Thai Health and Health Care
Problems
concerning health and health careHealth and health care related problems are intricate
issues involving various factors. Similarly, the ways of how such problems can
be coped are also diverse in nature. A systematic approach to problem analysis
and solution solving in a comprehensive and
interrelated fashion is deemed necessary for creating guiding a policy direction
and role of the people in the society.
Therefore, the Health Systems Research Institute (HSRI) has been
established to carry out such important mission whereby a body of knowledge is
created to solve the problems as well as improve the country’s health systems.
Thai Health Systems Situation
1. Health Situation
2. Thought Social
concern
3. The Evolution of Civil Society
4. Democracy and Governance
5. Alternative Health Care Services
6. Responsibility organization
1. Health Situation
During
the past decade, Thailand has gone undergone through a series of rapid changes,
A fast pace and drastic of development inthe economics, politics, cultures and information
technologyand
events have
has allhad impacts impacted the health
systems. ItIn other words, it can be stated that
the overall effects have made the health systems to be unable tosufficiently
cope with and adjust to the ever emerging situations circumstances of the current world.
Statisticsof
certain trends indicate that the Thai health systems are moving
towards a crisis similar to the recent economic crisis which has wrecked havoc on the Thai people’s way of
life since 1997. The indicators and events in the Thai society which reflect the
severity of the national health problems are as follows :
Ø Two thirds of the
Thaispeople die before the age of 70[i]
Ø Traffic accident is thecauses more than 35,000Thai’s deaths annually[ii]
Ø More than 30,000
people with HIV infection die annually[iii]
Ø More than 11 million
Thaispeople are addicted to tobacco-smoking[iv],
half of which would die from theof diseases caused by
tobacco-
smoking
Ø A use of narcotic
substances is widespread among the general public and the youths.. It
is Such an illegal businesswhich hasbeen expanded
in scope and yielded a great benefits
profit
to the producers as well as
dealers.
Ø Emotional stress, has beenwidespread commonplace among the
population, leading leads to failures in job careers, violences, broken families,
community disintegration and suicides.
Ø The pPeople have shoulder a heavy burden of
treatment expenses,to be
shouldered
judging, bythe voice of various groups of people grievances from various groups on costs of
health care.including a
call There are
also improved demands for an improvement in service quality and professional
ethicsquality and ethical issues.
Ø The health service
systems is inefficient since it continues to increasingly misuse national
resources as overhead expenditures. Thais have to pay for the health care
services for up to 200,000 million bahts per annum[v]. The Asian Development Bank estimated
that the real-term expenditures will increase five folds within the next few decades.
Ø More than 25 million
Thais are without health insurance [vi]
and will suffer the consequences when they get sick. Moreover, two out of three
of those with health insurance, namely the holders of the low-income health cards,
cannot access the benefits they are entitled to.
Ø The publicis not
confident does
not confide in the service quality of the health services due to a lack
of the standard accreditation system. Therefore,the people attempt tend to seek medical services from well known
medical experts in monumental tertiary care hospitals or put their faith on in the advanced and costly medical technology / and equipment.
which
are costly.
2. Thought
Social Concern
Although
many statistical evidencesare which
reflect a clear sign of looming crisisas well as reflecting indicates that “the health
problems do not belong to any individuals but those of to the country as a
whole”,many
of the population remain to be familiar with majority of people is still accustomed to traditional
health systems. This The system was designed
and developed under the state authority and relied on the state mechanisms in
the formulation of policy on health care ssystems. Illness and death are still seen considered as individuals’ sufferings rather than those infliction jointly shared by all
members of the society. Peopleare so gradually get used to the conditions in the health care
institutions which have gradually transformed into what they are
nowadayswhile
at the same time they have also been used to witness a gradually increasing trends
towards of
commercialization of medical care.
