIV/AIDS 645 11.3 7.4 313 Stroke2 Traffic accidents 584 10.2 6.9 291 HIV/AIDS3 Stroke 332 5.8 6.4 271 Diabetes4 Alcohol dependence/harmful use 332 5.8 4.6 191 Depression5 Liver and bile duct cancer 280 4.9 3.4 142 Ischaemic heart disease6 COPD 187 3.3 3.0 125 Traffic accidents7 Ischaemic heart disease 184 3.2 3.0 124 Liver and bile duct cancer8 Diabetes 175 3.1 2.8 118 Osteoarthritis9 Cirrhosis 144 2.5 2.7 115 COPD
10 Depression 137 2.4 2.6 111 Cataracts
Male Female
DALY
Top ten DALY loss among Thais in 2004
Note – The number of total DALY loss increased from 9.5 million DALY loss in 1999 to 9.9 million DALY loss in 2004
Source: Thai BOD Study 2004
Year of DALY loss of Thais in 1999 and 2004 by risk factor
29
53
25
54
91
132
144
169
238
410
440
595
594
838
943
30
70
40
60
120
370
120
140
220
370
400
490
490
550
1310
0 200 400 600 800 1000 1200 1400
Malnutrition (Thai standard)
Malnutrition (International standard)
Not using safety belt
Water and sanitation
Air pollution
Illicit drugs
Inadequate exercise and activity
Inadequate vegetable and fruit intake
Hyperlipidemia
Obesity and overw eight
Not w earing helmet
Hypertension
Smoking
Alcohol consumption
Unsafe sex
Ris
k fa
ctor
Year of DALY Loss (x 1000)
1999
2004
Profile of DALY loss, Thailand 2004
DALYs Lost by age and sex and disase categories, Thailand 2004
0
200
400
600
800
1,000
1,200
1,400
1,600
0-4 5-14 15-29 30-44 45-59 60-69 70-79 80+ 0-4 5-14 15-29 30-44 45-59 60-69 70-79 80+
Males Females
Dis
ab
ility
Ad
just
ed
life
Ye
ar
Lo
st (
'00
0s)
Group III Injuries
Group II Non-communicable diseases
Group I Infections, maternal, perinatal and nutritional cond
Prevalence of smoking by educational level, 2001-2006
65.674.1
80.7
66.975.9
81.771.6 75.9
86.4
6.2
4.2
6.6
7.1
5.45.9
6.25.2
4.628.2
21.712.7
26.018.7
12.422.2 18.9
9.0
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%pr
imar
ysc
hool
or
low
er
seco
ndar
ysc
hool
colle
ge o
run
iver
sity
prim
ary
scho
ol o
rlo
wer
seco
ndar
ysc
hool
colle
ge o
run
iver
sity
prim
ary
scho
ol o
rlo
wer
seco
ndar
ysc
hool
colle
ge o
run
iver
sity
2001 2003 2006
Educational level and year
perc
ent currently smoke
ever smoke
never smoking
Prevalence of smoking by income quintile, 2001-2006
67.0 66.4 66.7 69.4 74.368.2 67.3 68.9 71.9 76.6
71.1 71.6 74.3 74.8 78.7
7.0 5.5 5.4 5.05.9
6.6 6.8 6.66.4
6.35.6 5.8
5.2 5.86.3
26.0 28.1 27.9 25.619.8 25.2 25.9 24.5 21.7 17.1
23.3 22.6 20.5 19.4 15.0
0%
20%
40%
60%
80%
100%
Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5
2001 2003 2006
Income quintile and year
Perc
en
t currently smoke
ever smoke
Never smoke
Prevalence of drinking alcohol by educational level 2-0012006
58.7 62.270.6
62.9 63.8 65.3 60.3 62.074.0
27.1 22.915.3 24.8 22.9 20.0 28.9 26.5
16.5
14.2 14.9 14.1 12.3 13.3 14.7 10.8 11.5 9.5
0%
20%
40%
60%
80%
100%
2001 2003 2006 2001 2003 2006 2001 2003 2006
Primary school or low er Secondary school College or university
Educational level and year
Perc
en
t Drink alcoholregularly
Drink alcoholoccasionally
Never drinkalcohol
Prevalence of drinking alcohol by income quintile, 2-0012006
58.4 59.5 59.9 60.9 60.2 64.1 61.9 61.3 63.2 62.470.9 71.6 70.4 68.7 68.5
30.2 27.9 25.4 23.8 26.224.2 23.4 24.1 21.4 23.2
16.8 15.8 15.4 17.3 17.1
11.4 12.6 14.7 15.3 13.6 11.7 14.7 14.6 15.4 14.4 12.3 12.6 14.2 14.0 14.4
0%
20%
40%
60%
80%
100%
Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5
2001 2003 2006
Income quintile and year
Perc
en
t
Drink alcohol regularly
Drink alcohol occasionally
Never drink alcohol
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System building blocks of a health system:
its aims and desirable attributes
Source: WHO. Everybody business: strengthening health systems to improve health outcomes: WHO’s framework for action. 2007, Geneva, World Health Organization.
