ความท้าทายในการวางแผนและจัดการกำลังคนด้านสุขภาพของประเทศไทย

ผศ.ดร.นพ.บวรศม ลีระพันธ์

การประชุมเชิงปฏิบัติการเพื่อจัดทำแผนบริหารจัดการกำลังคนด้านสุขภาพของประเทศไทยในระยะ 20 ปี15-16 พ.ค. 60

Pix source: www.cdc.gov/healthbound; blog.wolfram.com

Systems Thinking & System Dynamics

Pix source: online.wsj.com

John Godfrey Saxe's ( 1816-1887) version of the famous Indian legend

“Health Systems = Complex Systems”

Pix source: WHO’s framework for action. (2007)

• Interconnections among “WHO’s Six Building Blocks of health systems

Vicious Cycle of Congestion at Emergency Departments

Systems Design: Health Workforce and Labor Market

Pix source: online.wsj.com

Pix Source: www.bangkokpost.com, www.kapook,com

Healthcare Providers vs. Public Health Officers

Healthcare providers & Labor Market:Healthcare Delivery Systems

การสาธารณสุขมูลฐาน/Primary Health Care (population-level, public health-type functions)

Community(Self-care)

Primary Care Services(family doctor-type services)

Secondary Care Services

Tertiary Care Services

(Supra-tertiary/Quaternary Care Services)

2

3

1

ระบบส่งต่อ(Referral systems)

Source: NEJM 2014;370(26):2457-60.

• End-of-Life Care(Hospice Care)

• Long-term care• Palliative Care• Subacute Care

(Intermediate Care)• Emergency Care• Primary Care/Chronic Care• Acute Care/Hospital Care

Source: W. Simpson del.; E. Walker lith.; Day & Son, Lithrs. to the Queen.Pix source: http://en.wikipedia.org/wiki/History_of_hospitals#mediaviewer/File:Hospital_at_Scutari_2a.jpg

“Hospital at Scutari” - A ward of the hospital at Scutari where Florence Nightingale worked and helped to restructure the modern hospital

“Care Cycle”

Source: Tishihiko Hasegawa (2013)

Pix source: WHO (2008) The World Health Report 2008, Figure 3.5

Coordination (Among Care Models)

Causal Loop Diagram (CLD) &

Stock and Flow Diagram (SFD) in Healthcare

Pix source: online.wsj.com

Source:www2.cdc.gov/syndemics/game.htm

Source:forio.com/simulate/simulation/cdc/health-bound/#app=e95c&fb7a-selectedIndex=0

Source:forio.com/simulate/simulation/cdc/health-bound/#app=e95c&fb7a-selectedIndex=0

Systems Archetypes

Pix source: online.wsj.com

“Fix That Failed”

“Growth and

Underinvestment”

“Shifting the Burden”

-

+

+

+

+

-

+

+

-

-

+

-

+

+

+

UtilizationofHospitalOPDs&IPDs

UnmetHealthNeedsofChronicPatients

UtilizationofPrimaryCareServices

HealthLiteracyandSelf-care

EffectivenessofChronicCareandPreventiveMedicine

TotalHealthcareExpenditures

AvailabilityofPrimaryCareServices

InvestmentsonPrimaryCareServices

PressuretoImprovePrimaryCareServices

Newly-developedPrimaryCareModels

MedicalGraduatesChoosingPrimaryCareSpecialties

(B3)

(B4)

(R1)

(B1)

(B2)

HealthyBenefitiaries

SimplePatients

ComplexPatients

newbenefitiaries

deathscomplex

mortalityratecomplex

progression-regression

projectednewbenefitiaries

incidence

incidencerate

effectivenessof

preventivemedicine

effectivenessof

diseasemanagement

opdutilizationratecomplex

20

ipdutilizationrate

1.53

opdutilizationratesimple

5

effectivenessofopd

utilizationmanagement

opdvisitssimple

opdvisitscomplex

ipdadmissions

baseaveragecost

peropdvisitcomplex

8k

baseaveragecost

peropdvisitsimple

560

totalopdcomplex

expenditures

totalopdsimple

expenditures

totalhealthcare

expenditures

averagecostper

opdvisitsimple

avaragecostper

opdvisitcomplex

totalipdexpenditures

investmentin

integreated

primarycaremodels

averagecostper

dayofadmission

422k

average

lengthofstay

5.83

deathssimple

mortalityratesimple

baseincidencerate

0.05

investmentinopd

utilizationmanagement

1

basemortalityratesimple

0.01

basemortalityratecomplex

0.05

CSMBSHealthcareExpenditures

years

0

100B

200B

2013 2018 2023 2028 2033

totalhealthcareexpenditures

totalopdsimpleexpenditures

totalopdcomplexexpenditures

totalipdexpenditures

NumberofOPDVisitsforSimplePatientCare

years

vis

its

0

10M

20M

2013 2018 2023 2028 2033

opdvisitssimple

NumberofOPDVisitsforComplexPatientCare

years

vis

its

0

2M

4M

2013 2018 2023 2028 2033

opdvisitscomplex

NumberofHospitalAdmissions

years

Adm

issio

ns

0

200k

400k

2013 2018 2023 2028 2033

ipdadmissions