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Health Care Delivery and Referral System in Thailand

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Title: Health Care Delivery and Referral System in Thailand Author: gigabyte Last modified by: pichet.l Created Date: 12/15/2009 7:00:15 AM Document presentation format – PowerPoint PPT presentation

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Title: Health Care Delivery and Referral System in Thailand


1
Health Care Delivery and Referral System in
Thailand
Wilailuk Wisasa, M Econ, Bureau of Policy and
Planning National Health Security Office
2
Background
  • GNI/cap - US 4,210 (2010)
  • Population - 67 million
  • Total fertility rate 1.6 (2009)
  • Life expectancy at birth 74.1 years
  • Under 5 Mortality 14/ 1000 live births
  • Maternal mortality 48/100,000 live births
  • Health Expend/cap US 175 (2009)
  • Physicians/cap 4/10,000
  • ANC SBA coverage - 99-100 (2009).

3
Health Care System in Thailand
  • Government Sector
  • - Ministry of Public Health
  • - Other Governmental Agencies
  • Non-Governmental Organizations
  • Private Sector

4
Health Care Delivery System
  • Government owned 70 of Bed
  • MOPH Facilities
  • Health Center (no Bed)
  • Primary Care Units (PCU)
  • Community Hospital (10-90 Beds)
  • General/Regional Hospital
  • (300-1,000 Beds)
  • Private Hospitals 30 of Bed
  • not-for-profit Hospital
  • for-profit Hospital

5
Public Health Services Facilities
  • Bangkok 5 Medical school
    hospitals
  • 29 General hospitals
  • 19 Specialized hospitals and institutions
  • 83 community health care centres
  • Regional Level 25 Regional hospitals
  • 38 Specialized hospitals
  • Provincial Level
    67 General hospitals (MOPH)

  • 56 Hospitals under
    Ministry of Defense
  • District Level
    725 Community hospitals

  • 212 Municipal health
    centers
  • Sub-district (Tambon) level 9,791
    Health centers

  • 72,192 community PHC centres
  • Village Level
    834,711 Village Health Volunteers

6
Primary Health Services in Thailand
  • Primary Health Services under the responsibility
    of MoPH
  • -Health Centres
  • - Primary Care Units (PCU)
  • Primary Health Services under the responsibility
    of BMA
  • - community Health Care Centres

7
Private Hospitals and Clinics
436 Private hospitals (Bangkok 115, other provinces 321)
10,819 Medical clinics
11,094 Drugstores
2,106 Traditional medicine drugstores.
7
8
Health Service Delivery Infrastructure (Ministry
of Public Health)
25 67 725 9,738 72,192 25 834,711
  • Regional Hospitals
  • General Hospitals
  • Community Hospitals
  • Health Centers
  • Community PHCs Centres
  • Other Hospital (Under
  • Department)
  • Village Health Volunteers

9
Health Service Infra-structure
Excellent Centers
General, Regional Hos.(95) 3 o
MC Province( 200,000-2M.)
Community Hos.(741) 2 o
MC District(10,000-100,000)
Health Center (9,770) 1 o
MC Subdistrict(1-5,000)
CPHC. Center PHC
Village
(80,000)
PCU

SELF CARE
Family
10
Thai Health Care Structure
  • Principles
  • Equity
  • Accessibility
  • Quality

2 Million
Ex.cent.
1 Million
Tertiary Care
Referral System
0.2 Million
High level Middle level Secondary care Low
level
80,000
30,00-50,000
10,000
Primary Care
Community-Family-Self Care
11
Health Infrastructures
12
Community Hospital Main Primary Care Unit (PCU)
13
Health center close to client PCU
14
Population Ratios of Major Health Personnel in
Thailand (2008)
Region
Doctors
Dentist
Pharmacists
Nurses
  • Bangkok
  • North
  • Northeast
  • Central
  • (Except BKK)
  • South
  • Whole country

1756 14,862 18,062 13,620 14,825 13,395
12,975 127,188 138,232 117,334 125,334 115,
295
12,121 116,588 125,783 111,353 113,210 110,
158
1303 11,021 11,696 1847 1961 1905
15
Model on Referral System Development
  • Referral Center (Region)
  • Situation Assessment
  • Support Resources
  • Monitoring Evaluation
  • Share Resources

Community Hospital
Community Hospital
  • Regional Coordinating Referral Center
  • Staff 24 Hrs.
  • Technical Support
  • Update data

Referral Center
High Care
Referral Center
Referral Center
16
Stimulus Package Plan (SP II)
2010-2014
Ex. Centers 163
40 Cardiac,
26 Cancer, 51 Trauma 1 Thai
Traditional Medicine
  • 10 Centers for showing Health products ( 17 MB)
  • 10 Health production offices(7 MB)
  • 4,800 Food Safety places (12 MB)

Health Manpower Development
10,376 MB.
  • Production 1,620 Doctors,
  • 2,500 Nurses, 6,000Asst. Nurses
  • 400 Dental Public Health ,
  • 750 Health Technical Officers,
  • Capacity Building
  • 25,000 persons
  • 5,870MB.
  • Sounthern Border
  • Health Development
  • (2,659 MB)


395 MB.
  • Tertiary Care
  • 115 Regional/General Hospitals
  • 2 Elderly Health Care Services Centers

22,302 MB. 76 MB
13,499 MB.
  • Secondary Care
  • 235 Node of Community Hospitals
  • Primary Care
  • 14,763Tambol Health Promoting Hospitals

14,763 MB
Supportive Health Services System
1,100 Accommodation Units, Offices, Cars
1 Health Information System
Infrastructure 18 Referral Health Service
Centers
14,625 MB.
2,974 MB.
616 MB.
14 Projects for Investment in Health Development
( 86,685 Million Baht)
17
The Three Main Financial System in Thailand
  • Civil Servant Medical Benefit Scheme (CSMBS) and
    State Enterprise Benefit. It is not social
    insurance scheme but in stead it serves as fringe
    benefit for Govt. officers and operated by
    Ministry of Finance.
  • Social Security Scheme (SSS) for employees
    working in the private company with employs more
    than 1 employee
  • Universal Coverage Scheme (UC) for the rest of
    the population

18
Enabling Factors for Achieving UC
  • Strong political support
  • Health system capacity and its resilience to
    rapid nationwide program scaling-up
  • Nationwide extension of PHC coverage, and
    mandatory rural health services by new graduate
    medical doctors and other health workers
  • Integral relationship among researchers-reformists
    -politicians

19
UC Benefit Package
  • It is quite comprehensive comprising OP,
    hospitalization, health promotion and disease
    prevention, most of high cost case, dental care,
    medicines, operations
  • including heart surgery, HIV/AIDS treatment
    and prosthesis replacement
  • Except special nursing fee, eye glasses and
    some really high cost treatment

20
Policy Recommendations andPerspective for the
Future
  • ? Strengthening the national policy and
    strategic approach with participation of all
    stakeholders to drive and formulate integrated
    action plans and necessary associated
    implementation.
  • ? Increasing accessibility in quality health
    services for all and to invest in
    cost-effectiveness interventions.
  • ? Strengthening to success in higher level of
    primary health care, community health care
    services, comprehensive national health promotion
    program, and decentralization in health.
  • ? Preparation for elderly economic security,
    health security, social security

21
Thank you Sawasdee
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