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Current status, problems, and challenges in public health in Thailand

Current status, problems, and challenges in public health in Thailand. Dr. Phusit Prakongsai, MD. Ph.D. International Health Policy Program – IHPP Ministry of Public Health, Thailand Presentation to Asian Consultation Workshop on Education for Global Health Leadership

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Current status, problems, and challenges in public health in Thailand

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  1. Current status, problems, and challenges in public health in Thailand Dr. Phusit Prakongsai, MD. Ph.D. International Health Policy Program – IHPP Ministry of Public Health, Thailand Presentation to Asian Consultation Workshop on Education for Global Health Leadership Melia Hotel, Hanoi, Vietnam November 4-5, 2008

  2. Mortality profiles by income groups, 2005 * * Sources: WHO projection baseline scenario *Thai working group, BOD 2004

  3. Top ten mortality in 2004 Source: Thai Working Group on BOD % of Total national deaths 63.9 56.0

  4. Top ten DALY loss in 2004(total 9.9 DALY loss) % of Total 52.6 42.8

  5. Profile of DALY loss by age groups Thailand 2004

  6. Risk Burden in 2004

  7. Health expenditure in Thailand by function in 2001 and 2005

  8. Household consumption: tobacco, alcohol and healthMedian household expenditure (Baht per month) Sources: Analyses from 2006 SES

  9. Thailand: historical development of achieving universal coverage Establishment of prepayment schemes User fees Informal exemption 1945 Expansion of prepayment schemes 1970 1975 LIC 1980 CSMBS 1-3rd NHP 1962-76 Provincial hospitals 1983 CHF 1990 SSS 1980 SSS CSMBS LIC  MWS Universal Coverage 1990 4th -5th NHP (1977-86) District hospitals Health centers 1994 PVHI SSS 2000 2001 Universal Coverage CSMBS Health Infrastructure 2001

  10. Health care finance and service provision of Thailand after achieving universal coverage (UC) General tax General tax Standard Benefit package Tripartite contributions Payroll taxes Risk related contributions Capitation Capitation & global Co-payment budget with DRG for IP Services Fee for services Fee for services - OP Ministry of Finance - CSMBS (6 million beneficiaries) National Health Insurance Office The UC scheme (47 millions of pop.) Social Security Office - SSS (9 millions of formal employees) Voluntary private insurance Public & Private Contractor networks Population Patients

  11. Share of public and private financing sources from total health expenditure in Thailand,1994 - 2005

  12. Number of public health workers and health centre for primary care in Thailand, 1979 - 2006 • More than 70% of health centres have the public health workers below the national standard (1 public health worker: 1,250 population) More than 17% of health centres are responsible to more than 10,000 population.

  13. Public health education in Thailand • The Ministry of Public Health (MOPH) produces most of the certificate level HRH for its own facilities; whereas University Faculty of Medicine, Nursing, etc. produces graduates with Bachelor degrees, • The Faculty of Public Health at Mahidol University and others are functioning as Public Health administrators mostly serving medical doctors with or without Public Health education, • There is no standard for the design of the public health curriculum in Thailand, only a common feature with core and elective courses for two-year programme, • There is an increasing trend in cooperation between university based department and MOPH in designing and implementing a module-based graduate Public Health programmes.

  14. Conclusion(1) • Thailand is facing epidemiological transition from CD to NCD, and disease burden (in term of DALY loss) from NCD is increasing, • There is an urgent need to prepare public health competency of health personnel to address disease and illness from life styles and risk behavior, • There is an increase in public investment in health, and share of household out-of-pocket payments is decreasing, • However, a very small amount of health resources were spent on health promotion and disease prevention, and mostly on conventional clinical based prevention and health promotion services.

  15. Conclusion(2) • Households in Thailand spent more on harmful products to health (tobacco and alcohol), compared to household health spending, • Achieving universal coverage (UC) in 2001 with the comprehensive benefit package including disease prevention and health promotion, and using primary care unit as a gatekeeper, is an advantage for primary health care reform in Thailand, • There is an urgent need to address the issue of inequitable distribution of health facilities and human resources for health among regions, and between urban and rural areas in Thailand.

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