The government's vision to reform the health system is becoming clearer.
Overhauling the public healthcare system is one of the Yingluck Shinawatra government's priorities. The administration hopes major health reform will improve health service s and benefit Thais across the country.
The Pheu Thai -led government has been in office for nearly two years. Public Health Ministry permanent-secretary, Dr Narong Sahamethapat, spoke to Bangkok Post reporter Anucha Charoenpo about the elements of the government's public health reforms.
How much progress has been made in the reform of national healthcare? The Public Health Ministry has just issued a 10-year plan (2013-2022) on public health reform and its vision to make all Thais stronger and healthier.
Under the plan we went average life expectancy to rise from 72 to 80 years and to improve the health of all Thais, especially the elderly.
So we have placed greater emphasis on health promotion and disease prevention.
Public Health Minister Pradit Sinthawanarong and ministry executives worked together to develop the plan.
The minister has focused his attention on the 10-year plan which must urgently be put into action.
Dr Pradit instructed ministry offcials to divide the public into age groups and to study what kinds of health problems are common to each age group.
The age groups are: 0-6, 7-18, 19-60, and 60 years and older.
For example, if it is found that many children aged 0-6 are growing and developing slowly, we will study the problem and develop ways to deal with it.
Obesity, for instance, has been a major concern in this age group.
Another example is teen smoking. We find that many teens start smoking because their friends smoke and we will have to find ways to prevent them from smoking.
For working-age people of 19-60 years, we will prioritise informing people about how they can take care of themselves to prevent a variety of cancers and HIV/Aids. We will also focus on the prevention of road accidents.
For people in the category of 60 and older, we will focus on Alzheimer's disease because we know that many elderly people are suffering from this disease. Are you sure the Public Health Ministry's 10-year plan will succeed in reducing the risk of these target diseases? Don't worr y. We incorporate many indicators to measure our targets. For example, if we have a target to reduce the rate of HIV/Aids infection, we would find ways to increase the use of condoms among the age group involved.
We would then assess whether our strategy worked. The 10-year plan was launched at the beginning of this year. A part from studying the health risk indicators, the plan also requires health officials to talk to local people in each jurisdiction, asking them about changes they would like to see in their local health services.
We will have to inspect the readiness of clinics and hospitals to ensure they are prepared to make the changes. The 10-year plan will rely on the participation of local people and health networks to improve services under a so-called district health system.
The system will act as a mechanism to link public health executives with local staff in community and district hospitals.
The ministry will have to work holistically and closely with local staff. Furthermore, officials from each department will have to regularly discuss ways to integrate their work.
I heard the structure of the Public Health Ministry has been revamped as part of the reforms. Could you explain that?
The ministry divides its healthcare service zones into 18 sections, or network zones. A ministry inspector-general oversees each of the zones. But under the10-year plan, we will reduce the zones to 12. We require all the hospitals in each zone to work together and share staff and medical equipment.
They operate as if they are all part of the same company.
In each network zone, bigger hospitals with more physicians and advanced medical technologies must contribute to help smaller hospitals with fewer doctors.
For instance, if one provincial hospital has six ophthalmologists while other smaller community hospitals have none, the six doctors must provide their services at smaller hospitals.
In some cases, smaller hospitals are able to contribute medical resources to larger hospitals.
Sirindhorn Hospital in Khon Kaen is doing a good job. Sirindhorn is a smaller hosp ital which has f our operation rooms that can receive transferred patients with appendicitis from nearby Khon Kaen Regional Hospital.
The doctors at Khon Kaen Regional, a larger hospital, often find themselves overloaded with more than 20 cases of appendicitis every day.
The ministry will speed up informing doctors across the country particularly those in larger hospitals about the policy to share resources.
This policy is also related to the ministry's new performance-based payment or P4P. Doctors who work harder will receive a larger income than those who work less.
We know that some doctors are strongly opposed to the P4P system because they are worried about their income. The more you work, the more you get paid.
How much do you worry about decentralization ? It seems possible the new zoning system will not help to promote decentralisation and the public health system will remain political.
Hospitals at all levels in each network zone must work together and now there are 12 network z ones. Fundamentally, each network zone will be administered under an area health board. Its members comprise of representatives from community, district, provincial and regional hospitals in the network zone.
The area health board must come up with health ser vice policies in each network zone. Each inspector-general will work as if he is the network zone's chief executive officer (CEO) overseeing administration and finances.
We will empower each area health board to administer money provided by the three health schemes: the 30-baht universal scheme, the social security fund and the state offcials' scheme.
Currently, the money from the three health funds is administered by the National Health Security Office. I can tell you the administration of the area health boards will be independent of politicians because executives from each board represent the public health ministry. It will be difficult for politicians to interfere in our work.
How will the ministry select or create its network zones?
It depends on the area's population and geography. Each network zone will comprise 3-5 million people. The hospitals within the networks must be located in close enough proximity to each other to ease patient transfers and reduce travel costs for patients.
How will people benefit from the public health ministry's new structure?
The goal is to have each network zone take on more responsibility and have a clearer mandate. The cost of medicine will also come down because the area health boards will administer the purchase of medicine.
People will be able to buy cheaper medicines and receive better health services. We will be closely measuring all of these projects and goals.
The government is trying to promote Thailand as a medical hub for foreigners. Can you explain this policy?
The government has assigned the Public Health Ministry to oversee this project. We have proposed our plan to the government for consideration. We will focus on the promotion of four medical and health care service areas: wellness spas, medical services, medical academic promotion and herbal products.
We also want to promote Thailand as a medical hub for tourists and we are seeking cooperation from private hospital owners to help support this policy.
Source: Bangkok Post June 24, 2013
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