Date post: | 06-Aug-2015 |
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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 Primary Health Care Classification Consortium of WONCA International Classification Committee Working Groups, 2013)
• Relational view
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)
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
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)