Abstract
The objectives of this research are to study: 1) the knowledge, understanding, and health promotion practice of medical doctors; 2) the health promotion delivery process of public and private hospitals; 3) existing compensation and incentive measures provided medical doctors to enhance positive health promotion behavior; 4) condition for health promotion practice of medical doctors; and 5) guidelines for the development of effective compensation and incentive mechanism enhancing participation of medical doctors in health promotion. Samples in this study are 15 central, general, community and private hospitals representing the Northern, Northeastern, Southern and Central Regions. Interviews are conducted with 26 hospital administrators and 41 medical doctors, while group discussions are organized for 106 medical personnel and 300 copies of questionnaire are administered to 300 patients. The study finds that medical doctors have fair knowledge and understanding on health promotion. For instance, they understand that health promotion is a preventive measure, “good health” covers 4 dimensions namely physical, mental, social and spiritual, health promotion is worth as an investment and is very one’s responsibility. Most medical doctors view that the Health for All Policy which emphasizes health promotion service in congruent with treatment is a good policy but has not yet been materialized. Health promotion behavior of medical doctors at the time of the study is not much evident. Those who adopt the practice are found to be the ones who have been trained in family medicine or specialized doctors who are personally interested and voluntarily carry out the task, believing that health promotion makes people healthy and do not need to come to the hospital for treatment which helps saving the expenses. Health promotion roles of medical doctors are found to include: 1) giving health promotion service to individual patients; 2) giving health promotion information to groups of patients; 3) formulating health promotion policy; and 4) acting as good examples in health promotion for the people. Health promotion process as practiced by general and specialized medical doctors in different categories of hospital relatively differs. Most central and general hospitals tend to introduce health promotion service in a lesser degree than community hospitals, but more than private hospitals. Generally health promotion process takes place during the treatment rather than before of after the treatment and has not been operated holistically, as physical health is more emphasized than mental, social or spiritual health. Conditions hindering medical doctor’s health promotion behavior are the lack of clarity and integrity of the policy, budget allocation which does not facilitate the process, outnumbered patients, heavy workload, long-time measurement of success, lack of spicalization, less chance for progress and social acceptance. Compensation and incentive measures for medical doctors and other medical personnel are not visibly existed. Doctors who give health promotion service are mainly inspired by their in-born attitude, by the leaders, teamwork and spiritual support from the patients. Contributing factors as seen by the doctors are for instance appropriate and fair compensation, recognition of their dignity, opportunity for professional progress, balance between number of doctors and the workload, corresponding educational system offered in schools of medicine, upgrading of doctors’ skills and support from the administrators Recommendation of the study are that health promotion service should be successively continue in accordance with The National Health Insurance Act, B.E. 2545. Schools of medicine’s curricula should have more contents on health promotion and appropriately integrate its body of knowledge therein. The hospitals should be prepared for health promotion service which includes the policy consideration, plans, activities, structure, resources and public relations. Concept that doctors are the main engineers of health promotion system should be cultivated and consequently incentive measures and appropriate compensation should be established for them along with other health promotion development mechanism.
