การกำหนดชุดบริการสุขภาพจำเป็นขั้นพื้นฐาน : ทฤษฎีและการทบทวนวรรณกรรม

Abstract

Determination of basic essential health care package :theory and literature reviewBasic essential health care package is a set of health services that should be made available to all people in a society, equity, the poverty reduction, the scanty of health care and human rights are four major reasons supporting the provision of the package. The allocation of other health services is subject to the market mechanism. This study reviews the concepts underlying the determination of basic essential health care package, assesses the experiences of providing basic health care in some countries and offers some guidelines in determining basic essential health care package in Thailand. There are five approaches to determining basic essential health care package : equity, adequacy of health care, basic needs, minimum standard and social security. The United States of America provides free health services to the poor through Medicaid program based on the minimum standard approach. Health insurance in Germany and Japan, based on the social sercurity approach, identifies basic health services for all health insurance schemes to include. The World Bank suggests the burden of disease and the cost-effectiveness of health programs as two major factors in establishing basic essential health care package in developing countries. Normal opportunity range of life, the need for health care and the demand for health care are three major theories explaining the behavior of health care consumers. Health care utilization is influenced by factors surrounding the users and the providers. Moral hazard and supplier-induced demand make actual health care utilization differ from predicted health care utilization. A comparison between theoretical basic essential health care package and actual health care uses indicates that the inefficiency of the health resource allocation is most likely to exist. However, basic essential health care package based on the equity concept is consistent with health care utilization based on the normal opportunity range of life concept. This is because the former encourages equity in health care provision while the letter, equity in health status. The determination of basic health services provided by four health schemes in Thailand is evaluated. The principle underlying free medical care scheme for low income people, relying on the annual grvernment budget, is correspondent to the minimum standard approach. Health Card program and the Social Insurance scheme are obviously based on the social security approach. The civil servant medical benefit scheme using fee-for-service reimbursement method is based on the adequacy of health care approach. According to Thai experts' opinions, the most desirable objective of the Thai health sector is equity in health care. Therefore, the equity approach should be employed to determine basic essential health care package. In providing the package, health scheme involved have to meet four important aims : efficiency, full coverage, acceptable quality of care and catastrophic-illness management.