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บรรยยายพัฒนานโยบายสาธารณะ พยาบาลปริญญาโท

บรรยยายพัฒนานโยบายสาธารณะ พยาบาลปริญญาโท

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  • ขอขอบคุณมากๆคะ มีข้อมูลที่เป็นประโยชน์ต่อวิชาชีพพยาบาลที่ต้องพร้อมรับการเปลี่ยนแปลง
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  • ภาพนี้แสดงถึงสัดส่วนค่าใช้จ่ายครัวเรือน ด้านค่ารักษาพยาบาลเมื่อเทียบกับค่าใช้จ่ายรวมจะพบว่า ส่วนของ Decile ที่ 1,2 ซึ่งเป็นกลุ่มคนยากจน สัดส่วนดังกล่าวลดลงเรือ่ยๆ จนใกล้เคียงกับกลุ่มผู้มีรายได้สูง
  • ผาสุก พงษ์ไพจิตร (2536) แบ่งคนชั้นกลางเป็น 4 กลุ่มคือ (1) นักวิชาชีพผู้จัดการ ผู้บริหาร (2) กลุ่มพี่น้อง (3) คนงาน คอปกขาวระดับล่าง (4) นักคิดและนักวิชาการ

Rama nursepublicpolicy Rama nursepublicpolicy Presentation Transcript

  • The Impact of Socio - EconomicsChanges on Health and HealthSystem chuchai.s@nhso.go.th February 20, 2012
  • Total Health Expenditure (THE) 1994-2008 Rising healthcare costs But… compare to % of GDP: rather stable ~ 4% 400,000 4.2% 4.5% 4.0% 3.8% 3.7% 350,000 3.7% 3.7% 3.7% 4.0% 3.5% 3.5% 3.5% 3.4% 3.5% 3.5% 3.5% 3.3% ~ 30% 3.5% 300,000 3.0% THE was increasing…Mil. Baht 250,000 %GDP 2.5% 200,000 2.0% 150,000 ~ 70% 1.5% 100,000 ~ 55% 1.0% 50,000 0.5% ~ 45% 0 0.0% 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 1994 2008 public private %GDPIncreasing rate of THE was not greater increasing rate of GDP: AffordableSource: Thai Working Group on National Health Account 2009
  • Household payment for health as % of income 8.17 % of income: The poor paid more… 1992 4.28 3.74 3.65 2.87 2.57 2.45 1.99 1.84 2.18 2.05 1.95 1.69 1.66 1.74 1.68 1.66 1.83 1.64 1.27 % of income: The poor and the rich paid ~ the same 2008 Poorer Richer From: Prakonsai et al. 2009
  • Page  6
  • BRICS country
  • ASEAN Economic Community ASEAN ASEAN
  • มูล า ค่(ล้น รีย สรอ า เห ญ .) การค้าของไทยกั บอาเซียน40,00035,00030,00025,00020,00015,00010,000 5,000 0 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 ปี 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 การส่งออกไทยไปอาเซียน การนาเข้าไทยจากอาเซียน
  • (General Agreementon Trade in Services – GATS) Mode of Supply) Mode 1 “ ” (Cross Border Supply) Mode 2 “ ” Consumption Abroad)
  • AEC 2015 MutualRecognition Arrangements: MRAs
  • 1. Engineering Services)2. Nursing Services)3. Architectural Services)4. Surveying Qualifications5. Accountancy Services)6. Dental Practitioners)7. Medical Practitioners)
  • มู ค่ ลา(ล้น รีย สรอ า เห ญ .) การค้าของไทยกั บอาเซียน40,00035,00030,00025,00020,00015,00010,000 5,000 0 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 ปี 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 การส่งออกไทยไปอาเซียน การนาเข้าไทยจากอาเซียน
  • Impact Health Services Cluster Para-medicLabtestingR&DHealthinsuranceLifeScience CORE ACTIVITIES Manufacturing
  • Medical Hub
  • JANUARY 2012 = , , +7.65%)
  • International Avarag Average Tourist Revenue e ExpenditureYear Number Change Length /person Chan Million Change of Stay /day ge (Million) (%) (Days) (Baht) (%) (Baht) (%) 10.06 + 5.82 7.93 3,748.0 - 2.93 299,04 + 4.832001 0 7 10.80 + 7.33 7.98 3,753.7 + 0.15 323,48 + 8.172002 4 4 10.00 - 7.36 8.19 3,774.5 + 0.55 309,26 - 4.392003 0 9 11.65 + 16.46 8.13 4,057.8 + 7.51 384,36 + 24.28
  • Page  26
  •  - -
  •  ( )Page  28
  • Cross-Cultural Impact Health LiteracyHealth literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.Health literacy is dependent on both individual and systemic factors: 1. Communication skills of lay people and professionals 2. Knowledge of lay people and professionals of health topics 3. Culture 4. Demands of the healthcare and public health systems 5. Demands of the situation/context http://www.health.gov/communication/literacy/
