HealthCare System Development Project

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Dr. Pradit SintavanarongMinister of Ministry of Public Health, Thailand

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ยุ�ทธศาสตร์ปร์ะเทศ1. Growth & Competitiveness 2. Inclusive Growth3. Green Growth4. Internal Process Development

เพื่��อท�าให้�ร์ะบบสาธาร์ณส�ขของปร์ะเทศมี�มีาตร์ฐานเท�ยุบเท�าสากล

วั"ตถุ�ปร์ะสงค์

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1 .สอดคล้�องกับยุ�ทธศาสตร์�ปร์ะเทศ แล้ะป�ญหา / ความต�องกัาร์ของปร์ะเทศ2. เชื่ !อมโยุงหร์ อสนับสนั�นัโคร์งกัาร์อ !นัของร์ฐบาล้3. ม%ธร์ร์มาภิ'บาล้ในักัาร์บร์'หาร์จัดกัาร์โคร์งกัาร์4. กั*าหนัดมาตร์ฐานั5. ปร์ะเม'นัสถานัภิาพ (Gap Analysis)6. กั*าหนัดตวชื่%-วดเพ !อล้ดชื่.องว.าง (Indicators to fill gap)7. กั*าหนัดกัร์อบแล้ะตาร์างเวล้าชื่ดเจันั ฯล้ฯ8. บ0ร์ณากัาร์ร์ะหว.างหนั.วยุงานัในักัร์ะทร์วงสาธาร์ณส�ข แล้ะนัอกัร์ะบบกัร์ะทร์วง

สาธาร์ณส�ขท-งหมดท%!เกั%!ยุวข�อง9. กัาร์ม%ส.วนัร์.วมของภิาคเอกัชื่นั1 0 .พฒนัาคร์บวงจัร์ โร์งพยุาบาล้ บ�คล้ากัร์ ยุา เคร์ !องม อ ร์ายุได� ความ

กั�าวหนั�า1 1 .ม%ความยุ!งยุ นัของร์ะบบ1 2 .ปร์ะโยุชื่นั�ท%!ปร์ะชื่าชื่นัจัะได�ร์บอยุ.างชื่ดเจันัเป4นัร์0ปธร์ร์ม1 3 .เพ'!มค�ณภิาพชื่%ว'ต

กลยุ�ทธ

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Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2010 Revision

Japan

Korea

China

Thailand

World

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Proportion of elderly (>65 years old)

Disease Year 2011 Year 2012Infectious disease 2007.28 2044.77Non communicable diseases• Circulatory diseases• Accident• Cancer

1881.01712.36700.91467.74

1970.27724.18762.75483.34

Rate per 100,000 populations

Morbidity

6Source: Bureau of Policy and Strategy, Ministry of public health

Disease 2007 2008 2009 2010 2011

Infectious disease 60.6 61.2 60.7 64.9 64.6Non communicable diseases• Circulatory diseases• Accident• Cancer

208.2555.268.184.9

209.7356.066.187.6

209.6755.266.188.3

215.7961.962.791.2

227.3268.863.495.2

Rate per 100,000 populations

Mortality

7Source: Bureau of Policy and Strategy, Ministry of public health

Source: Thailand Health Profile 2008 - 2010 8

Major Causes of Death in Thailand, 1967-2009

Diphtheria Pertussis

Neonatal Tetanus Measles

Source: Disease Control Department, Ministry of Public Health 9

Mark reduction of vaccine preventable diseases Thailand 1977 - 2008

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Health service delivery system in Thailand

Health centers9,768

Municipality Medical

Centers 365

District hospitals776

Provincial hospitals 68

Pharmacy 11,154

Private clinics 17,671

Other public

hospitals 120

Private hospitals

323

Regional hospitals 28

University hospitals 17

Other MoPH hospitals 55

MOPH facilities

Sub-district

District

Province

Source: 1. Thailand Health Profile 2008-20102. Bureau of Policy and Strategy, MoPH, http://hrm.moph.go.th/res53/res-rep2553.html

Private Hospital Clinics (2013)Private Hospitals• Bangkok 98, Other provinces 224• Total 322

