Health for Wealth Day 1 - Medical Association & Nursing Council

The Medical Association of Thailand

This morning (July 1, Day 1 of the Health for Wealth Program) involved a meeting at the Medical Association of Thailand, hosted by Assistant Professor Colonel Dr Kidaphol Wadhanakul M.D (Physician for the Royal Army), Professor Dr. Teerachai Chantrarojanasiri (Vice President, and Paediatrician), and Dr Yothin Berajawung (Family Physician). This presentation introduced us to the Association and provided an overview of the Thai health care system.

Royal Golden Jubilee Building, 2 Soi Soonvijai, New Petchaburi Road, Bangkok 10310

According to the World Health Organisation (WHO), Thailand has had a "long and successful history of health development." The Medical Association is responsible for developing strategies to promote better health care in Thailand and is also recognised by the WHO as having the best governance for medicine and prevention of corruption.

Statistics

• Thailand population - 65 million
• Life expectancy - 75.4 years
• Religion - 94.6% Buddhist
• Under 1 mortality - 6.6 per 1000 live births
• Maternal mortality - 48 per 100,000 live births
• Typical Thai income - 260,330.40 THB (roughly $9144 AUD)
• Health care expenditure - $195 AUD (2010)

Health Service Network Facilities

77 Provinces

• 28 Regional Hospitals (more than 500 bed capacity)

• 68 General Hospitals (more than 200 bed capacity)

District

• 763 Community Hospitals

• 51,308 Community Health Centres

Sub District

• 10,195 Primary Care Unit

• 7,751 Local Administrative Health Funds

Village

• 800,000 Health volunteers

Private sector

• 33,405 hospital beds

• 17,671 private clinics

• 17,187 drug stores

Health Personnel:Population (2011)

• Doctors – 1:4,319
• Dentists – 1:14,833
• Pharmacists – 1:2,622
• Professional Nurses (RNs) – 1:529

By early 2002, Thailand had achieved universal coverage (UC) of health care for the whole population, becoming one of only a few lower-middle income countries to do so. Prior to UC, Thailand experienced a mal-distribution of health resources throughout regions. There was also an increase in the role of the private sector, but with service provision still limited in urban areas. With increasing evidence and intolerance of inequities (18 million Thai remained uninsured) and inequitable distribution of health resources (focus towards hospital care in urban areas), the Universal Health Coverage Scheme (UCS) formulated a goal: "to equally entitle all Thai citizins to a quality health care according to their needs, regarless of their socioeconomic status," based on the universal principle that the scheme is for everybody, "not just only the poor, vulnerable and disadvantaged."

Expectations arising from the UCS included:

• Extended coverage to all
• Universal benefits with an emphasis on primary care
• Decreased out-of-pocket expenses
• and Harmonising the UCS with other government financed insurance schemes.

UC is provided through three programs:

• Civil Servants Medical Benefit Scheme
• For those who work for the government, and their children
• About 8% of the population
• Social Security Scheme
• For private employees
• About 1/8th of the population
• Universal Health Coverage Schemes
• Theoretically available to all other Thai nationals

Means-tested health care for low income households was replaced by a new and more comprehensive insurance scheme, originally known as the 30 THB Project, in line with the small co-payment charged for treatment. People joining the scheme receive a gold card which allowed access to services in their health district, and, if necessary, be referred for specialist treatment elsewhere. The UC Gold Card allowed for more universal and inexpensive health care: the cost for a visit was 30 Baht, but free for anyone under the age of 12 or over the age of 60, for those in poverty, and also for those who volunteer in health care. This allowed equal opportunities for people to receive the health benefits that they need.

This reform proved popular with poorer Thais, and has since been abolished by the Health Minister, Mongkol Na Songkhla, making the UC scheme free. UCS has not only improved equitable access to health care and reduce household poverty, it has also improved equity in financing health and increased efficiency of the Thai health system.

However, the UCS still faces significant challenges:

• Many doctors are not general physicians, resulting in patients with minor problems experiencing difficulties in accessing a specialist who will treat them.
• Rural areas face problems with the amount of time doctors are available and transportation to clinics. Even clinics that are only 14km away are too far for villagers to get to.
• Urban areas also face transportation problems with there being no efficient emergency transportation system and a low number of ambulances, resulting in fatalities and serious health consequences.

Ambulances share the traffic with every other road user

Although everybody should be entitled access to quality health care for free, this raises concerns regarding such a system’s sustainability. How long will free health care last? What else can fund free health care, and what will be the financial mechanism to serve the population? Are raised taxes on cigarettes and liquor enough? It then becomes apparent that prevention is key: aiming to reduce injuries and disabilities by and increasing education regarding healthy lifestyles and providing holistic care. To make this possible, health professionals must be properly equipped with the resources and knowledge - resources to reach out to target populations (especially rural areas), and knowledge and understanding of communities, living conditions, and an understanding of how such factors influence health and people holistically.

Overall, the goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. This requires: a strong, efficient, well-run health system; a system for financing health services; access to essential medicines and technologies; a sufficient capacity of well-trained, motivated health workers (http://www.searo.who.int/thailand/en/).

Lunch was purchased at the markets on the grounds of the Ministry of Public Health. 

A coconut and strawberry ice drink

Nursing and Midwifery Council

In the afternoon, we had a meeting with the president of the Thailand Nursing Council (TNC), Professor Wichet Srisuphan (RN, RM, Dr.). Here we learnt that nursing in Thailand has a positive history and nurses themselves are highly regarded, especially due to Her Royal Highness Princess Srinagarindra Mahidol (the mother of the King) once being a nurse herself.

Nagarindrasri Building, Ministry of Public Health, Tiwanon Road, Amphur Muang, Nonthaburi 11000

The TNC is Thailand’s governing body of nursing, and was initiated by the Nurses Association of Thailand in 1968. Prior to 1968, nurses were governed by the Act of Health Practice, and the Practice of the Art of Healing Act. In 1985, the Nursing Council became the regulatory body of nursing and the profession was bound by the Professional Nursing and Midwifery Act.

It was also learnt that the Professional Practice of Nursing is based on scientific principles of nursing, the nursing process, and the art of nursing (encompassing a holistic approach to care). The Council also acts to ensure nurses are entitled to flexibility, freedom and control in their work, and promote professional standards, thereby protecting the public. Interestingly enough, there is no current nursing union, making the council is responsible for managing issues of the nursing industry. A union is currently trying to be established.

Museum display

A demonstration of old nursing uniforms

I don’t really have much to reflect on regarding the TNC. The main point that was highlighted by the presentation was how similar the Australian Nursing and Midwifery Council and Thailand Nursing Council are: governing the nursing profession and ensuring competence of health professionals and enforcing standards, contributing to a skilled and trusted workforce. The Council, (also similarly to Australia) works to ensure the nurse to patient ratio of 1:4, mentioning that in many cases it is unfortunately not possible.

The rest of my day…
After a very educational day, it was time to check out the MBK shopping centre (that I had been told so much about!) for some bargains and my first Thailand Pad Thai! It is truly amazing in there - about 6 levels, 2 of which are dedicated to markets, selling anything you could possibly need/want!

The preferred (and quite unsafe) mode of transport

My first authentic Pad Thai - level 6 of MBK!

MBK Centre - across the road from Ibis Siam, and close to two BTS stations