  • Demand side Supply side Dependency Ratio  Drugs , Medical supplies, Elderly persons 65 & over Food for health promotions / Working persons 15-64  Shelter Sex Ratio  Health care professional Women 65 & over  Aging Gen B professional  Potential (Golden Aged) Gen Marital Status X Widowhood  Gen Y 1-parent and 1-person  Care givers of Thai and households global New comers Expat & Retire  Self management support From Abroad : Domestic cross culture tools
  • Special Conditions in Asia ImpactSocial security and health care reform policies must contend with such considerations  Fastest pace of economic transition  Highest rates of population ageing and population growth  Strong traditional family support systems
  •  International travel and commerce that quickly transport people and goods vast distances. Changes in food processing and handling, including foods prepared from many different individual animals and transported great distances.
  • 
  • Impact••Contact farming :
  • Impact Access to healthy lifestyle optionsImplications Access to healthy food Availability & affordability of recreational opportunities Urban environments
  • The top 10 emerging technologies for 20121. Informatics for adding value to information2. Synthetic biology and metabolic engineering3. Green Revolution 2.0 – technologies for increased food and biomass4. Nanoscale design of materials5. Systems biology and computational modelling/simulation of chemical and biological systems6. Utilization of carbon dioxide as a resource7. Wireless power8. High energy density power systems9. Personalized medicine, nutrition and disease prevention10. Enhanced education technology World Economic Forum’s Global Agenda Council on Emerging Technologies Global Agenda Council on Emerging Technologies presents the technological trends expected to have major social, economic and environmental impacts worldwide in 2012.
  • Imaging This is especially the case in today’s rapidly evolving and hyperconnected globalized society.PACT and Digital Imagings Scanning + fast visualization + information fusion Non-invasive exploration Direct information to doctors Shorten the treatment chain, reduce sidetracks Requires change in routines
  • Biotech medicineSystems biology and computational modelling andsimulation are playing increasingly important roles indesigning therapeutics, materials and processes thatare highly efficient in achieving their design goals,while minimally impacting on human health and theenvironment.  Regenerative medicine  Rational drug design  Bionics  Genetic testing  Vaccines  Enhancing medicine
  • The New Pharmacology Rapid advances in synthetic biology and metabolic engineering are allowing biologists and engineers to tap into this potential in unprecedented ways, enabling the development of new biological processes and organisms that are designed to serve specific purposes Rational design Based on genomics, simulation and knowledge of basic processes Generics threatened, business models in pharma threatened Blurs the borders between palliative, curative, preventative and enhancing medicine