Considering
these issues from another perspective reflects a more innovative reform
concept. It implies that the state of the problems presented by academics in
the forms of statistical trends of health status and existing health care
systems has never depicted the scenario that the general public can perceive
and realize as their actual hardship. The fact that people do not take control
in solving health problems they are confronting, may result from their lack of
thoroughness in assessing health problems and the ability to relate the problem
with factors from their walks of life and socio-economic environments. This
ignorance is caused by a shortage of mechanisms or opportunities that allow
people to critique, for the sake of improvement, the health systems as well as
to participate in the process of the health systems reform.
3. The Development of the Civil Society
During
the past few decades,an arrangement for the health care services and
their regulation were considered to be under the provision and regulation of
health care services were state’s
responsibilities. However, amid the more complexity of the current society’s
evolution, the state’s capacity in
this area has become less than too inadequate to address the more
diversed needs of the
Thai public. At the same time, the people have started to be
increasinglySimultaneously, people become more knowledgeable and start to empower their own
decision-
making capability. to the extent which causes them to beThey are enthusiastic to
closely participate in the policy formulation and, implementation and checkingas well as to monitor the
transparency of various public implementation
mechanisms. Therefore, it is
essential to
give much consideration to the development of the civil society in the
improvement of the health care systemsthat health care development take these evolution of civil society into consideration. Moreover, it is also necessary to allow the civil society toreflect the
problems of various groups of people in the visionary dimension of a collected
force point
out visionary problems of various interest groups in order to create an a common understanding of
the crisis. as well asThe civil society should also be free to truly
participate in the process of health care reform.
Thailand
is going
weathering through
a storm of the economicsystem reform. The incident creates an
opportunity for a multi-sectoral participation in the overall social reform at the same time.Based on the
principle that
In that the health systems are a small part of the overall social system.
The HSRI should take this opportunity to turn the major health
crisis facing the Thai society into a pushing driving force to leverage health systems
reform towards
the appropriate way and up to date as well as that is in line with the national development directions.
4. Democracy and Governance
TheAnother major
trend is the development of the democratic process and the
people’s participation in the governance of the state’s mechanisms and the
public serviceswhich have
relentlessly expanded. In addition, the new constitution provides a clear
guidance in
the to political system reform which results in the increaseda proliferation of local
and regional governments government agencies. It is expected that in
the next decade, the people willjoin forces in the jointly form of civil society and interest groups in a more systematicway fashion. This will
cause a call to returnAs a consequence, the power of formulation and
management of the social and economic policies to will be sought after by various
civil societies. This change phenomenon
will become so powerful social movement that the current ly
implementing decentralization and devolution of the existing
traditional state power will not be able to coperespond effectively to their demands. Therefore, the health systems reform
musttake
into consideration the deliver a system which thatcan address is in sync with the direction of
decentralization as well as the empowerment of the local power structure.
Another
phenomenal incidenceof the adjustment and which reflects a constructive
change of administrative and
governing infrastructure structure,or the equitable administrative
infrastructurewhich has become the current movement of the Thai
social reformwhich , includes the roles of the non-government organizations
and private enterprises have largely expanded their roles in the provision
of providing
health services and social welfare to the public. Their distinctive
characteristics of the infrastructure organizational structure are different from those of the
government. Their small and compact organizationsize, efficient unobstacled workflow and efficient services
render
themake
people to
make a comparison and clearly see therealize the comparative disadvantages of the
government’s management capacity. This benchmark creates a movement which that calls for the public
sector to
becomereform
of its agencieswith improved capacity (i.e.
corporatization or special administrative agencies or privatization) to be more agile. As a
result, the adjustment of the health care systems’ administrative structuremay be is urgently needed during
this period of time.