Health service delivery:Better coverage of essential vaccines, ARV and
condom use
0
20
40
60
80
100
120
Year (B.E.)
Per
cen
t co
vera
ge BCG
DPT
OPV
Measles
Hep B3
TT pregnant women
Compulsory licensing
Include ART in UC package
Generic production of triple ART
0
10
20
30
40
50
60
70
80
90
100
2004 2005 2006 2007
(%)
General client
Regular client
Spouse or regular partner
Non-regular partner
Percentage of female sex worker consistently use condom when having sex with general client in the past 1 month, 1995 – 2007
Current situation and challenges of human resources
for health in ThailandFigure 1 Physicians per 1,000 population and GDP per
capita
0
1
2
3
4
5
0 5000 10000 15000 20000 25000 30000 35000 40000
GDP per capita (USD)
Ph
ys
icia
ns
pe
r 1,
00
0 p
op
ula
tio
n
Thailand
Source: World Development Indicator 2002 and World Health Report 2006
Figure 2 Health w orkforce production capacity in 2004, 2005 and 2006
7,770
6,936
1,3491,482478
1,417
4,319
1,577
502 793
2,179
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
Phy sicians Dentists Pharmacists Nurses
Nu
mb
er)
2004 2005 2006
Figure 3 Population per Health w orkforce in 1987, 1997 and 2006
14,800
3,6491,073
5,595
36,516
1,743
17,711
10,178
2,965
7,3407,862
617
0
5000
10000
15000
20000
25000
30000
35000
40000
Phy sicians Dentists Pharmacists Nurses
Nu
mb
er
1987 1997 2006
Figure 7 Annual resignation rate of health w orkforce betw een 1999-2005
6.86
17.41
21.58
8.769.17 10.16
19.58
25.59 26.00
43.66
45.03
16.68
9.37 9.90
5.57 5.100
5
10
15
20
25
30
35
40
45
50
1999 2000 2001 2002 2003 2004 2005
ปี�
per
cen
tag
e
Pharmacists Dentists Phy sicians Nurses
Inequity in geographical distribution of Health
workforce in 2007
Physicians800-3,3053,306-6,2746,245-9,2729,243-12,300
Pharmacists4,600-8,4328,433-12,27412,275-16,11516,116-19,956
Nurses280 - 652653 - 904905 - 1,1561,157 – 1,408
Dentists5,500-15,14315,144-25,76725,768-36,39036,391-47,011
Child mortality in Thailand from various sources of surveys
Source: Hill et al. Int J Epidemiol 2007 (with updates)
0
10
20
30
40
50
60
70
80
90
100
1970 1975 1980 1985 1990 1995 2000 2005
Un
der
5 m
ort
alit
y ra
te (
per
1,0
00)
Vital registration DHS 1987 - direct Census 1990 - indirect Census 2000 - indirect
SPC 1985 - direct SPC 1985 - indirect SPC 1995 - direct SPC 1995 - indirect
SPC 2005 - indirect SPC 2005 - direct Predicted
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Comparison between broad causes of death from vital registration (VR) and verbal
autopsy (VA)
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
All Infectious All CVD All Cancers All other non-communicable
All injuries Ill-defined
Broad causes of death from VR and VA estimated:female,Thailand,2005
estimate VR
Health care finance and service provision of Thailand
after achieving universal coverage (UC)
General tax
General tax Standard Benefit
package
Tripartite contributions Payroll taxes
Risk related contributions
Capitation
Capitation & global Co-payment budget with
DRG for IP
Services
Fee for services Fee for services - OP
Population Patients
Ministry of Finance - CSMBS(6 million beneficiaries)
National Health Insurance Office The UC scheme (47 millions of pop.)