  • Prosthetics and NeurointerfacesSystems biology and computationalmodelling and simulation are playingincreasingly important roles in designingtherapeutics, materials and processesthat are highly efficient in achieving theirdesign goals, while minimally impactingon human health and the environment.  Neurointerfaces rapid development (~300 electrodes, permanent)  Prosthetic research underfinanced  Large gains for small groups
  • Geno Informatics Genetic Testing Advances in areas such as genomics, proteomics and metabolomics are now opening up the possibility of tailoring medicine, nutrition and disease prevention to the individual. Cheap, fast genetic tests many conditions How many wants to test? How does the health system respond? Benefits: More individually adapted, good for preventative medicine and pharmacogenomics Problems: Interpretation, too much faith in genetics, diagnosis develops faster than treatment, breaks information monopolies
  • Reproductive MedicineThe quantity of information now available to individuals andorganizations is unprecedented in human history, and the rate ofinformation generation continues to grow exponentially. Reproduction as a right? We are willing to spend enormous sums on our children and their health Genetic testing, preventative medicine Perinatal medicine
  • The New VaccinesRapid advances in synthetic biology and metabolic engineeringare allowing biologists and engineers to tap into this potential inunprecedented ways, enabling the development of newbiological processes Vaccines for treatment instead of just prevention Immune system control Vaccines against  Allergies  Diabetes  Autoimmune illnesses  Metabolic illnesses  GYN Cancer  Narcotics
  • Neurotechnologyemerging technologies like synthetic biology and nanotechnology,they are laying the foundation for a revolution in healthcare andwell-being that will be less resource intensive and more targetedto individual needs. The brain/mind increasingly visible New pharmacology + understanding of brain leads to treatment of many mental disorders Hybrid therapies
  • Impact Professional Practice
  • The Implications of Social and Digital MediaNew approaches are needed to meet the challenge ofeducating a growing young population and providing the skillsthat are essential to the knowledge economy. Smart phone Skype™ Facebook Youtube Etc.
  • Asymptomatic ScreeningsLifestyle ModificationsCessation of Addictive BehaviorsMedical Regimen CompliancePrecaution Adoption
  •  Improve dietary habits Increase physical activity levels Reduce heavy drinking Decrease disordered eating behaviors Improve adherence to treatment protocols Impact on health care utilization and costs? Office of Disease Prevention and Health Promotion, DHHS. Expanding the Reach and Impact of Consumer e -Health Tools. 2006.
  • Digital Digital Video Gaming Audio Imaging Watch movies and TV Managing money Listen to music PC Broadband iTV Play games Send & receive photos and video Browse the Internet Online shopping Download songs E-mail Chatting with Friends Fantasy sports Digital Imaging Shoot photos Download songs Audio and video Watch videos Play games on-the-go Fantasy SportsGaming Digital Fantasy Sports Browse the Video Internet E-mail Working Listen to Music E-mail Talk to friends Mobile Managing Managing money money Electronics Collaborating Shopping PC Broadband Trading Stocks Trading Stocks Digital Stream Wireless Audio Mobile Wireless Electronics
  • International Tourist Arrivals to Thailand (Jan 2012) = 1,944,130 The Americas = 110,994 South Asia = 85,593
  • Impact
  • GNI per capita)Atlas method 1 2554 3,976– 12,275 118,662- 366,337 Atlas method
  • @ 2553
