Health systemmn tdevelopment

Health & Medicine

CURRENT TREND HEALTH SYSTEM
DEVELOPMENT AND MANAGEMENT
chuchai.s@nhso.go.th
Facebook , twitter : Morchuchai
Line : chuchai55

=
Relationships between
the functions and objectives of health systems
Performance framework (WHO, 2000)

Evidence already exists tiering practice
changes within primary care.
tier 1 : "full-service brokers" and will be delivered by a wide
variety of clinicians.
tier 2 : grapple with
tensions created by
patient demand and
bureaucratic systems
tier 3 : concerned with
community health and
social justice.

Strengthening health systems
Building Blocks of the health system and link to health outcomes
Source: World Health Organization. Everybody’s Business:
Strengthening health systems to improve health outcomes—
WHO’s Framework for Action. Geneva: WHO, 2007, page 3.

Building blocks
– Health systems are highly context specific
– No single model for improved performance
– Key challenge: cost-effective and high-impact
interventions available
– But…they require a functioning health system to
have an effect at the population scale
– Question: how to get drugs, vaccines, and other
forms of prevention, care and treatment – on
time, reliably, in sufficient quantity and at
reasonable cost – to those in need?
– Need for learning from country’s experience on
integration of building blocks

Building blocks
– Integration of building blocks
Leadership/
stewardship
Human
Resources
Pharmaceuticals
Planning
and M&E
Health Care
Financing
Health
Services

The World Health Report 2008
The social values that drive PHC
and the corresponding sets of reforms

Three ways of moving towards universal
coverage
(WHR: 2008 & 2010)

Chronic Care Model
Epping-Jordan, J E et al. Qual Saf Health Care 2004;13:299-305

(Home
services)
(Home
care)
(Home
modification)
(Home nursing
services) (Home-based
& Community
Health services)
(Day care) (Respite
care)
(Hospital day care)
(Intermediate care)
:
:
19

Percent DALY 1999, 2004
and 2009 Male
24
Burden of Disease Thailand, 2009

Percent DALY 1999, 2004
and 2009 Female
25
Burden of Disease Thailand, 2009

Percent DALY 1999, 2004,
and 2009 Both
26
Burden of Disease Thailand, 2009

Integration of building blocks
CEO District Health System
Leadership/
stewardship
Human
Resources
Pharmaceuticals
Planning
and M&E
Health Care
Financing
Health
Services

2557-
2557
[ ]
1,056.96 1,056.96
1,018.35 1,027.94
3 281.02 271.33
4 383.61 383.61
5 14.95 14.95
6 8.19 8.19
7 128.69 128.69
8 3.32 3.32
9 - 0.10
2,895.09 2,895.09

29
Quality and Outcome Framework 2557
Quality and Outcome Framework :QOF) 25571:
1.1 Low Birth Weight (
CUP)
1.2
2:
2.1 OP PCU)
2.2 PCU)
2.3
PCU)
2.4
HT ( PCU)
3:
3.1
PCU)
3.2
CUP)
4:
QOF

•Concept &
Policy
•Structure &
Organization
•Resources
Allocation &
Sharing
•Manpower
Development
•Information
System
•Supportive
mechanism
•New
Management
(Partnership &
Networking)
1. P &P
2. MCH
3. EMS
4. Acute Minor
Diseases
5. Dental Health
6. Chronic
Diseases
7. Psychiatric
Diseases &
Mental
Health
8. Disabilities
9. End of life
care
10.High risk
groups (Pre-
school, Adole
scent, Elderly)

2542 - 2555
80
68
Trainees: Resident Training program.
Trainees: In-service training
Prctical FM

314
: 2550-2552
, 2553-2555
.
130
157
96.34
PT 27

0
2000
4000
6000
8000
10000
12000
14000
2549 2550 2551 2552 2553 2554 2555
: 2549 – 2553
2554
2555 on top
2555
-
11,531
(NP) 9,392
81.45%
2549 – 2555

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เรื่องการสร้างระบบสวัสดิการทางสังคมด้านสุขภาพ อย่างถ้วนหน้า โดยไม่ทิ้งใครไว้เบื้องหลัง เป็นความมั่นคงของประเทศ เป็นหนทางหนึ่งที่จะทำให้ประเทศพ้นจาก "กับดัก" แห่งประเทศรายได้ปานกลาง ความเหลื่อมล้ำ และสมดุลของรายได้รายจ่ายของประชาชน (ดังคำกล่าวของท่านนายกรัฐมนตรี พลเอก ประยุทธ์ จันทร์โอชา เมื่อ 21 มิถุนายน 2560 ที่มหาวิทยาลัยขอนแก่น) และถูกกำหนดไว้ในเป้าหมายแห่งการพัฒนาที่ยังยืน เป้าหมายที่ 3.8 ด้วย การมีประเด็นถกเถียงสาธารณะในประเทศไทยขณะนี้เกี่ยวกับการปรับแก้ พรบ. หลักฯ ๒๕๔๕ แม้ว่าจะเป็นส่วนเดียว (ยังไม่ครอบคลุม ปกส. ขรก. พรบ. ฯลฯ) ก็ยังนับได้ว่า เป็นนิมิตรหมายที่ดี ที่สังคมไทยพัฒนาสู่สังคมที่มีอารยะ