Social Security Office - SSS(9 millions of formal employees)
Voluntary private insurance
Public & Private Contractor networks
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Scheme beneficiaries by income quintiles, 2004
4% 1%
25%7%
5%
25%
11% 14%
23%
26% 31%
17%52% 49%
10%
0%
20%
40%
60%
80%
100%
CSMBS SSS UC
Q1 (poorest) Q2 Q3 Q4 Q5 (the richest)
The incidence of catastrophic health payments from 2000 to 2007
2000 2002 2004 2006 2007
Q1(poorest)
4.0% 1.7% 1.6% 0.9% 1.9%
Q5(richest)
5.6% 5.0% 4.3% 3.3% 2.8%
All quintiles 5.4% 3.3% 2.8% 2.0% 2.2%
Note: Catastrophic health expenditure refers to household out-of-pocket payments for health exceed 10% of household consumption expenditure
Total health expenditure 1994-2005
0
50,000
100,000
150,000
200,000
250,000
300,000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Mil
. B
aht
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
4.50%
%G
DP
public private %GDP
Total health expenditure during 2003-2005 ranged from 3.49 to 3.55% of GDP, THE per capita approx 100 USD
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Real term growth GDP versus THE, 19-942005
25
9.5%
15.6%
4.6%
-11.4%-13.4%
15.6%
3.6%
6.3%8.3%
-0.1%-0.6%
-15.0%
-10.0%
-5.0%
0.0%
5.0%
10.0%
15.0%
20.0%
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
THE GDP
Trend of financing sourcesNHA 1994-2005
0
50,000
100,000
150,000
200,000
250,000
199419951996199719981999200020012002200320042005
million baht
Government NON Government
55
45
53
47
53
47
46
5554
45
36
64
3737
6356
646356
4444
55
45
36
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Health care expenditure in Thailand by function in 2001 and 2005
Health administration and health insurance
8.5%
Medical goods4.3%
Ancillary services 0.4%
Prevention and public health services
4.8%
Services of curative & rehabilitative care
78.1%
Gross capital formation
3.9%
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8.2
4.8
3.7 3.7
2.92.6 2.5
2.01.6
1.32.2
1.8 1.8 1.6 1.4 1.4 1.3 1.4 1.2 1.10
1
2
3
4
5
6
7
81992
1994
1996
1998
2000
2002
2004
Household OOP for health, % income 1992-2004
Household consumption: tobacco, alcohol and health
Median household expenditure per month Sources: Analyses from 2006 SES
52 65
152
303
433
303
390433
650
867
47 6093
120
205
0
500
1000
Q1 Q2 Q3 Q4 Q5
Income quintiles
Bah
t p
er c
apit
a
Tobacco
Alcohol
Health expenditure
Distribution of ambulatory services at different health facilities between the 2001 and 2003 HWS
1.2 1.0 0.7 0.5 0.1
1.91.3
0.7 0.60.2
0.70.6
0.4
0.20.2
1.8
1.3
0.90.7
0.3
0.70.6
0.7
0.7
0.6
0.4
0.4
0.30.4
0.3
0.3
0.40.4
0.5
0.6
0.7
0.6
0.60.7
0.6
0
1
2
3
4
5
6
Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5
Income quintiles
Am
bu
lato
ry v
isit
s p
er
ca
p p
er
ye
ar
Health centre Community hospital Provincial and regional hospital Private clinic Private hospital
The distribution of ambulatory service use among different income quintiles in 2001 and 2003, by types of health facilities
2001 2003
Concentration index
Type of health facilities 2001 2003
Health centers - 0.2944 - 0.3650
Community hospitals - 0.2698 - 0.3200
Provincial and regional hospitals - 0.0366 - 0.0802
Private hospitals 0.4313 0.3484
Source: Prakongsai P et al. Assessing the impact of a policy on universal coverage on financial risk protection, health care finance, and benefit incidence of the Thai health care system. Presentation to the 6th IHEA World Congress, July 2007, Copenhagen
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Equity in utilization: Concentration Index OP service by levels: 2001 to 2007
Facility levels 2001 2003 2004 2005 2006 2007
Health centers -0.294 -0.365 -0.345 -0.380 -0.267
-0.292
District hospitals -0.270 -0.320 -0.285 -0.300 -0.256
-0.246
Provincial and regional hospitals -0.037 -
0.080 -0.119 -0.100 0.028 0.013
Private hospitals 0.431 0.348 0.389 0.372 0.516 0.528
Overall -0.090 -0.139 -0.163 -0.177 -0.054
-0.041
31
Note: CI range from -1 to + 1. Minus 1 (plus 1 ) means in favour of the poor (rich), or the poor (rich) disproportionately use more services than the rich (poor).
