Governance issues of health screening and the practice of periodic physical examination in Thailand. Presented in Joint Conference of Medical Sciences Chula-Rama-Siriraj (JCMS2015) 2015.6.4

1. Health Screening & Periodic Physical Examination in Thailand:
An Overview of Health Systems Governance
Asst. Prof. Borwornsom Leerapan, MD PhD
JCMS2015: Health Equity Through Innovation and Collaboration
June 4th, 2015
Pix source: Yuko Sato “The greatest wealth is health” (PMAC 2015 World Art Contest)

2. ① An overview of how health services, including health
screening practices, are currently regulated in the contexts of
Thailand’s health systems.
② To what extent the existing empirical evidence provides an
insight for policymakers on how health screening practices
should be governed in Thailand.
③ How researchers could contribute to the evidence-informed
policymaking process and to facilitate a good governance for
health screening in Thailand.
Outline
Pix source: online.wsj.com

3. Scope of Health Services
Types/Functions of
Health Services
Level of Disease
Prevention
1. การสร้างเสริมสุขภาพ
(Health promotion)
2. การป้องกันโรค
(Disease prevention)
3. การรักษาโรค
(Medical treatments)
4. การฟื้นฟูสภาพ
(Rehabilitation)
1. การป้องกันขั้นแรก
(Primary prevention)
2. การป้องกันขั้นที่สอง
(Secondary prevention)
3. การป้องกันขั้นที่สาม
(Tertiary prevention)
4. การป้องกันขั้้นที่สี่
(Quaternary prevention)

4. Levels of Disease Prevention
Pix source: Adapted from Leavell & Clark (1958)
• Chronological view

5. Levels of Disease Prevention
Pix source: Adapted from Primary Health Care Classification Consortium of WONCA International Classification Committee Working Groups, 2013)
• Relational view

6. Stakeholders in Thai Health Systems
Pix source: www.nationalhealth.or.th

7. Regulation of Health Services
Pix source: Teerawattananon et al. (2003)

8. Regulation of Health Screening?
• Royal Colleges?
• NHSO, SSO, CSMBS
• OOP?
• Education vs. Marketing?
• Social media?
• Practitioners
(e.g. MD, RN)
vs.
• Organizations
(e.g. hospitals)
• MRD?
• FDA
• HITAP?

9. National Practice Guidelines?
สุรจิต สุนทรธรรม (2542)
สุรจิต สุนทรธรรม (2543)
สุรจิต, เชิดชัย, เด่นหล้า (2553)

10. Health Technology Assessment?
อุษา, ยศ, สิริพร, เนติ (2551) อุษา, ยศ (2556)

11. Mass Media?
สุรเกียรติ อาชานานุภาพ (2557)
VS.

12. Governance Issues of Health Screening
① Utilization issues:
• Overuse and misuse
• Underuse: limited coverage and
access
② Standard/Guideline issues:
• Limited local evidence
• Inconsistency among
professional bodies
③ Delivery systems issues
• Limited use of IT
• Fragmented healthcare
• Laboratory standards
④ Govt expenditures issues:
• Deviation from EBM
• Limited fiscal space
of the government
⑤ Health literacy issues:
• Relationship between health
promotion and health
screening
• Expectation & uncertainty:
false positive, false negative
• Dynamic vs. Static status
⑥ Inequity issues:
• CSMBS, SSS, UCS vs. OOP

13. 3 Types of Problems/Systems
Source: Adapted from Glouberman and Zimmerman (2002)

14. Pix source: WHO’s framework for action. (2007)
“Simple”

15. “Complex”
Pix source: Don de Savigny and Taghreed Adam (2009).

16. Health Systems = Complex Systems
Pix source: WHO’s framework for action. (2007)
• Interconnections among WHO’s Six Building Blocks of health systems

17. New Research Mapping?
Figure source: Hoffman (2012) et al.
“Health Policy and Systems Research” (HPSR)

18. Q&A
borwornsom.lee@mahidol.ac.th
Pix
source:
online.wsj.com