  • 2533 2539 2540 2541 2543 2547 65.9 62.8 62.6 63.3 63.2 63.6• 57.1 54.4 54.4 53.8 54.0 54.9• 8.8 8.4 8.2 9.6 9.2 8.6 39.1 42.5 34.2 21.3 19.9 22.5• 33.2 32.1 22.7 12.1 12.5 16.4• 5.9 10.4 11.6 9.2 7.4 6.1 36.5 42.0 45.7 55.3 64.7 65.7 :
  • - 12-15 -16 -14121086420 2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550 65
  • 100%90%80%70%60%50%40%30%20%10% 0% 25292531253325352537253925412542254325442545254725492550 66
  • 100%90%80%70%60%50%40%30%20%10% 0% 2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550 67
  • 100%90%80%70%60% ช ท นบ50% เมื ง อ40%30%20%10% 0% 2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550 68
  • 14,000,000 18,000,000,000 16,000,000,00012,000,000 14,000,000,00010,000,000 12,000,000,000 8,000,000 10,000,000,000 8,000,000,000 6,000,000 6,000,000,000 4,000,000 4,000,000,000 2,000,000 2,000,000,000 0 0 2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550 69
  • 90 18000 -80 1600070 1400060 1200050 1000040 800030 600020 400010 20000 0 2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550
  • -90 35000 - -80 - 3000070 2500060 200005040 1500030 1000020 500010 71 0 0 2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549
  • 14,000,000 40 3512,000,000 3010,000,000 25 8,000,000 20 6,000,000 15 4,000,000 10 2,000,000 5 0 0 72 2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550
  • - 4 3.25 5 3.86 3 4 2.33 2.42 4 3 2.14 2.86 3 2.47 2.59 2 1.74 3 2.10 2 2 1 2 1 1 1 0 0 Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5 1 0.82 1 0.76 0.77 1 0.72 1 0.71 0.63 0.67 0.65 1 1 1 1 0.45 0.47 1 1 0 0 0 0 0 0 0 0 0 0 Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5 73: 50
  • % %5 3 2.77 2.81 4.39 2.69 2.705 4.304 3 3.55 3.574 3.25 2.00 233 222 11 110 0 Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5 74 :
  • : Q1) เท บ ล ศา นก ศา อ เท บ ล20000 15000 17,255 12,86615000 1000010000 8,528 6,277 6,071 5000 4,4005000 2,990 4,489 3,106 2,218 0 0 Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5: 75
  • 94.71 83.01 81.77 77.68 74.54 / / 66.63 96.44 56.64 91.04 41.56 88.14 / / 19.70 85.73 7.12 / / 78.51 5.19 4.81 68.02 60.77 0 20 40 60 80 100 57.71 26.74 22.89/ / 21.19 17.59 76 0 20 40 60 80 100
  • The Urbanization 2008 •World 50% Urban •Thailand 32.3 % Urban 2010 •Thailand 34% Urban UNDP
  • 85,750 90,500-92,75024,250 -40,000 40,000-41,25021,500 22,750-23,0009.06.815.30.9
  •  : Q2) %- 0.5%) 20% Q1 % Q1 % Q2 - %
  • Sources: National Health Examination Survey (NHES) I, age group > 20 years. Ministry of Public Health. National Health Examination Survey (NHES) II, age group 13-59 years. Ministry of Public Health. National Health Examination Survey (NHES) III, age group ≥ 15 years. Ministry of Public Health.• Growth of fast food culture : One of key determinantsto an increase in overweight and dietary change from under-nutrition to over-nutrition(French S et al., 2001; Paeratakul S et al., 2003; Katherine L et al., 2001; Adair LS et al., 2005)
  • China S. Korea Japan Thailand USA Calorie/day/personVegetable 2333 2587 2187 2172 2727Animal 618 478 572 295 1047total 2951 3058 2761 2467 3774 Consumption/person/year (kg)Cereals 166.6 151.7 113.8 122.3 112.5Starchy roots 80.7 17.2 34.1 18.0 63.7Vegetable oils 9.5 12.3 14.1 6.3 27.8Fruits 47.3 66.8 56.3 87.8 110.3Vegetables 254.1 209.2 106.5 42.1 127.7Sugar 7.2 19.2 19.3 31.9 32.9Meat 52.5 49.2 43.9 26.4 124.1Milk 13.3 29.4 67.1 18.8 261.3fish 25.6 58.7 66.3 30.9 21.3 Source: FAO, quoted in Ivan Roberts & Neil Andrews, Developments in Chinese Agriculture, ABARE, eReport, July 2005, p.5, Table 2.