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Equity in utilization: Concentration Index IP service by levels: 2001 to 2007
Types of health facilities
2001 2003 2004 2005 2006 2007
Community hospitals -0.316 -0.293 -0.294
-02.66 -0.242
-02.93
Provincial and regional hospitals -0.069 -0.138
-0.114
-0.156 -0.049
-0.114
Private hospitals 0.320 0.309 0.254 0.366 0.398 0.464
Overall -0.079 -0.121
-0.127
-0.114
-0.051
-0.080
32
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Equity in budget subsidies: BIA, 2001 and 2003
A comparison of percent distribution of net government health subsidies among different income quintiles in 2001 and 2003
28
20
17 17 18
31
22
1516
15
0
5
10
15
20
25
30
35
Q1 Q2 Q3 Q4 Q5
Income quintile
perc
ent
2001
2003
Note: -Overall net government health subsidies in 2001 were approximately 58,733 million Baht, and in 2003 were 80,678 million Baht (in 2001-value)- The concentration index of government health subsidies in 2001 was -0.044 and in 2003 was -0.123
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Kakwani index of health care finance from 2000 to 2006
2000 2002 2004 2006
Out of Pocket -0.1502 -0.0755 -0.0764
-0.0450
Direct tax 0.3913 0.4159 0.4424 0.3617
Indirect tax -0.0964 -0.0691 -0.0435
-0.0831
Premium Insurance -0.3623 -0.3906 -0.3233 na
Social health Insurance Contribution 0.1650 0.1121 0.1046 na
Premium Insurance+SHI Contribution na na na
-0.0491
34
0
10
20
30
40
50
1 (poorest) 2 3 4 5 (richest)
Economic status quintile
Un
de
r 5
de
ath
s p
er
1,0
00
liv
e
bir
ths
1990 census 2000 census
RR = 2.8 (95% CI 2.5-3.0)
RR = 1.8 (95% CI 1.6-2.0)
55% (39%-68%) reduction
Error bars are 95% CIs
Equity in health:Child mortality by economic status
Source: Vapattanawong P, Hogan MC, Hanvoravongchai P, Gakidou E, Vos T, Lopez AD, Lim SS. Reductions in child mortality levels and inequalities in Thailand: analysis of two censuses. Lancet 2007; 369:850-855
Inefficiency of the Thai health care system:CSBMS expenditure from 1989 to 2008, current year
price
Note: Expenditure for 2008 is extrapolated from 6 months actual spendingSource: Ministry of Finance, Comptroller Generals Department, various years
Figure 1 CSMBS expenditure 1989-2008 current year price, annual nominal growth rate %
58,390
23%
19%16%
33%
26%
12%
22%
14%
6%
-7%
12% 12%
7%
11%
15%13%
26% 26% 26%
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
*
million B
aht
-10%
0%
10%
20%
30%
40%
% g
row
th
OP IP
Total Growth rate
Inequity in quality and patterns of health service provision:
Percentage of caesarian section to total deliveriesby health insurance schemes
15.4% 15.9% 16.4% 17.0% 17.2% 17.8% 18.3% 18.9% 19.8% 20.0% 20.0% 20.1%
17.0% 17.3% 16.2% 16.8% 18.4%20.2% 20.3% 21.6% 20.6% 20.1% 19.3% 19.7%
28.8%
36.3%
30.5%
24.3%
35.9%
42.3%
37.7%41.4%
45.6%
40.1%
48.4% 48.1%
9.8%
14.3%
6.0%
9.3%
14.0%12.2% 12.7%
18.5%16.4% 16.4%
20.4%
15.1%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
2004Qtr1
2004Qtr2
2004Qtr3
2004Qtr4
2005Qtr1
2005Qtr2
2005Qtr3
2005Qtr4
2006Qtr1
2006Qtr2
2006Qtr3
2006Qtr4
UC SSS CSMBS ROP
Source: Electronic claim database of inpatients from National Health Security Office, 2004-2006 (N=13,232,393 hospital admissions)
Inequity in quality and patterns of health service provision:Propensity of receiving single source antiplatelets
0%
2%
4%
6%
8%
10%
12%
Qtr
1
Qtr
2
Qtr
3
Qtr
4
Qtr
1
Qtr
2
Qtr
3
Qtr
4
Qtr
1
Qtr
2
Qtr
3
Qtr
4
Qtr
1
Qtr
2
Qtr
3
Qtr
4
Qtr
1
Qtr
2
Qtr
3
2003 2004 2005 2006 2007
CS
SS
UCE
UCP
clopidogrel, cilostazol: 6 regional hospitals
Inte
rna
tio
na
l H
ea
lth
Po
lic
y P
rog
ram
-T
ha
ila
nd
Inte
rnati
onal H
ealt
h P
olic
y P
rogra
m -
Thaila
nd
Discussion – Key concerns in HSD (1)• An increasing disease burden from chronic NCD and the
situation of aging society, => what needs to be changed wrt financing model and service delivery model/practices? (F, D)
• Inequitable health risk distribution among different SE groups, => alternative model for financing, resource allocation and service purchasing (F)
• Inefficiency and inequitable access to good quality of health services among beneficiaries of different health insurance schemes, => should we have a single system with multiple fund manager? How else could be improve inefficiency, inequitable access and quality/safety? (G, D)
