Abstract
There is a notion saying “the most reliable prediction of the future is to build it”. This synthesis of
tacit and explicit knowledge in shaping referral network of health services in the upper north of Thailand reflects collective actions among doers of the region in accord with such a notion. The actions started from
a health manpower crisis of the former single node of referral chain in 2006 characterized by draining of
almost 300 nurses instantly from the node hospital to private hospitals after dramatic increased workload
without perceived competitive adjustment of financial incentives. The crisis forced the node hospital to
shift its policy of hospitalizing referred cases from unlimited to a limited quota. Joint coordinating and
collaborating mechanisms among networks of public and private hospitals were set up under the jurisdiction
of public health administrative region no. 15. The mechanisms facilitated 1) restructuring roles and
functions of the hospitals into zones of referral chains each with a node and sub-nodes; 2) capacity building
of public hospitals under the restructured zones; 3) planning of human resources, service delivery and
upgrading of facilities including buildings, medical equipment and communication technology through
public and private subsidies; 4) adjustment of payment mechanisms to mobilize previously untapped
capacity i.e., specialized cares of private hospitals; neurosurgery of a public hospital which previously
excluded emergency cases. During 2008-2010, evidence has shown a decline in the number of referred
cases being turn away; better access to standard care such as thrombolysis for acute STEMI, traumatic
brain surgery; neonatal care. Strengths and weaknesses were discussed. Finally, opportunity for future
improvement of continuity of care within the referral network was identified in terms of relational, informational
and managerial continuity.
