Decentralise Thailand's health system: Experts

Decentralise Thailand's health system: Experts

Experts have recommended that the health system be decentralised and healthcare zones be implemented - a move they claim would lead to greater hospital efficiency.

They believe decentralisation would give state hospitals greater flexibility in managing resources and staff without losing backup support.

The call comes in response to findings that the country's only autonomous hospital - Banpaew - finds it quite hard to go all alone when it comes to financial matters.

These experts made their voices heard at the 16th Healthcare Accreditation National Forum, which took place late last week to discuss "de-concentration" of healthcare and the effects on a hospital's quality, performance, survival and fairness.

At the forum, Public Health Ministry senior adviser Dr Supakit Sirilak said that in order to boost hospitals' performance and administration, the health system should be decentralised to let hospitals have freedom to manage their own affairs.

"Under the current system, the administration of public hospitals is directly governed from the ministry, which results in slow development of the hospitals," Supakit said.

He said the most appropriate way to decentralise the health system is to do it via zones, not by individual hospitals.

"What we learnt from the Banpaew Hospital case is if 'de-concentration' is done individually, it will very difficult to sustain a hospital's survival. But if we do it as a whole healthcare zone, hospitals can work together and make the transition easier," he said.

Three types

There are three types of the health 'de-concentration' - autonomous hospitals, healthcare zones, and commissioning.

These three all have the same purpose - to enhance accessibility, quality, performance and fairness in the provision of healthcare.

Banpaew Hospital director Suraphong Bunprasert described managing the country's "only autonomous [public] hospital", saying it had struggled very hard to stay viable financially and develop quality service.

"It is certain that decentralisation benefited our hospital by letting us manage our matters independently. But as the only autonomous hospital, we are working alone to stay afloat financially," Suraphong said.

He said he disagreed with the autonomous hospital system but its administration system was quite good because it represented all stakeholders.

The hospital is administered by a board that has government representatives, experts and local community representatives.

Klongkhung Hospital director Winai Lismith said health reforms, including "de-concentration" and public health areas, were issues the National Reform Council is currently considering.

But he said some in the Public Health Ministry still feared that decentralisation would limit their authority.

Winai noted that 'de-concentration' is different from privatisation of public hospitals, which worries many people.

"De-concentration is like halfway between private and public style of administration. That way hospitals would not be under direct control of the ministry but still under central regulations," he explained.

Health "de-concentration" and zones are now hot issues. The recent transfer of Dr Narong Sahametapat from his post as permanent secretary of the ministry was somehow linked to the conflict over such policies.

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