Medical clinics• Bangkok 3,970 , Other provinces 14,533 • Total 18,503

Drugstores• Bangkok 4,912 , Other provinces 11,780 • Total 16,692

Traditional medicine Drugstores• Bangkok 443 , Other provinces 1,615 • Total 2,058

Private Hospital Clinics (2013)

11Source: Bureau of Policy and Strategy, Bureau of Sanatorium and Art of Healing, Food And Drug Administration; Ministry of public health

Health Facilities in the Public Sector (2010)

Source : Bureau of Health Administration; Ministry of public health

Administrative Level Health facility

Bangkok • 5 medical school hospitals• 26 general hospitals• 13 specialized hospitals/institutions• 68 community health care centers

Regional level • 6 medical school hospitals• 33 regional hospitals• 48 specialized hospitals

Provincial level • 83 general hospitals

District level • 774 community hospitals• 284 municipal health centers

Sub-district level • 9,768 health promoting hospitals

Village level • 198 community health posts• 48,049 rural community primary health care centers• 3,108 urban community primary health care centers• 1,055,000 Village Health Volunteers

Health Facilities in the Public Sector (2010)

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Excellent Center

General,Regional Hos.(96)

Community Hos.(743)

THPH(9,750)

CPHC. Center(9,750)

Family health leader

Province(200,000-2M.)

District(10,000-100,000)

Subdistrict (1- 10,000)

Village

FamilySELF CARE

PHC

1o MC

2o MC

3o MC

Health Service Infra-structure

13Source : Bureau of Health Administration; Ministry of public health

Service plan

Regional hospitalHigh level

Advance = 33

Standard = 48

M2 = 91

F1-3 (F1=73,F2=518,F3=92)

P 1-2 (P1=226 ศสม P2=9,750 ร์พ.สต)

Primary health care

Primary care

Secondary care

Large community hospital

Small general hospital

General hospital

Excellent center

M1 = 35Mid level

First level

14Source : Bureau of Health Administration; Ministry of public health

• Health service delivery system in Bangkok is not well organized and fragmented.

• MoPH has limited role in service provision in Bangkok

• Private sector and other ministries play greater role in Bangkok.

15Source: Thailand Health Profile 2008 - 2010

Proportion of hospital beds by region and agency, 2008

• Declining of the population to bed ratios over time was observed, especially those of the North and Northeast; however, disparities between regions remain.

16Source: Thailand Health Profile 2008 - 2010

Population to bed ratios by region, 1979 - 2008

17Source: Thailand Health Profile 2008 - 2010

Population to provider ratios, 1979 - 2009

• There was mark reduction in the disparities of population to health care provider ratios for Bangkok and the Northeast during 2001-2009

• Population to doctor ratio of the Northeast remained 5 time of Bangkok while the ratios of other professions were 1.5 – 2 times of Bangkok

18Source: Thailand Health Profile 2008 - 2010

Disparities of population/healthcare provider ratios for Bangkok and the Northeast, 2001 - 2009

19Source: Kanchanachitr et al (2011)

Thailand has relatively low numbers of doctor and nurse to 1,000 populations compared with countries at the same level of economy

Doctor and nurse to 1,000 population among ASEAN countries

Aim to ensure security of drug supply and to maintain price level of necessary pharmaceutical supplies to ensure accessibility for all Thais

• Production• Stocking• distribution

Trade of between national security and promoting local pharmaceutical industry (push and pull)

• Competing with local pharmaceutical firms in producing generic drugs

• Production of vaccines

Role of Government Pharmaceutical organization (GPO)

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Policies response to increase demand for healthcare of Non-Thais

Medical hub (academic training and conference, medical care, dental care, spa and Thai traditional medicine)

• Promoting Thailand as center of medical education, academic training, and conferences)

• Loosening professional barrier in importing foreign professions

• Reduce income gap between public and private sector in order to prevent brain drain

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2. ท*าแผนัความต�องกัาร์พร์�อมกัร์อบเวล้า3. ท*าแผนังบปร์ะมาณพร์�อมกัร์อบเวล้า4. กั*าหนัดตวผล้ล้พธ�ท%!ปร์ะชื่าชื่นัจัะได�ร์บ5. กั*าหนัดผ0�ร์ บผ'ดชื่อบในัแต.ล้ะส.วนัของแผนั

วั%ธ�ท�างาน

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THANK YOU