Benchmarks of Fairness for Health Care Reform in Thailand Combining evidence with opinion of the civic group

1. Benchmarks of Fairness for Health Care Reform in Thailand Combining evidence with opinion of the civic group Supasit Pannarunothai Center for Health Equity Monitoring Faculty of Medicine, Naresuan University

2. Scope • Equity trends in Thailand • Benchmarks Phase I • Objectives and methods for Phase II • Quantitative data on equity in Thailand • Qualitative data from focus group discussion • Experiences learnt

3. Equity trends in Thailand The Constitution 1997 Universal health coverage The Decentralization Act 2001 Equity Efficiency Social accountability Quality

4. Benchmarks of Fairness Phase I Scoring of Provincial Health Reforms Score from -5 to +5 with zero representing status quo The overall score was made by implicit weighting Pannarunothai and Srithamrongsawat (2000)

5. Lessons learnt from Phase I • The benchmarks provided a comprehensive framework for evaluation of health system. • It could be used as a tool for provincial health system development. • If combining with more objective data, the benchmarks should provide more accurate directions for developments.

6. Objectives for Phase II • The possibility of involving larger groups of civil society in using the benchmarks. • Combining quantitative data of the provincial health system with qualitative data (the interpretation of civil society) to rank performance of the provincial health system

7. Focus group discussion Secondary data analysis Quantitative tool Qualitative tool Qualitative data Quantitative data Distribution, national level Quality data Strength, weakness at local Equity score Methods for Phase II 10 provinces, 8 groups each 81 indicators, 30 groups 46 item-questionnaire Objective & Across provinces Subjective & Over time

8. Quantitative data: 81 graphs . .

9. Qualitative data 8 focus group discussions in each province 1 health managers at provincial level 1 health providers at provincial level 1 health providers at district and subdistrict level 1 non-health officers at local governments 1 health civic group in urban area 1 non-health civic group in urban area 1 health civic group in rural area 1 non-health civic group in rural area

10. Each member of focus group discussiongave scores for 46 questions before and after discussion Score from +5 the greatest improvement to -5 the very worst condition . . 1 focus group discussion took about 1:30 hour

11. Workload by doctor Use at primary care Admission rate Demographic factor Overall health status Use of public services Strengths and weaknesses of a province by quantitative data Chiang Mai

12. Scoring before and after focus group discussion By civic groups By benchmarks

13. Final scores for a province

14. Lessons learnt from Phase II • The quantitative data were interesting to all groups and facilitating discussions. • Judgement of each participant was the mix of quantitative data and own experiences. • Non-health civic groups gave lower scores than other groups. • The scores could be used for improving the provincial health system.

15. Recommendations • The benchmarks should be used for evaluation of health system within the decentralization context. • Both objective data and qualitative judgement of the participants in the province are useful information for health system development.