Health Service Centre

Promote the role of the private sector in health development

Change with structure of the economy both in the Thai context and at the global level towards a system of free enterprise have underscored the importance of the private sector’s role in national development.

In the field of public health a specific condition exists in that the free market mechanism can not function at its best because health service providers themselves can generate demand for utilizing services. Countries with well developed systems of free enterprise have set up rules and procedures to contain the cost of medical care services provided by the private sector an appropriate level to ensure that the general public have access to all essential health care services at affordable cost.

Meanwhile in other countries where free enterprise is fully exercised there have been many instances of health care expenses sky-rocketing out of control, thus affecting the low-income population.

Promotion of the appropriate role of the private health care business can be divided by type of business as follows :

1. Health care service business

The Thai many of Public Health has directly and indirectly supported private sector participation in organizing health care services to reduce its workload and provide a possible alternative for those who could afford to pay for extra conveniences. However, experiences in Thailand and clsewhere have shown that competition among private hospitals is extremely high, particularly in utilizing costly technologies and medical equipment. This competition coupled with imperfect information of the consumers have often resulted in a sharply rising cost of services which not only placed a burden on individuals or their families but also affected the national health expenditure as a whole.

On the other hand, the people who seek health care services from the private sector would expect high quality services and if their needs are not met or if mistakes are made in the course of treatment, they will certainly complain or sue the service provider, a trend which is currently on the rise.

While the government exercises control over the private hospital business, the latter tries to find appropriate measures for protecting itself. This defensive mechanism is unproductive for both sides. It is essential for the government to monitor the private sector and ensure that its role in providing health care services is properly carried out and of real benefit to the general public.

2. Pharmaceutical and medical supply business

The pharmaceutical and medical supply business in Thailand is well advanced and has high potential. Should it be actively supported by government mechanisms and motivated to improve its quality control measures to meet international standards, the country would become more self-reliant as regards pharmaceutical and medical supplies. There would also be a better chance of its expending its to markets in neighbouring countries and thus fostering the growth of the national economy.

Divise an effective managerial system to promote environments conductive to good health.

Environmental problems in Thailand have had an ever-increasing negative impact on the physical as well as mental health of the Thai people. In order to solve the health problems caused by the environment, there should be a strong intersectoral mechanism to promote a better environment. It should involve all concerned sector both within and outside the Ministry of Public Health including the private sector, individuals and communities.

The health-oriented strategies the following :

1. Develop an effective surveillance system to monitor the environmental impact on health

Even though efforts have been made in environmental quality monitoring, they have not been strongly motivated, and sustained support of all concerned sectors has been lacking. Development of an effective surveillance system would keep the society informed of the impact of the environment upon health, and lead to more collective efforts for preventing and reducing the magnitude of the problem.

2. Promote environments that are conductive to good health

This means promoting healthy environments for the people, whether in urban areas or in the workplace. Efforts must be  supported by public policy or financial incentives such as tax reductions, together with provision for training and teaching/learning experiences as well as technologies and other essential inputs for ensuring better environments.

3. Promote the role of community organizations /
people in environmental conservation

Community organizations and the people themselves have critical roles in looking after and promoting healthy environment such as forest and river conservation, provided they preceed in the right direction.

Encourage the establishment of a semi-private organization as a mechanism for health service systems reform

A non-profit semi-private organization is deemed most appropriate for creating desired changes as it would be flexible in adjusting its functions to meet ever changing condition in the society. Such an organization could serve as an effective mechanism for mobilizing efforts form all relavant public and private and private organizations, and the general public to jointly tackle healths problems and reorganize current health systems to be more responsive to changing conditions and needs.

1. Mechanism for health promotion

Its role would be to develop a long-term scenario for health promotion, with a budget allocate by the government to promote activities, mechanisms or environments that are conductive to good health e.g. promote dissemination of accurate data and information concerning health to the general public by concerned agencies and organizations both of the public and private sectors, and encourage healthy behaviours through the mass media. The mechanism should be hightly receptive to changes and ready at all times to reorientate its strategies and managerial style in accordance with change in the environment, society, the mass media or business systems that may affect or have an impact on health.

