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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”
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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