Governance of health screening in Thailand 2015.6.4

Health Screening & Periodic Physical Examination in Thailand: An Overview of Health Systems Governance

Asst. Prof. Borwornsom Leerapan, MD PhD

JCMS2015: Health Equity Through Innovation and Collaboration June 4th, 2015

Pix source: Yuko Sato “The greatest wealth is health” (PMAC 2015 World Art Contest)

①  An overview of how health services, including health screening practices, are currently regulated in the contexts of Thailand’s health systems.

②  To what extent the existing empirical evidence provides an insight for policymakers on how health screening practices should be governed in Thailand.

③  How researchers could contribute to the evidence-informed policymaking process and to facilitate a good governance for health screening in Thailand.

Outline

Pix source: online.wsj.com 

Scope of Health Services

Types/Functions of Health Services

Level of Disease Prevention

1.  การสร้างเสริมสุขภาพ (Health promotion) 

2.  การป้องกันโรค (Disease prevention) 

3.  การรักษาโรค (Medical treatments) 

4.  การฟื้นฟูสภาพ (Rehabilitation)  

1.  การป้องกันขั้นแรก (Primary prevention) 

2.  การป้องกันขั้นที่สอง (Secondary prevention) 

3.  การป้องกันขั้นที่สาม (Tertiary prevention) 

4.  การป้องกันขั้้นที่สี่ (Quaternary prevention) 

Levels of Disease Prevention 

Pix source: Adapted from Leavell & Clark (1958)   

•  Chronological view 

Levels of Disease Prevention 

Pix source: Adapted from Primary Health Care Classification Consortium of WONCA International Classification Committee Working Groups, 2013)  

•  Relational view 

Stakeholders in Thai Health Systems

Pix source: www.nationalhealth.or.th

Regulation of Health Services

Pix source: Teerawattananon et al. (2003)  

Regulation of Health Screening? •  Royal Colleges?

•  NHSO, SSO, CSMBS •  OOP?

•  Education vs. Marketing? •  Social media?

•  Practitioners (e.g. MD, RN) vs.

•  Organizations (e.g. hospitals)

•  MRD? •  FDA •  HITAP?

National Practice Guidelines?

สุรจิต สุนทรธรรม (2542) 

สุรจิต สุนทรธรรม (2543) 

สุรจิต, เชิดชัย, เด่นหล้า (2553) 

Health Technology Assessment?

อุษา, ยศ, สิริพร, เนติ (2551)  อุษา, ยศ (2556) 

Mass Media?

สุรเกียรติ อาชานานุภาพ (2557) 

VS.    

Governance Issues of Health Screening

①  Utilization issues: •  Overuse and misuse •  Underuse: limited coverage and

access

②  Standard/Guideline issues: •  Limited local evidence •  Inconsistency among

professional bodies

③  Delivery systems issues •  Limited use of IT •  Fragmented healthcare •  Laboratory standards

④  Govt expenditures issues: •  Deviation from EBM •  Limited fiscal space

of the government

⑤  Health literacy issues: •  Relationship between health

promotion and health screening

•  Expectation & uncertainty: false positive, false negative

•  Dynamic vs. Static status ⑥  Inequity issues:

•  CSMBS, SSS, UCS vs. OOP

3 Types of Problems/Systems

Source: Adapted from Glouberman and Zimmerman (2002)

Pix source: WHO’s framework for action. (2007)

“Simple”

“Complex”

Pix source: Don de Savigny and Taghreed Adam (2009).

Health Systems = Complex Systems

Pix source: WHO’s framework for action. (2007)

•  Interconnections among WHO’s Six Building Blocks of health systems

New Research Mapping?

Figure source: Hoffman (2012) et al.

“Health Policy and Systems Research” (HPSR)

Q&A [email protected]

Pix  source:  online.wsj.com