Health System and Service Delivery System

1. Health System and Service Delivery System

2. Learning objectives • To analyze components of health system • To analyze factors affecting health • To analyze relationship of compenents of health system

3. Health vs. System • A “system” can be understood as an arrangement of parts and their interconnections that come together for a purpose • Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. • World Health Organization, 1948

4. Health System • A health system has many parts. In addition to patients, families, and communities, Ministries of Health, health providers, health services organizations, pharmaceutical companies, health financing bodies, and other organizations play important roles. The interconnections of the health system can be viewed as the functions and roles played by these parts • Healthy Development, The World Bank, 2007

5. Health Care System • A health care system is a collection of organizations, practitioners and supporting workforce, facilities and technologies, financing mechanisms, policies, and information that provide and support the provision of health care for a population

6. Objectives • improving the health status of individuals, families and communities • protecting people against the financial consequences of ill-health • providing equitable access to people-centred care • WHO

7. TheMOPH’sstrategies •  To improve the sanitationbehaviourof the people and to prevent and control diseases with involvement of all concerned parties. • To increase the varieties and capacity of the research, including bio-medicines, development, transfer, applications of technology and knowledge. • To develop the system of health security and public health services to be holistically efficient with equal quality services for all.

8. The MOPH’s strategies  • To promote people’s involvement in developing public health, managing public health environment accordingly and efficiently. • To encourage innovations, develop mechanism of facilitating innovations of health products and services, which make use of domestic resources to further enhance the Thai traditional wisdom so that the products and services are of better quality and meet the international standard. • To develop and improve the systems and procedures of operations of public health management to make them better and more efficient.

10. ปัจเจกบุคคล สิ่งแวดล้อม ระบบบริการสุขภาพ ปัจจัยกำหนดสุขภาพ • การผลักใสให้อยู่ชายขอบ • กลุ่มชนดั่งเดิม • การกดขี่ • การค้าและตลาด • การไหลของทุน • วิทยาศาสตร์และเทคโนโลยี • สิทธิบัตร การกีดกันทางสังคม ความขัดแย้ง ความยากจน ความรุนแรง ผู้สูงอายุ โลกาภิวัตน์ พัฒนาเด็กปฐมวัย เทคโนโลยีสารสนเทศและการสื่อสาร วิถีชีวิต บรรยากาศทางการเมือง กายภาพ/ชีวภาพ แอลกอฮอล์ พฤติกรรม เศรษฐกิจ/การเมือง ยาสูบ ความเชื่อ วัฒนธรรม/ศาสนา พันธุกรรม ภัยธรรมชาติ ยาเสพติด ประชากร จิตวิญญาณ การศึกษา เพศสภาพ สุขภาพ ภาวะโลกร้อน ความมั่งคงปลอดภัย สตรี การขนส่ง ทุนทางสังคม เมือง/ชนบท สิทธิมนุษยชน การศึกษาทางวิชาชีพ คุณภาพและประสิทธิภาพ ความเท่าเทียม/ความครอบคลุม/ ชนิดและระดับการบริการ อาหาร การแพทย์ทางเลือกและการแพทย์พื้นบ้าน บริการสาธารณะ/บริการเอกชน การจ้างงาน การเงินการคลังด้านสุขภาพ 5 10 การสาธารณสุขมูลฐาน สุขภาวะทางจิตวิญญาณ สุขภาวะทางกายและจิตใจ

11. Health care structure • The components of the health service system include • Health resources • Health system management • Organizational structures • Health care financing • Health services

12. Essential Health Services in Thailand • Health promotion • Health prevention • Health treatment • Rehabilitation • Alternative Medicine (Strategy 5 :Creation of diverse health alternatives with integrated Thai and international wisdom)

13. 1) Health Resources • Health resources are: • Manpower (essential resources in the health system including doctors, dentists, pharmacists, and health centre staff) • Health facilities • Medical supplies and technologies • The body of knowledge

14. 2) Health System Management • The Thai health system (particularly in the public sector) has been developed in accordance with the Health Development Plan, which is part of the National Economic and Social Development Plan • Laws related to health include acts, ministerial regulations, orders and procedures (Public Health Act (1992), Communicable Diseases Act (1980) • Professional laws includes Nursing and Midwifery Profession Act, (1985); Amendment No. 2 in 1997)

15. 3) Structure of Organization • In Bangkok Metropolis: 5 medical school hospitals, 29 general hospitals, 19 specialized hospitals/institutions, three 10-bed community hospitals (under BMA), and 60 public health centres (with 83 branches, in all BMA districts). • Regional level: 4 medical school hospitals, 25 regional hospitals, and 38 specialized hospitals. • Provincial level: 67 general hospitals covering all provincial areas (previously there were 75 general hospitals; and now eight of which have been upgraded as regional hospitals) and 56 hospitals under various agencies of the Ministry of Defence. • District level: 712 community hospitals, covering 89.56 percent of all districts, one extended OPD or hospital branch, and 212 municipal health centres. • Tambon level: 9,689 health centres, covering all Tambon; some Tambon have more than one health centres.

16. 4) Health Services • Health services in Thailand are classified into five levels according to the level of care • Self-Care at Family Level: Services at this level include the enhancement of people’ s capacity to provide self-care and make decisions about health • Primary Health Care Level: The primary health care services include those organized by the community • Primary Care Level. Primary care is provided by health personnel and general practitioners (GPs)such as Health Centers

17. Health Services (Cont.) • Secondary Care Level:Medical and health care at this level is managed by medical and health personnel with intermediate level of specialization. General and specialized medical facilities such as Community hospitals. • Tertiary Care: Medical and health services at this level are provided by medical specialists and health professionals such as general hospital, regional hospital, and university hospital

18. Health Services (Cont.) • For the government establishments, there are 915 generic healthcare services (74.7%) and 93,268 beds • For private establishments, there are 309 generic healthcare services (25.3%) and 28,511 beds • For the specialized healthcare services establishments, the government has 58 (84%), 12,271 beds and the private has 11 (16%), 403 beds.

19. 5) Health care financing • Refers to all mechanisms for raising the money that pay for activities in health sector. These mechanisms include taxes, insurance premiums, and direct payment by the patients. • Health care financing has extremely important impact on the performance of a health system. • It determines how much money is available, who controls the funds, how risks are pooled, and whether health care cost can be controlled.

20. Health financing models • National health service (NHS): compulsory universal coverage, national general revenue financing, and national ownership of health sector inputs • Social insurance: compulsory universal coverage under a social security (publicly mandated) system financed by employee and employer contributions to nonprofit insurance funds with public and private ownership of sector inputs • Private insurance: employer-based or individual purchase of private health insurance and private ownership of health sector inputs.

21. Questions & Answers