  • ± Impact : Retail Health Care Clinics and Nurse Practitioners ACNP has watched with interest the development and growth of retail health care clinics; this new and emerging role provides both critical visibility for NPs and offers health care services to the public in a cost-effective, convenient and efficient manner. Most of these retail clinics (also called the "Convenient Care Industry") are being staffed by nurse practitioners and provide patients with fast, affordable treatment for routine medical conditions as well as preventive care. NPs are using their skills to diagnose, treat and prescribe medications, in addition to providing health screenings, medical tests, vaccinations/immunizations and physicals in some locations. http://www.acnpweb.org/
  • Source: http www nationmaster com country th Age_distribution
  • 2549-2552 ( :2549 2550 2551 255221,149 21,560 22,102 21,82457,562 58,029 58,580 58,02243,124 45,912 48,895 51,7064,870 5,185 5,522 5,839126,912 130,686 135,099 137,391
  • Household consumption: tobacco, alcohol and health Median household expenditure per month Sources: Analyses from 2006 SES 1000 867 650Baht per capita บุหรี่ สุ รา 500 สุ ขภาพ 433 433 390 303 303 205 152 120 93 52 47 65 60 0 Q1 Q2 Q3 Q4 Q5 Income quintiles
  • Generation 2010 2020 2030Baby Boomer - -Gen X - -Gen Y -Gen M - 6,462 22,204
  • Gen-BBaby Boomer Generation 50 – 4 @ 2012     Elvis 
  • Gen-X 31 – 49 Gen-B Managers
  • Gen-Y -30 ± style Gen-B
  • Gen-Y -30 ± 15 Gen-Y Gen-Y
  •  18 ±
  • Impact
  • 
  • 
  • National Health and Welfare Survey 2551 – 2552
  • Life expectancy Male FemaleAt birth 66.1 74.1At 60 years 18.0 20.9At 80 years 10.0 10.2Source: Population Gazette, 2005, IPSR Mahidol 100
  • National Health and Welfare Survey IV 2551 – 2552
  •  Social and economic (and sometimes environmental) conditions that affect people’s health
  • Poorer people live shorter lives and are more often ill than the rich. This disparity has drawn attention to the remarkable sensitivity of health to the social environment.[Social Determinants of Health, The Solid Facts, WHO 2003]
  • 
  • Prevalence of chronic disease on the rise DALY
  • National Health and Welfare Survey 2551 – 2552
  • The Epidemiologic Transition
  • Transition DM & HT
  • Policy Implications – Towards Cost-effective Care Avoid hospitalization and institutions Provide substitutes and alternatives eg. day care, home nursing, hospice, etc Develop community-based services Strengthen family support and home care Improve housing and living arrangements
  • The approach in communitarian community care:•Partnership of the Public, Private & People(3P) Sectors•Joint responsibilities of the individual andfamily, communityTHE FUTURE
  •  Building on Chronic Care Model Includes:  organizational support  clinical information services and disease registries  team-based care  case management  regular follow-up Numerous studies have demonstrated  For patient: decision Improvements in care and intermediate support, self- patient outcomes; evidence is management support, beginning to emerge on cost community resources effectiveness* *Source: Katie Coleman et al, “Evidence On the Chronic Care Model in the New Millennium,” Health Affairs, Jan-Feb. 2009, pp. 75-83.
  • Creating Sustainability ThroughPatient and family centered and health outcome basedPopulation health status is the benchmarkContribute to measurable improvements in healthAppropriate range/mix of health professionalsInter professional teams with integrated scope/ practiceChange management leadershipEmphasis on primary health care, health promotion, self management and the social determinants of healthChanging role to accountable healthcare organization (PHSOR Report, 2007)
  • Building Blocks of the health system and link to health outcomes Source: World Health Organization. Everybody’s Business: Strengthening health systems to improve health outcomes— WHO’s Framework for Action. Geneva: WHO, 2007, page 3.