ระบบบริการทางการแพทย์เพื่อการฟี้นฟูสมรรถภาพคนพิการ

Abstract

Medical rehabilitation service system in Thailand This research project aims at analyzing the situation and synthesizing the recommendations for the development of an equitable, efficient, and good quality medical rehabilitation system in Thailand, after the enactment of the Rehabliltation of Disabled Persons Act, 1991 with the legal announcements of the 4 Ministerial rules for implementation in 1994. The research includes literature review on eqidemiology of disability and the management process of the existing medical rehabilitation system, as well as in-depth qualitative study on community perception and the existing medical rehablilithation services. Major findings are: 1) There are many health related surveys which include epidmiology of disability such as: the study of epidemiology of disability by Banlu Siripanit, the Health and Welfare Survey of National Statistics Bureau, the National Health Examination Survey by the Thailand Health Research Institute and the Provincial Health Survey by the Health Policy and Planning Bureau. Review of documents showed that : 1.1) In 1996, the proportion of the disabled persons in Thailand was approximately 1.8-8.1 percent of tolal population, this amount to 1.07-4.83 million people. Only 2.31-10.4 percent of those expected to need rehabolitation services had come to registered for their right under the 1991 Act. 1.2) The results of each survey/study varied widely because of the different in concepts, definitions and methodlogies used. No study on socio-economic impact of disability in Thailand had ever been carried out before. 1.3) There is an increasing trend for the proportion of disabled persons among Thai population. This causes of disabilites correspond with the changes of morbidity trend. Occupations, accidents, chronic diseases and elderly are incresaing by become the main causes, while infectious diseases and congenital disability are getting less and less important. 2) Policy on medical rehabilitation serviecs was formulated for more than 2 decades ago. The services had not much been developed, however. The existing medical rehabilitation services focused mainly on social welfare concept and stressed more on rehablilitation of the sick than of the disables. Not until the enactment of the Disabled Person Rehabilitation Act in 1991 that the concept moved towards viewing the disables as national resources that need development. Rehabilitation services was then considered as human investment aim enabling the disables to live gracefully in the society. Nevertheless, the ministerial rules for implementation of the act was announced 3 years after the act, in 1994, and the development of medical rehabilitation services started to receive more resources since 1995. The Sirindhorn National Medical Rehablilitation Centre was established in 1994. The centre supposed to act as national coordinating focal point and give technical support, has an administrative structure of a health service unit, however. The research also revealed that except for the Workmen Compensation Fund, the expenses for medical rehabilitation can not be reimbursed by any heatlh insurance system scheme. Thus there are inequitable access to medical rehablilitation service for persons under different health insurance schemes. 3) Due to the management problems, medical rehabilitation system is still weak, staring from lacking the proper understanding of the right concept, no clear development plan, shortage of all sort of man power, little appropriate knowledge, inadequate facilities, and budget to support equitable and efficient implementation. 4) There are also misconceptions among disables and their families in the studied communities. Disabilites were viewed as fate, sympathy which need help through social welfare services. Thus they only demand free good medical care, They did not understand their rights for medical rehabilitation specified in the new act. Those who know their rights, did not know where to use these rights.