Abstract
Synthesizing Knowledge Underlying the Development of Position Paper on the Definitions of Levels in Health Service System in ThailandThis research aims at synthesizing knowledge underlying the development of position paper on the definitions of levels in health service system in Thailand by exploring service systems in 7 countries including; South Korea, Japan, New Zealand, Malaysia, Singapore, Australia, and Thailand. The study identified scope and functions of each level in the system and analyzed factors that differentiated all levels of health services and other supportive systems. Documents analysis was conducted priori to interviews with experts in health system designs and forums of academics and researchers in health system. Reflections from National Forum on the National Health Act were analyzed. Results indicate the following. 1. Lessons learned from other countries indicate that 1)factors influencing health service system design included; population structure and illness pattern, health care expenditures, social demands on quality health services; 2) two concepts defining levels, scopes, functions, and levels referrals were technical and professional explanation through levels of sophistication of treatment, severity of illness, and specialization of care; and management concept of ownership and networking, and 3)health insurance played a major role in making the health service system able to be implemented as planned. Roles and scopes of the health services at each level would be functioning well upon the regulations stated in the health insurance system and others related such as financial, health manpower development, and health promotion systems. 2. Concepts explaining scopes of care in the health service system of Thailand must be based on technical and professional and management reasons. “High Touch-High Tech” is the principle of the technical and professional concept of which “High Touch” be used when social and humanistic knowledge are vital and “High Tech” be used when medical treatment and cure are central to the services. Health services could be differentiated into two types; community care and institutionalized care. The institutionalized care could be ranged in four levels, which are; primary, secondary, tertiary, and specialized care. Supportive mechanism must be designed accordingly especially health insurance system, hospital accreditation system, and technology appraisal system. Through management concept, the emphasis is on ownership and networking, which community care could be governed by the local authorities and the community. While the institutionalized care should be governed by own board and controlled by the health insurance system. Networking relationships among authorities and service units must be equal on contractual basis of which benefits could be shared. Health services on this management basis include 1)individual and family care, 2)community care, 3)primary care and 4)hospital treatment. 3. It is suggested that the involving parties including the local authorities, the government, and the health professions play vital roles in managing all factors influencing the design of health services system.
