Family Medicine and Community Orientation as a New Approach to Quality Primary and Person-centered Care in Thailand
Keywords:Family medicine, primary care, person-centered care, people-centered care
AbstractThailand’s health system, dating back to the 1880s, was traditionally anchored in hospital medicine. Thus, when the family medicine concept was introduced in the 1980s, it was immediately perceived as relating to a hospital-based doctor without a specific specialization. Workforce is a crucial issue for the reform. Overall shortage of human resources is not the only issue. In each facility there should be staff fit to function. The question of human resources can indeed be tackled only when there is an agreement on what is expected from first line services that are close to the population.When the push for universal health coverage gained political momentum starting in Ayutthaya province, in the 1990s, primary care reform became necessary and urgent . It was within this context that person-centered care, family medicine, and community-based care finally made headway in Thailand’s hospital-centred medical culture. A strategy which proved instrumental in facilitating the reforms was that of ‘demonstration’ and ‘diffusion’. The idea behind the ‘demonstration health centers’ was to develop and demonstrate the family practice concept in a few selected areas in order to stimulate interest and demand for primary health care towards person- and people-centered care [1,2]. When the universal coverage policy was adopted some years later, family practice as a cornerstone for health sector development had already proven its worth and was therefore taken up as a tested model of care.
. Mezzich JE, Snaedal J, van Weel C, Heath I (eds) (2010): Conceptual explorations on Person-centered Medicine. International Journal on Integrated Care. Supplement 10.
. World Health Organization (2008): World health report: primary health care now more than ever, World Health Organisation, Geneva.
. Sangvichean S. (1998): Siriraj Hospital, The First Hospital in Thailand], in Sangvichean S. (Editor): 100 years of Siriraj Hospital, History and Evolution, Faculty of Medicine of Siriraj Hospital, Mahidol University, Bangkok, p. 1-14.
. Pearce,RM. (1922): Letter from the Director of Medical Education of The Rockefeller Foundation to the Minister of Education of Siam, Archive of Thai National Library.
. Donaldson PJ. (1976): Foreign intervention in medical education: a case study of the Rockefeller Foundation's involvement in a Thai medical school: Int.J.Health Serv., v. 6, p. 251-270.
. Wonca (1991): Statement issued at the 13th Wonca Conference, Vancouver.
. Pongsupap Y. (2007): Introducing a human dimension to Thai health care: the case for family practice. VUB Press, Brussels.
. Zimmerman CC (1931): Siam Rural Economic Survey 1930-31 (Originally published by G. P. Putnam's, Ltd., London & New York in 1931), reprinted by White Lotus, Bangkok in 1999.
. Nitayarumphong S., Srivanichakorn S., Pongsupap Y. (2000): Strategies to respond to health manpower needs in rural Thailand. In: Ferrinho, P. and Van Lerberghe, W (Editors) "Providing health care under adverse circumstances: Health personnel performance & individual coping strategies". ITG-Press, Antwerp , 55-72.
. Nittayaramphong S., Pannarunothai S. (1998): Thailand at the crossroads, challenges for health care reform, in the proceedings of the 5th Wonca Asia Pacific Regional Conference on Family Medicine Education "Learning and Teaching Family Medicine" 8-10 February, Bangkok.
. Nittayaramphong S., Tangcharoensathien V. (1994): Thailand: private health care out of control?: Health Policy Planning, p. 31-40.
. World Bank (2011): Thailand: Overview and key indicators, http://www.worldbank.or.th/WBSITE/EXTERNAL/COUNTRIES/EASTASIAPACIFICEXT/THAILANDEXTN/0,contentMDK:22994296~pagePK:1497618~piPK:217854~theSitePK:333296,00.html?cid=3001_163 (accessed 27 November 2012)
. Rao C., Porapakkham Y., Pattaraarchachai J., Polprasert W., Swampunyalert N., Lopez A. D. (2010): Verifying causes of death in Thailand: rationale and methods for empirical investigation: Popul.Health Metr., 8:11.
. Health Care Reform Project Team (2001): Final Report, Thailand's Health Care Reform Project, 1996-2001, Annex 2: strategy for developing family practice, Health Care Reform Project, Bangkok.
. Pongsupap Y., Vatcharasil P., Suksom J. (2002): Analysis of visitors of Ayutthaya Urban Health Centres, Health Care Reform Project, Bangkok.
. McManus J (2012): Thailand's Universal Coverage Scheme: achievement and challenges, an independent assessment of the first 10 years (2001-2010), a synthesis report. Health Insurance System Research Office, Bangkok.
. Pacharanrumol W., Tangcharoensathien V., Limwattananon S., Panichkriangkrai W., Pachanee K., Poungkantha W., Gilson L., Mills A. (2011): Why and how did Thailand achieve good health at low cost?, in Balabanova D., Mackee M., and Mills A. (eds), 'Good health at low cost' 25 years on: what makes a successful health system?, London School of Hygiene and Tropical Medicine, London, p. 193-234.
. Prueksaritanond,S, P Tuchinda, 2001, General practice residency training program in Thailand: past, present, and future: J.Med.Assoc.Thai., 84: 1153-1157.
. Pongsupap Y., Van Lerberghe W. (2006): Choosing between public and private or between hospital and primary care: responsiveness, patient-centredness and prescribing patterns in outpatient consultations in Bangkok: Trop.Med.Int.Health., 11:81-89.
. Pongsupap Y., Van Lerberghe W. (2006): Is motivation enough? Responsiveness, patient-centredness, medicalization and cost in family practice and conventional care settings in Thailand: Hum.Resour.Health., 4:19.
. Polpak A., Pongsupap Y., Aekplakorn W., Srithamrongsawat S., Sansern R. (2012): Responsiveness under different health insurance schemes and hospital types of the Thai health care system: Journal of Health System Research, 6:207-218.
. National Health Security Office (2011): Annual Report of National Health Security Office, NHSO, Bangkok.
. Pongsupap Y, Boonyapaisarncharoen T., Van Lerberghe W., (2006): The perception of patients using primary care units in comparison with conventional public hospital outpatient departments and "prime mover family practices": an exit survey: Journal of Health Science, 14:475-483.
. Pongsupap Y., Van Lerberghe W., (2006): Patient experience with self-styled family practices and conventional primary care in Thailand: Asia Pacific Family Medicine Journal, v. 5.
. Prakongsai, P., Limwattananon S., Tangcharoensathien V. (2009): The equity impact of the universal coverage policy: lessons from Thailand. Adv.Health Econ.Health Serv.Res., 21:57-81.
. Limwattananon S., Tangcharoensathien V., Prakongsai P. (2007): Catastrophic and poverty impact of health payments: results from national household surveys in Thailand: Bull.World Health Organ., 85: 600-606.