• Poor governance of health systems in Thailand, => what roles and functions and relationship should be like between 4 major organizations in health system (MOPH, NHSO, NHCO, HPF) (G)
39
Inte
rna
tio
na
l H
ea
lth
Po
lic
y P
rog
ram
-T
ha
ila
nd
Inte
rnati
onal H
ealt
h P
olic
y P
rogra
m -
Thaila
nd
Discussion – Key concerns in HSD (2)
• The unknown impact of current economic crisis on health of the population (F, G, D)
• The internationalization of health care seeking => should Thailand develop itself as medical hub for international patients? (G, F, HRH)
• The pandemic of new emerging infectious disease and unsuccessful control of tuberculosis and HIV/AIDS, => does it have to do with financing model, HRH quantity and quality, or management capacity? (D, G, HRH)
• Maldistribution and internal brain drain of HRH. => what policy options should be adopted, separating HRH payment from service purchasing package? (HRH)
• Complex and inefficient HIS (multiple purchasers and MOPH line of command) => standardization will help? What else should be done? Humanware? (HIS)
• Access to & more efficient use of (new) technology => CL and R&D investment for local production of health tech, and R&D for national health priority? (Technology)
=> the future role of HiTap? (G) how to influence cost-effective use of technology (D)
40
Inte
rna
tio
na
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ea
lth
Po
lic
y P
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ram
-T
ha
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nd
Inte
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onal H
ealt
h P
olic
y P
rogra
m -
Thaila
nd
Potential areas for research collaboration between
Thai partners and AHSPR (1)• Effective health and non-health interventions towards
NCD which is an increasing BOD in Thailand and many developing countries,– Policy recommendations for the Thai government through
the 10th national Development Plan,
• Reorientation of public resources towards health promotion and disease prevention of disease burden priorities e.g. – HIV/AIDS, – road traffic injuries, – Obesity / overweight and inadequate activity and exercise, – tobacco and alcohol consumption,
• Social determinants of health (SDH)
Inte
rna
tio
na
l H
ea
lth
Po
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y P
rog
ram
-T
ha
ila
nd
Inte
rnati
onal H
ealt
h P
olic
y P
rogra
m -
Thaila
nd
Potential areas for research collaboration between
Thai partners and AHSPR (2)• Improving equitable quality and patterns of health
service provision among beneficiaries of different health insurance schemes provider payment reform,
• Harmonization of benefit package and provider payment methods among three public health insurance schemes,
• Effective health interventions to tackle mal-distribution and internal brain drain of HRH,
• Economic impact on health of the population,• Sustainability of health care finance in Thailand,• Improving efficiency and rational drug use of the Thai
health care system,• Improving health information system in Thailand, • Enhancing regulatory capacity and governance of the
Thai health care system.
Inte
rna
tio
na
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ea
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Po
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-T
ha
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Inte
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h P
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y P
rogra
m -
Thaila
nd
Your ideas/suggestion
• Which area/issues are of high priority?• How should we go about doing it?
– Potential researchers– Needs for new capacity in research– Funding for research– Institutional backup => what should be the
role of IHPP, HFRO,HISO, HRO, CHEM, other faculties in universities?
• International collaboration– Research conduct (technical collaboration)– Capacity building – Research funding – how should we go about?
43
Inte
rna
tio
na
l H
ea
lth
Po
lic
y P
rog
ram
-T
ha
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nd
Inte
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onal H
ealt
h P
olic
y P
rogra
m -
Thaila
nd
Thank you for your attention