5. Alternative Health Care Services
Another
major controversial issue with a clear conflict Posing
conflicts between the society’s culture and the
modern medical practice is the development of the alternative health care.
in Under the current health systems, the professional
health personnel (i.e., physician, pharmacist, etc.) are the people who set the
appropriate rules and occasion whenfully possess the authority to impose the medical technology that will be used for the
treatment while theservice users patients have tototally comply to these rules
and regulations
follow the order
inarguably. However, at the present time people have recently
started to voice their needs forthe physician to reveal more
information so that the service users can base their own decision on they can make a better judgment.
They also need
demand for a more
transparency in the medical practice system and procedures. At the same time, various communities have
introduced alternative health care practices, i.e. traditional medicine,
various ways
techniques of
health promotion and health behavior which are the integration combination of the evolution of bio-scientific methodsbio-scientific evolution,local folk folklore wisdom and spiritual
healing. All
of which resultedThe alternative methods result in a frameworkof paradigm with a different
basis that
differs from the western medicine perspective and caused conflicting views
fromand subsequently ignites conflicting views with the modern
medical community. The continued ongoing expansion of the alternative health care
process can benefit the populationin that since it increases the availability ofchoices of
care health care options. However, its disadvantage also exists
in that some choices may not be useful andthey even cause harmful effects. Therefore, it is important thatenhancing the people’s decision-making capacity lies with developing
the appropriate information system andcapability be enhanced by developing resourceful
information system and
efficient consumers protection
mechanism that truly cater to people’s needs.
Responsibility
organization
The Health Systems Research Institiue (HSRI) was founded under the Health
Systems Research Institute Act of 1992, as an autonomous government
agency. Its board of Directors is
chaired by the Minister of Public Health. The HSRI is responsible for promoting and supporting
research studies which aim at
obtaining essential knowledge and information for health policy
formulation or improving program
implementation for effectively solving health problems of the people.
During the past seven years HSRI has been assigned to contributed its strong solid foundation in of the health systems
researchand
are which is
widelyacknowledged
and accepted among researchers and health development experts both
nationally
domestically and
internationally. Some examples of the previous research structures which will help support the health
systems reform in the next upcoming decade, includeResearch Projects to
Develop development of community
participation in the health services of the Government Hospitals;Research
Projects to development the Role of Provincial Agenciesof the purchaser’s role of Provincial agencies in health services procurement, Research
Projectsdevelopment
the of policy and mechanisms
of communityUsing Appropriate Technology in Health health, Research projects to development in organizing the
health welfare. The structure of
these plans forms a strong sound foundation for the future adjustment modification of the health
systems in Thailand. However, to be successfulin creatinmustering a force that
triggers a movement towards the true health systems reform, there must be
an interrelated link between developing thecalls for interrelations between learning
process development from the
basic knowledge, and based fields with the mobilized
force frommobilization of the local and
national communities as well as from the interest groups at all levels. in order toThis relationship will forge ahead the social
movement thatwhich in turn will leads to the sustainable
change in the health systems.
These
incidences are all considered both an opportunity and a tool for the health
systems reform of the nation.
[i] Statistics derived from the Public Health
Statistics 1993
[ii] Research findings by Assoc. Prof. Dr. Paiboon Suriyawongpaisal et al, 1995
[iii] Epidemiology
Division, POPH (a Death Report) However, the National Economic and Social
Development Board estimated that there are 45,000 deaths among the HIV infected
people annually. The statistics in
the Death Report (Epidemiology Division) is usually found to be underreported.
This is due to the fact that the death certificate often specifies the cause of
death as “other complications / opportunistic infection resulted from AIDS.”
[iv] An estimate by Prof.
Richard Peto, the world-renown epidemiologist at a conference on the Asia
Pacific Control of Tobacco moking
in 1995
[v] The
National Economic and Social Development Board in proportion to the national
per capita income estimate this amount. In addition, the Asian Development Bank
has further estimated that the real expenditures of the Thai on
healthcare expenses
will increase approximately
five folds within the next 25-30
years.
[vi] A
Report of the Survey on Health and Welfare 1996, Office of the National
Statistics, Office of the Prime Minister