ทบทวนประสบการณ์ Universal Health Coverage 11 ประเทศ

ผมไม่รู้จัก Natt Hongdilokkuly เป็นส่วนตัว เห็นรายงานนี้ซึ่งเพิ่งออกรายงานเมื่อเดือน พ.ค. 2560 นี้ ก็ทำให้ได้แนวคิดเกี่ยวกับการจัดสวัสดิการถ้วนหน้า แก่ประชาชนคนไทย โดยไม่ทิ้งใครไว้เบื้องหลัง ตามคำที่ท่านนายกรัฐมนตรีกล่าวไว้ ก็เห็นว่า คนไทยน่าจะมีภาระลดลงด้านค่าใช้จ่าย การบริโภคที่ผิดเพี้ยนก็ดีขึ้น อานิสงฆ์นี้ก็เป็นผลการสนับสนุนของท่านผู้บริหารประเทศตลอดมา

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การจัดการกับเรื่องราวให้มีการพัฒนาอย่างยั่งยืน sustainable development goal ให้เกิด health and well being ตาม SDG 3 สำหรับสังคมผู้สูงอายุนั้น ต้องการการร่วมมือบูรณาการและผลักดันอย่างยิ่ง ทั้งนโยบายประชากร นโยบายทางการเงิน การจัดสวัสดิการ การจัดการสุขภาพ การจัดการสิ่งแวดล้อมและความปลอดภัย

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บทความนี้ผมขออนุญาต คุณเพียงหทัยแล้ว ในการเอามาเผยแพร่ในสื่อสารธารณะได้ ผมคิดว่าเป็นประโยชน์ในประเด็นที่พูดกันมากในกระบวนการการปฏิรูประบบหลักประกันสุขภาพถ้วนหน้าของไทย "ร่วมจ่าย" คือ กลไก เครื่องมือ ในการบริหารระบบ มีหลายกลไกเพื่อให้ประชาชนทุกคนถ้วนหน้า ได้รับบริการสาธารณสุขภาครัฐโดยมีหลักประกันด้านคุณภาพ ประสิทธิภาพ ปกป้องการล้มละลายจากภาระค่าใช้จ่าย ไม่ทิ้งใครไว้เบื้องหลัง ตามเป้าหมายการพัฒนาที่ยั่งยืนเป้าหมายที่ 3.8 เรื่องร่วมจ่ายเป็นเครื่องมือหนึ่งในหลายเครื่องมือ เท่านั้น และมีทั้งข้อดีข้อด้อย (พูดตามประสาหมอศัลยกรรม ในการดูแลผ่าตัดคนไข้ต้องใช้หลายเครื่องมือ มิใช่มีดอันเดียวก็ทำได้ทุกอย่าง)

ร่วมจ่ายทบทวนประสบการณ์ระบบสุขภาพอเมริกา

ปีนี้การประชุมวิชาการประจำปี เขาตั้ง Theme ประเทศไทย 4.0 ก็เลยเล่าแรงบันดาลใจให้นักกำหนดอาหาร นักโภชนาการ โภชนากร ทั่วประเทศฟังว่า startup น่าเอามาประยุกต์กับสังคมสมัยนี้มาก

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รายงานประจำปีฉบับนี้ ต้องการแสดงให้เห็นถึงว่า การสร้างหลักประกันสุขภาพให้ถ้วนหน้า ไม่ทิ้งใครไว้เบื้องหลัง และทำให้ประชาชนเข้าถึงสิทธิประโยชน์ด้านสุขภาพครอบคลุม และปกป้องคนที่ป่วยต้องไม่เสียค่าใช้จ่ายด้านยา ด้านการรักษาพยาบาลจนตนเองครอบครัวล่มสลายจากค่าใช้จ่ายสุขภาพ (UHC Cube WHO) ต้องผ่านการบริหารและความมุ่งมั่น

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เรื่องราวของการบริหารโรงพยาบาล ถกหยิบยกขึ้นมากล่าวขานกันได้หลากหลายรปแบบ มุมมอง คุณหมอพีรมนต์ นิงสานนท์ กรุณาเขียนบทความมาให้ความร้ผมในมุมมองด้านการเงิน (องค์การอนามัยโลก บอก ต้องมองกระจกหกด้าน เพื่อสร้างความเข้มแข็งแก่ระบบสาธารณสุข การเงินเป็นด้านที่ห้าครับ) อ่านแล้วน่าสนใจ เลยไม่อยากเก็บไว้คนเดียว

ช่วงนี้ มีประเด็น

สาธารณสุขเชิงรุก

ความชุกของโรคเบาหวานในประชากรอายุตั้งแต่ 18 ปีขึ้นไป เพิ่มขึ้นจากร้อยละ 6.9 ใน พ.ศ. 2552 เป็นร้อยละ 8.9 ใน พ.ศ. 2557 และความชุกของภาวะอ้วนในประชากรอายุตั้งแต่ 18 ปี ขึ้นไป เพิ่มขึ้นจากร้อยละ 34.7 ใน พ.ศ. 2552 เป็นร้อยละ 37.5 ใน พ.ศ. 2557

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