Abstract
This study reviews the management of national health strategy and policy of three countries: Canada, Australia and South Korea which have the experiences in health development including universal health insurance, health promotion and disease prevention, and risk reduction. These experiences could be examples for Thailand to apply to the management of national health strategy and policy.
Canada, Australia, and South Korea are in the high-income country group, have progress in economic and social development especially in health development of their populations. These result in life expectancy longer than 80 years and high proportion of old age over 65 year more than 10%. Moreover, these three countries are fully decentralized, the central governments provide directive policies to the state or province or local government. The central governments might provide partial support budget to policy implementation of local governments that support the central policy. The local governments are responsible for health service provision under the universal health insurance policy.
Canada has established a new organization for management of health strategy and policy with the same level of health ministry called Public Health Agency of Canada in 2004 under Public Health Agency of Canada Act (2006) in which the Chief Officer of this agency reports directly to the Health Minister. This agency provides health policies, health information, and capacity building for organization to sustainable health development in Canada which emphasize health promotion and protection including reduction of health threats. This agency coordinates networks and stakeholders, enabling health promotion innovations closely collaborated with state or province or local government. However, the universal health insurance under Medicare is managed by the province and local government.
Australia likes Canada fully decentralized and governs by the states and local governments. The health system is fully managed by the states. The Medicare Australia used to be under the Minister of Health and Ageing but recently has been reorganized to be under the Minister of Human Services. Medicare Australia is the main organization that takes care of the Universal Health Insurance Policy in Australia. This policy covers the whole population in which the government pays 75% and the people pay 25% of the health services provided by both public and private facilities. While health promotion has been organized by various agencies both public and private, the central government has established called National Health Promotion Authority directly reported to Australian Health Minister’s Advisory Council in which other sectors such as Agriculture, and Education are included. The central government has put efforts in formulating national health promotion strategies to align the implementations among the central, state and local level in dealing with the three major health risks: obesity, tobacco and alcohol consumptions The national strategies will have a positive impact on the health of the Australian population as the set vision of “Australia : The Healthiest Country By 2020.”
South Korea is one of the Asian countries that has established the Social Health Insurance for the whole population within 12 years. It has been recognized by the World Health Organization that Korea health insurance system is the most successful system in which covers 48.7 million in which 97% of the population pay contributions to fund managed by the National Health Insurance Corporation, an independent agency established in 2000, supervised by the Ministry of Health, Welfare, and Family Affairs. This agency is responsible for administrating Health Insurance Fund, utilizing modern information technology for efficiency system management. The lately Korea health system reform focused the system efficiency in term of increase in health promotion investment, combine into single health insurance system, change in method of payment to control the medical care costs, including separation of prescribing and dispensing roles. Furthermore, the health promotion fund was established in 1995 utilizing the tobacco sale tax and health insurance fund.
From the experiences of these three countries, there are some common crucial factors: the health ministry is responsible for directing policy and strategy while the health services are the role of state, province, and local government in which decentralization is fully developed. Therefore, the high capability of the national health policy and strategy management agency is highly crucial to the success of translation health policy and strategy into implementation. However, in order to materialize the reorganization of the Bureau of Policy and Strategy to an “Office of Strategy Management (OSM)”, the crucial issues are the capacity of human resources, the recruitment of capable policy analysts and reduction of work not related to policy analysis. If not, it will be only changing the name of the office instead of support effective strategy implementation role of OSM.