Buddhist Model of Health Care Reform

1. Buddhist Model of Health Care Reform Mettanando Bhikkhu B.Sc., M.D. (Chulalongkorn), B.A.,MA. (Oxford), Th.M. (Harvard), Ph.D. (Hamburg) Ethics Committee, Faculty of Medicine, Chulalongkorn University, www.mettanando.com

2. Introduction • Debates on health care reform • Participation of public • Libertarian system: free market economy, private hospitals, blooming medical industry • Egalitarian system: health services for every citizen equally (socialist system) • Most reform is about changing way of government financial support

3. Short History of Public Health in Thailand • Ancient Khmer Civilization: arogayasalas • Sukhothai: herbal hill • Ayutthaya: Western doctors, missionaries, terminated in 17 Century, at the end of King Narai • Bangkok: reentry of missionary in Rama III; Rama V Westernization of bureaucracy • After WWII: libertarian, health insurance companies • After 1975: egalitarian: right to health care, 30-baht Universal Coverage, etc.

4. Existing Health Care System in Thailand • 30-baht Universal Coverage • Social Security Scheme • Civil Service Medical Benefit Scheme

5. Adverse Effects of 30-baht UC Demanding huge governmental budget Exodus of doctors from government-run hospitals to private sector Double standards of medication and treatment When fully implemented: catalyzing family breakdown due to more individualism in community

6. Poll on Current Health Care Matichon, February 5, 2007 (2550 BE) A survey report was conducted by the Office of Heath Systems Research Institute and ABAC Poll on 13, 497 people from September 1, 2006- October 31, 2006. 34% felt that the health care services provided by the government are inadequate. 72.9% urge the government to solve the problem of over crowded tertiary care hospitals urgently. 59.3% felt the government provided insufficient budget for public health; 87.1% suggested the government to establish more health care centers.

7. New Challenge for health care reform • Aging population: The success of family planning campaign of the Ministry of Public Health during the seventies throughout the end of the millennium has apparently decreased population growth rate from 1.3 in 1994 to 1.1 in 1996 and finally to 1.0 in 2000 where it remains stable • aging population/total population is also increasing: 0.3 in 1947 and to 0.8 in 1990, then rose to 12.2 in 1998. The projected proportion will increase to 19.6 in 2025

8. Buddha’s healing of a sick monk • A monk suffering from diarrhea the Lord Buddha approached him and said to him: “Monk, what illness you are suffering from?” • The monk then replied: “Diarrhea, Sire”. • “Don’t you have any one to take care of you?” • “No, Sire”. • “What is the reason that other monks are not taking care of you?” • “My Lord, I have not been good to other monks. Because of this, they do not take care of me.” • Then the Lord Buddha told the Venerable Ananda, “Ananda, bring me some water, we will bathe this monk together.” • “Those who want to care for me, should take care for the ill,” Buddha.

9. If you are ill and you have a preceptor. Your preceptor should take care of your for the rest of your life or cured. If not a mentor should take care of his students for the rest of your life or cured. If not a fellow student should take care of his masters for the rest of their lives or cured. If not an inner student should take care of you for the rest of your life or cured. If not, students of the same preceptor should care of you for rest of your life or cured. If not, students of the same mentor should take care of you for rest of your life or cured. Without any preceptor, mentor, fellow student, inner student, apprentice of the same preceptor or mentor, the Community should take care of you, otherwise, this will befall every member of the Sangha for their misconduct.

10. Analysis of the story • Care for the ill is serving the Buddha: • One is serving the Buddha because he cares. • Buddha Nature is in every human being • Quality of life: spiritual, educational and heath • Sangha is a family of care and nurturing, failing to care for one another is misconduct of the Buddhist community, Sangha.

11. Triangle of Quality of Life Centers for the Quality of Life: Run by local volunteers

12. Volunteer Recruitment • 6 million Thai people registered with the Ministry of Culture as “Volunteers” • Volunteering at the grass-roots • Promoted by Office of Health Care Reform • Prof. Prawes Wasi (Guru of National Health Reform, Rural Doctor Group) • Volunteers are active in many areas of health care: cancer, HIV/AIDS, etc.

13. Monks in Health Care • Buddhist monks who were versed in herbal medicine were responsible for health care of people since the 13th Century when Sukhothai was the capital of Siam. • Throughout history of Thailand, monks have served as primary caregivers in local communities. • Monks have been actively involved with spiritual, education and health as volunteers. • Buddhist masters helped build many hospitals.

14. Emerging Elements of Communitarian Health Care System • Decentralization of government administration: • Establishment of Office of Heath Care Reform • Local leaderships with established community centers (best practices): 1 baht a day for membership, huge fundraising and payment for illness • Local infrastructure: village banking system (micro-economics)

15. Problem in Buddhist Community • Feudalistic administration needs reformation to allow local community to facilitate monastic administration • Monastic education: backward deprived of social and science; its needs radical reform and modernization • Popular culture of supernaturalism:obstacle to modernization and against Buddha’s teachings, especially amulet industry and astrology

16. Suggestion • Decentralization of monastic administration, transformation from feudalism to democratic system • Modernization of Buddhist studies and training • Promotion of socially-engaged Buddhism as mainstream Buddhist teaching • Setting up of networks and social activism in urban and rural areas

17. Conclusion • Culture has been the forgotten resource for health care reform in Thailand. • Culture of volunteer workers & culture of care in community should be promoted • Government supports: knowledge, training, setting standards of activities and programs at the grass-roots and networking; • Aging population: quality older people • Better selection of medical students, nurses, etc.