Transcript Benchmarks of Fairness for Health Care Reform in Thailand

Benchmarks of Fairness for
Health Care Reform in Thailand
Combining evidence with
opinion of the civic group
Supasit Pannarunothai
Center for Health Equity Monitoring
Faculty of Medicine, Naresuan University
Scope
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Equity trends in Thailand
Benchmarks Phase I
Objectives and methods for Phase II
Quantitative data on equity in Thailand
Qualitative data from focus group discussion
Experiences learnt
Equity trends in Thailand
The Constitution 1997
Universal health coverage The Decentralization Act 2001
Equity
Efficiency
Social accountability
Quality
Benchmarks of Fairness Phase I
Scoring of Provincial Health Reforms
Benchmarks
1 Intersectoral public health
2 Financial barriers to equitable access
3 Non-financial barriers to access
4 Comprehensiveness of benefits and tiering
5 Equitable health financing
6 Efficacy, efficiency and quality of health care
7 Administrative efficiency
8 Democracy, accountability and empowerment
9 Patient and provider autonomy
Overall score
Score from -5 to +5 with zero representing status quo
The overall score was made by implicit weighting
Pannarunothai and Srithamrongsawat (2000)
Phayao*
Yasothon
1.8
2.6
2.7
1.4
1.5
2.1
1.8
3.8
1.6
2.1
2.0
2.2
2.0
2.1
1.5
2.0
1.5
1.9
0.8
1.8
Lessons learnt from Phase I
• The benchmarks provided a comprehensive
framework for evaluation of health system.
• It could be used as a tool for provincial
health system development.
• If combining with more objective data, the
benchmarks should provide more accurate
directions for developments.
Objectives for Phase II
• The possibility of involving larger groups of
civil society in using the benchmarks.
• Combining quantitative data of the
provincial health system with qualitative
data (the interpretation of civil society) to
rank performance of the provincial health
system
Methods for Phase II
10 provinces, 8 groups each
Secondary data analysis
81 indicators, 30 groups
Quantitative tool
Quantitative data
Distribution, national level
Focus group discussion
Qualitative tool
Qualitative data
Quality data
46 item-questionnaire
Strength, weakness at local
Objective & Across provinces
Equity score
Subjective & Over time
Quantitative data: 81 graphs
Life expectancy at birth (year)
Standardized death rate (/1,000)
Under 5 Mortality rate (/1,000)
Traffic accident rate (/100,000)
Malnutrition under 5
Low birth weight
Complete antenatal care
Complete vaccination in children 1-2yr
Healthy Housing
Safe from Poisoning
Access to clean drinking water
Density of Population
Size of Household
Dependency ratio
.
.
Seek OP care Private : Public
Seek IP care Private : Public
Qualitative data
8 focus group discussions in each province
1 health managers at provincial level
1 health providers at provincial level
1 health providers at district and subdistrict
level
1 non-health officers at local governments
1 health civic group in urban area
1 non-health civic group in urban area
1 health civic group in rural area
1 non-health civic group in rural area
Each member of focus group discussion
gave scores for 46 questions before and after discussion
1.1 Overall health status
1.2 Specific health status
1.3 Coverage of health service
1.4 Environment
1.5 Demographic condition
1.6 Economic status
1.7 Educational condition
1.8 Resource deprivation
1.9 Intersectoral collaboration
Score from
+5 the greatest improvement
to -5 the very worst condition
.
.
9.1 Choices for primary care
9.2 Choices for specialized care
9.3 Choices for public health service
9.4 Choices for private health service
9.5 Choices for traditional medicine
9.6 Autonomy of provider
1 focus group discussion
took about 1:30 hour
Strengths and weaknesses
of a province by quantitative data
Workload by doctor
Use at primary care
Demographic factor
Admission rate
2
1.44 1.38
1.05
1
0.82
0.19
0.16
0.14
-0.24
-0.27
-0.44
-0.74
0.78
0.48
0.45
0
1.34
1.01
-1.04
-1
0.34
0.14 0.09 0.18
-0.19
-0.34-0.25
-0.74
0.69
-0.94
-0.82
-0.92
-2 -2.23
-3
1
2
3
4
5
6
7
8
9
Overall health status
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Use of public services
Chiang Mai
Scoring before and after focus
group discussion
4.00
2.00
-2.00
-4.00
4.00
3.00
pre-discussion
2.00
post-discussion
1.00
By civic groups
Pre-discussion
-
Post-discussion
-1.00
-2.00
-3.00
-4.00
1
2
3
4
5
6
7
By benchmarks
8
9
Final scores
3.00 - 4.00
for a province
- - 1.00
2.00 - 3.00
1.00 - 2.00
-1.00 - -2.00 --1.00
-3.00 --2.00
-4.00 --3.00
1
Benchmark 1
Benchmark 2
Benchmark 3
Benchmark 4
Benchmark 5
Benchmark 6
Benchmark 7
Benchmark 8
Benchmark 9
Benchmark
Health
Manager
0.82
2.27
0.64
1.73
1.00
1.55
0.45
0.09
1.36
1.09
Provider
Prov. Dist
1.44
1.67
1.44
2.11
1.67
2.00
1.56
2.00
1.22
2.00
Civil society
Local
Provider
Sub-dist Government Health (urban)
1.20
2.70
1.00
1.00
2.60
0.63
0.80
2.50
1.33
1.00
2.70
1.00
1.00
2.70
0.78
1.90
3.00
1.33
0.75
1.90
2.50
0.38
1.89
2.50
0.50
1.75
2.25
0.63
2
3
4
5
6
7
8
9
Civil society Civil society
Health (rural other (urban)
3.00
2.71
2.50
2.33
1.86
2.29
1.71
2.63
1.83
1.33
2.00
3.00
Civil society
other (rural)
3.00
1.80
2.40
3.20
2.75
2.50
2.43
2.43
2.43
3.17
2.40
2.80
2.13
1.67
2.60
Overall
average
1.85
1.87
1.56
1.93
1.54
2.12
0.89
1.72
1.68
1.82
Lessons learnt from Phase II
• The quantitative data were interesting to all
groups and facilitating discussions.
• Judgement of each participant was the mix
of quantitative data and own experiences.
• Non-health civic groups gave lower scores
than other groups.
• The scores could be used for improving the
provincial health system.
Recommendations
• The benchmarks should be used for
evaluation of health system within the
decentralization context.
• Both objective data and qualitative
judgement of the participants in the
province are useful information for health
system development.