Policy characteristics facilitating primary health care in Thailand: A pilot study in transitional country

International Journal for Equity in Health, Mar 2009

Background In contrast to the considerable evidence of inequitable distribution of health, little is known about how health services (particularly primary care services) are distributed in less developed countries. Using a version of primary health care system questionnaire, this pilot study in Thailand assessed policies related to the provision of primary care, particularly with regard to attempts to distribute resources equitably, adequacy of resources, comprehensiveness of services, and co-payment requirement. Information on other main attributes of primary health care policy was also ascertained. Methods Questionnaire survey of 5 policymakers, 5 academicians, and 77 primary care practitioners who were attending a workshop on primary care. Descriptive statistics with Fischer's exact test were used for data analysis. Results All policymakers and academicians completed the mailed questionnaire; the response rate among the practitioners was 53.25% (41 out of 77). However, the responses from all three groups were consistent in reporting that (1) financial resources were allocated based on different health needs and special efforts were made to assure primary care services to the needy or underserved population, (2) the supply of essential drugs was adequate, (3) clinical services were distributed equitably, (4) out-of-pocket payment was low, and that some primary health care attributes, particularly longitudinality (patients are seen by same doctor or team each time they make a visit), coordination, and family- and community-orientation were satisfactory. Geographical variations were present, suggesting inequitable distribution of primary care across regions. The questionnaire was robust across key stakeholders and feasible for use in a transitional country. Conclusion A primary care systems questionnaire administered to different types of health professionals was able to show that resource distribution was equitable at a national level but some aspects of primary care practice across regions is still of concern, in at least in this transitional country.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://www.equityhealthj.com/content/pdf/1475-9276-8-8.pdf

Policy characteristics facilitating primary health care in Thailand: A pilot study in transitional country

International Journal for Equity in Health Policy characteristics facilitating primary health care in Thailand: A pilot study in transitional country Krit Pongpirul 1 2 Barbara Starfield 0 Supattra Srivanichakorn 4 Supasit Pannarunothai 3 0 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA 1 Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University , Bangkok , Thailand 2 Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA 3 Department of Community, Family and Occupational Medicine, Faculty of Medicine, Naresuan University , Phitsanulok , Thailand 4 Institute of Community based Health Care Research and Development, Ministry of Public Health , Nonthaburi , Thailand Background: In contrast to the considerable evidence of inequitable distribution of health, little is known about how health services (particularly primary care services) are distributed in less developed countries. Using a version of primary health care system questionnaire, this pilot study in Thailand assessed policies related to the provision of primary care, particularly with regard to attempts to distribute resources equitably, adequacy of resources, comprehensiveness of services, and copayment requirement. Information on other main attributes of primary health care policy was also ascertained. Methods: Questionnaire survey of 5 policymakers, 5 academicians, and 77 primary care practitioners who were attending a workshop on primary care. Descriptive statistics with Fischer's exact test were used for data analysis. Results: All policymakers and academicians completed the mailed questionnaire; the response rate among the practitioners was 53.25% (41 out of 77). However, the responses from all three groups were consistent in reporting that (1) financial resources were allocated based on different health needs and special efforts were made to assure primary care services to the needy or underserved population, (2) the supply of essential drugs was adequate, (3) clinical services were distributed equitably, (4) out-of-pocket payment was low, and that some primary health care attributes, particularly longitudinality (patients are seen by same doctor or team each time they make a visit), coordination, and family- and community-orientation were satisfactory. Geographical variations were present, suggesting inequitable distribution of primary care across regions. The questionnaire was robust across key stakeholders and feasible for use in a transitional country. Conclusion: A primary care systems questionnaire administered to different types of health professionals was able to show that resource distribution was equitable at a national level but some aspects of primary care practice across regions is still of concern, in at least in this transitional country. Background Primary health care is a system-wide approach to designing health services based on primary care, which is regarded as a means to help reduce medical expenditures and provide more effective and equitable care to populations [ 1,2 ]. Equitable distribution of primary care services has been investigated in industrialized countries, mainly based on data from national surveys [ 1,3 ]. As developing countries are more likely to have inequitable access to health services, it is important to assess the extent to which new health policies improve the situation. Starfield introduced an approach to compare primary health care policy and primary care practice characteristics, using document review and national expert interview to score primary health care of selected industrialized nations [ 4 ]. Based on pre-defined criteria, each of 13 policy and 7 practice characteristics were assigned a score from 0 (connoting the absence or poor development of the characteristics) to 2 (connoting a high level of development of the characteristics) [ 4 ]. Subsequent research [ 1 ] demonstrated that four of the systems policy characteristics (attempt to distribute resources equitably, adequacy of resources in primary care facilities, comprehensiveness of services, and low or no copayment) are most important in distinguishing health systems that have strong primary care orientation from those that do not. The extent to which a similar approach would be useful in identifying differences in primary health care within countries with relatively greater resource limitations is unknown. For instance, relative shortages of physicians in different areas of these countries raises the question of whether having physicians at primary care facilities makes any difference. Moreover, prior studies have not determined the robustness of responses across various types of stakeholders: policymakers, academicians, and practitioners. Thailand is a transitional country with approximately 65 million populations. In 2001, the Thai government introduced a policy of un (...truncated)


This is a preview of a remote PDF: http://www.equityhealthj.com/content/pdf/1475-9276-8-8.pdf

Krit Pongpirul, Barbara Starfield, Supattra Srivanichakorn, Supasit Pannarunothai. Policy characteristics facilitating primary health care in Thailand: A pilot study in transitional country, International Journal for Equity in Health, 2009, pp. 8, 8, DOI: 10.1186/1475-9276-8-8