Abstract
The objective of the research is to study evidences of Dental Health Service in private hospitals regarding the Universal Coverage of Health Care Policy, in the selected province in Thailand. The research has been started at June 2001. Research findings are as follow: Preparing to participate in the Universal Coverage of Health Care, the managers of health service providers in private hospitals considerably study the policy in detail. Therefore, they can clarify their management goals, policies and strategies conforming to the policy of Universal Coverage. Generally, all health workers are trained and prepared for the new policy. Dental health practitioners, however, did not have as much information as other health practitioners. Some private hospitals even had never employed a full-time dentist according to the governmental criteria of basic essential health care service. New systems of data collection are designed conforming to the characteristics of works in private hospitals, which are different from the system that the Provincial Public Health Office need. Interestingly, since April 2001, it was the first time that a private hospital network has been established. Nevertheless, such network does not influence any decision making of each hospital to be the participant in the policy of the Universal Coverage of Health Care. In general, the reason that each private hospital becoming a part of such policy are the appreciation of the concepts and principles that based on the benefits of citizens, increasing health care accessibility with less expense, in other words, improve health at least cost. The budget managing system of the Universal Coverage provides a higher access for population than previous systems. It encourages consumers for a transparent accountability role, and provides more chance and authority for consumers to participate in deciding local health policy. In addition, the system provides a higher possibility to share resource utilization, which would decrease the nation cost of medical technology. It might be said that it is a rather disadvantage for health institutions that do not participate in the Universal Coverage policy since the beginning, for it could affected to the amount of consumers. Or, considering in a long term, there is a high tendency that finally the Universal Coverage of Health Care in the future will cover all private hospitals. Therefore, it would be wise to learn from problems of the procedure since the beginning. The faster the problems are learned the faster they could be solved and developed. Furthermore, the participation of private hospitals could influence other governmental hospitals to develop or reform their health service, which finally it is the advantage of consumers. Before the private hospitals participating in the Universal Coverage Project, the dental health management depended on the hospital managers, while dentist do not have any authority. There are various payment systems for dentist, i.e., a fixed-rate salary, a minimum rate guarantee, or the 50:50 sharing income. For some hospitals the dental health service should be developed regarding to the core package. One important point found in almost every hospital, except only one hospital, is that the health promotion and prevention in the community are ignored. After attending the Universal Coverage Policy, every hospital have re-arranged and developed their service and management. They have tried to contact and coordinate with government institutions, and find many problems in practical level about the communication and co-operating systems. Finally, many private hospitals decide to solve the problems by themselves. Therefore, the management systems tend to be centralized to the managers, in order to clarify the strategies and determine the method and approach for problems solving. Later, the authority has been distributed more to the head of each section. Each hospital considerably analyse and manage their income and expense. However, the information of financial system cannot be revealed. The dental health care service is relatively developed after entering the Universal Coverage of Health Care. For instance, hospitals pay considerably attention to dental health service to cover the core package. The working time planning for dental health service is extended further to overtime. Nevertheless, in some hospitals dental health service are controlled by the hospital managers. For example, the dental prosthetic service is limited for its high expense; each patient is limited to have only one dental health service each time; and the limitation of service time for health insurance consumers. In case of dental health care in communities, they merely assign nurses to screen oral health status in the school-children and finally refer to the hospital for further treatment. There are three types of health service networks among private hospitals: (1) the hospital that have their own primary care unit (PCU), in case of hospital that have small amount of catchment area without the primary health care institution, (2) the hospital that have PCU of their own together with another PCU in a primary health care institution, in case of private hospital that have a primary health care institution in the catchment area, (3) the hospitals that the catchment area cover a primary health care institution but they merely use it as a subcontractor rather than a PCU, and open their own PCU outside the hospital. At present there is a low possibility to extend health service network to private clinics, for there is not much catchment areas for each clinic. If a private clinic would like to be a subcontractor for a private hospital, it should received a reasonable payment. For example it should be more than 200 baht per head for at least 10,000 patients. However, the highest possibility would be that only severe cases are referred to private clinics. According to the interviewing of dental consumers from private hospitals, large amounts of the consumers appreciate with the core package and service from the health practitioners. Some of them, however, complaint that the core package is not enough and the queue for the next service is too long. The consumers’ need of health promotion and prevention are relatively ordinary; dental health education, oral health examination, mobile service, which is conforming to the planning of private hospitals. The research findings provide an important and interesting evidence of dental health and general health service in private hospitals. There are some further suggestions for the Universal Coverage of Health Care policy and practice in the future as follows: The understanding of participants are needed to be adapted conforming to the philosophy of the Universal Coverage of Health Care, in particular, the Health Insurance has a deeply meaning than a donated project for the poor. The understanding of public health practitioners regarding the difference between the concepts of health promotion and disease prevention need to be improved. In particular, the activities of dental health promotion should be more clarify. Whereas the efficiency of health promotion is the population capability of self-care, at present the primary care unit pays less attention to health promotion and prevention and work as the extended OPD instead. Therefore, in the future the roles of primary care unit should have been seriously considered. The development of community capacity should be developed. Moreover, there should be an encouragement for a consumer social network in order to examine the efficiency of hospitals. Regarding the Universal Coverage of Health Care, the health care budget will deliver directly to the hospital, thus, it is possible for consumers to estimate cost and assess local health service. In order to offer alternating to the consumers, the hospital should have an efficiency primary care unit, not merely work as an extended OPD. Particularly, the tertiary care hospital should clarify between the managing of primary and tertiary health care, otherwise the health care referral system would totally be demolished. Previous health care systems wrongly influence consumers to seek for the specialist health practitioners only thus health-seeking behaviour of the consumers should be improved. The separation of dental core package from general health core package has to be considerably concerned together with the studying of dental health cost-effective and types of dental treatment. Although it would help clarifying dental health planning, the most important point we should keep in mind is that, by separating dental core package it would possibly affect the concept of holistic approach. Thus, the question of a possibility to exclude dental health promotion and prevention from other works need to be seriously concerned. The health assessment institution should not merely finding faults and assessing, but suggesting and encouraging health institutions as well. Health expense must be carefully regulated, especially among the health providers. According to the research findings, the competition among health institutions could effect many in-appropriate health services. For instance the over expense of medical technologies and specialist employment. Consequently, the budget from the Universal Coverage of Health Care would be insufficient. At present none of private hospitals have data base of oral health status of their catchment area and lack of information about the important factors related to local oral health status. This would effect the health promotion and prevention assessment. Therefore, the data collection systems have to be re-arranged, and developed to achieve the efficiency of health care in the future.
