2.Problems concerning the quality of services.

In parallel with the expansion and increased coverage of health care services, the quality of care improved considerably but mainly from the service providers’ perspective.

Even though measures have been taken by hospitals to increase essential preventive care and the efficiency of curative care to reduce time of treatment and hospital admission days per patient, to strengthen personnel development as well as to acquire high technology for more effective treatment, the problem of “quality” as perceived by the people who receive the services needs further attention in regard to :

-    inadequate information about the illness because of the illness because of the extremely limited time for consulting doctors or other service providers ;
-    inadequate information about treatments such as special examinations of screening test, together with statement of their costs, which prevents patients from making a choice that might avoid unessential or costly services ;
-    inadequate information and advice on essential self-care, which could speed up the healing process or prevent recurrence of the disease ;
-    lack of convenience in obtaining services particularly in regard to waiting time, overall environment, supportive services such as reception, cleanliness, attitude of service providers in their human relations;
-    low professional standard of doctors or other service personnel which might cause complications or even death ;
-    delayed in receiving preventive care or screening, though readily available, until the illness becomes severe.

It can be seen that the people’s perceptions of the quality of services are different from those of the service providers and could not be tackled simply by increasing the scope of services or acquiring high-tech equipment and more qualified personnel. It is the issues relating to human behaviour, the organizational set-up, continuing quality surveillance and other client-oriented problem-solving measures that should be given due consideration.

1. Problems concerning accessibility to essential health services

Despite the considerable increase in coverage of health service centre’s and a more favorable ratio of health personnel to total population, problems of accessibility to health care services still exist in the from of :

- Long waiting time when seeking services from government hospitals which are always overcrowded ;

- high cost of health care services charged by private hospitals or even some government hospitals which, in certain cases, may entail debt or cause servere economic problems to the consumers ;

- refusal on the part of hospitals to render services, in particular to emergency or accident cases if the ability to pay the bills cannot be proved ;

- inaccessibility to specialized care, which is still limited particularly in the case of patients suffering from cancer, chronic degenerative diseases and need continning care ;

- distance between place of abode and health service centres both in rural and congested urban areas, particularly as regards transport of critically ill patients or emergency/accident cases.

It is evident that today’ s health problems cannot simply be solved by increasing coverage of health service infrastructure or merely treating the diseases patients’ once they have occurred. Careful study of all underlying problems should be made in order to find appropriate measures for comprehensive problem-solving.