2. Mechanism for controlling quality of health care

Naturally people want to have good quality health care, but enchancing the quality of health care services, be it in the public or private sector, usually takes a long time. Health services institutions at each level have their own special features and are thus different in reguard to readiness and motivation. Regulatory measures as well as follow-up and quality monitoring by a mechanism which is under the control of the public sector might not be effective as there would be no commitment on the part of the health care institutions themselves. Establishment of a semi-private organization as the focal point for quality control is recommended. This type of organization would be better able and more willing to ensure that all concerned sectors collaborate and take part in formulating long-term scenarios and plans of action in accordance with prevailing conditions, thus ensuring sustained quality control of health care services.

3. Mechanism for purchasing health care services

A semi- private organization responsible for managing the funds allocated by the government for purchasing health care services as well as the proceeds from payments by the clients themselves should be established This is to increase purchasing power, take rational decisions in selecting services and make best use of existing resources in terms of post and type of services received. As users of services, the people could also be involved in managing the funds, with support from the government.

Reorientate the role of the government in health development

Development of the capacity of the government health service infrastructure as reflected in strategy No. 1 does not mean that the government should continue to be responsible for the overall health care system of the country. It is timely that the government  reorientate its role to that of policy maker whose major task is to monitor health development to ensure that it is proceeding in the desirable direction. Following this principle, the government should limit the growth of its health service infrastructure and reorientate its role as follows :

1.    Developing mechanism for health policy formulation and monitoring its implementation in the desirable direction

The government should strengthen intersectoral collaboration for overall national development (not just the health sector) with the aim of incr
easing the quality of life of the population. It should also set desirable directions for the public and private health care authorities in providing essential services for the benefit of the general public.

This includes formulating guiding principles for utilization of medical technologies and equipment and criteria for their use, strategies for appropriate distribution of medical equipment based on real needs and problems in order to make the best use of expensive technologies without affecting the overall national economy. Most importantly care must be taken to  avoid a burden being placed on the people by the unnecessary use of expensive technologies or equipment.

2.    Reorientate the role of the government in regard to the national health expenditure

To control the rapidly increasing health expenditure and make sure that health services are cost-effective, the following actions should be taken :

-    reorientate the government budget allocation system for health care services, which used to follow programme budgeting principles, and make it more effective by taking into consideration the achievements against target of each health care organization as one of the criteria for budget allocation.
-    Enhance the role of the government in monitoring the cost of health care services provide by both the public and private sectors by developing an accountable system to designate ways and means to purchase services whose costs are to be covered by the government while stipulating precise guiding principles for services whose costs are to be covered by the patients themselves.

3.    Reorientate the role of the government in monitoring its own health service institutions.

Government hospitals and health centres should be given more freedom in managing their own operations which could help increase efficiency in financial and personnel management while continuing to render essential health services in accordance with the national health policy and receive a regular government budget. If the government could reorientate it role from health service provider to purchaser of quality services, it would then create healthier competition between public and private hospitals with respect to quality and efficiency.

The Thai people today are severely threatened by pollution both in their daily living and working environments which have become hazardous to health.

-    Traffic accidents now rank first among the leading causes of death of the Thai people, with a rapid increase from the rate of 12.4 per 100,000 population in 1989 to 31.5 per 100,000 in 1994.
-    The population problem has become highly critical in Bangkok with the quantity of dust in the air at 3.4 times above the acceptable standard. This problem now extends to other large provincial cities. Water pollution now affects the major rivers of the country while the agricultural sector is facing the problem of inappropriate use of chemicals, fertilizers and insecticides.
-    Problems pertaining to unsafe workplaces, accidents caused by machine operations and high-risk working environments greatly affect the quality of life of workers, particularly those in the industrial sector.

Even though the aforementioned problems are acknowledged by both the public and private sectors and studies on various aspects of this issue have been made, there is still a need to further develop effective strategies and actions to tackle them. This process requires more active intersectoral collaboration, with participation by the people, particularly in policy development and development of legal and financial measures, these problems are to be solved.

Apart from environmental problems, the hectic lifestyle in large cities has caused serious mental health problems in Thai society. People have to live in heavily congested areas, struggling to survive in a highly competitive, materialistic society while individual families are losing their potential to provide physical and mental support to their members. Even the stronger family ties in rural areas are gradually weakening due to the higher incidence of rural to urban migration.

Problems pertaining  to the health service systems

Besides the problems experienced by the public, current health service systems are facing a number of problems arising from the rapid changes in socio-economic conditions and population composition, technologies. In addition, the stagnant managerial mechanism. And the slow process for national health development, all require effective and urgent adjustment and reorientation.

The main problems can be classified as follows :