บรรยยายพัฒนานโยบายสาธารณะ พยาบาลปริญญาโท

1. The Impact of Socio - Economics
Changes on Health and Health
System
chuchai.s@nhso.go.th February 20, 2012

4. 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 %GDP
Increasing rate of THE was not greater increasing rate of GDP: Affordable
Source: Thai Working Group on National Health Account 2009

5. 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

6. Page  6

7. BRICS country

9. ASEAN Economic
Community


ASEAN

ASEAN


10. มูล า
ค่
(ล้น รีย สรอ
า เห ญ .) การค้าของไทยกั บอาเซียน
40,000
35,000
30,000
25,000
20,000
15,000
10,000
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

11. (General Agreement
on Trade in Services – GATS)
Mode of Supply)
Mode 1 “ ” (Cross Border
Supply)
Mode 2 “ ”
Consumption Abroad)

12. AEC 2015
Mutual
Recognition Arrangements: MRAs

13. 1. Engineering Services)
2. Nursing Services)
3. Architectural Services)
4. Surveying Qualifications
5. Accountancy Services)
6. Dental Practitioners)
7. Medical Practitioners)

14. มู ค่
ลา
(ล้น รีย สรอ
า เห ญ .) การค้าของไทยกั บอาเซียน
40,000
35,000
30,000
25,000
20,000
15,000
10,000
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

16. Impact Health Services Cluster
Para-medic
Lab
testing
R&D
Health
insurance
Life
Science CORE ACTIVITIES
Manufacturing

17. Medical
Hub

18. JANUARY 2012 = , , +
7.65%)

19. International
Avarag Average
Tourist Revenue
e Expenditure
Year
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 + 4.83
2001 0 7
10.80 + 7.33 7.98 3,753.7 + 0.15 323,48 + 8.17
2002 4 4
10.00 - 7.36 8.19 3,774.5 + 0.55 309,26 - 4.39
2003 0 9
11.65 + 16.46 8.13 4,057.8 + 7.51 384,36 + 24.28

26. Page  26

27.  -
-

28.  (
)

Page  28

29. Cross-Cultural Impact
Health Literacy
Health 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/

31. 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

32. Special Conditions in Asia
Impact
Social 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

35.  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.

38. 


39. Impact
•
•Contact farming
:

40. Impact
Access to healthy lifestyle options
Implications
 Access to healthy food
 Availability & affordability of recreational
opportunities
 Urban environments

42. The top 10 emerging technologies for 2012
1. Informatics for adding value to information
2. Synthetic biology and metabolic engineering
3. Green Revolution 2.0 – technologies for increased food
and biomass
4. Nanoscale design of materials
5. Systems biology and computational modelling/simulation
of chemical and biological systems
6. Utilization of carbon dioxide as a resource
7. Wireless power
8. High energy density power systems
9. Personalized medicine, nutrition and disease prevention
10. 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.

43. 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

44. Biotech medicine
Systems biology and computational modelling and
simulation are playing increasingly important roles in
designing therapeutics, materials and processes that
are highly efficient in achieving their design goals,
while minimally impacting on human health and the
environment.
 Regenerative medicine
 Rational drug design
 Bionics
 Genetic testing
 Vaccines
 Enhancing medicine

45. 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

46. Prosthetics and Neurointerfaces
Systems biology and computational
modelling and simulation are playing
increasingly important roles in designing
therapeutics, materials and processes
that are highly efficient in achieving their
design goals, while minimally impacting
on human health and the environment.
 Neurointerfaces rapid
development (~300 electrodes,
permanent)
 Prosthetic research
underfinanced
 Large gains for small groups

47. 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

48. Reproductive Medicine
The quantity of information now available to individuals and
organizations is unprecedented in human history, and the rate of
information 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

49. The New Vaccines
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
 Vaccines for treatment instead of just prevention
 Immune system control
 Vaccines against
 Allergies
 Diabetes
 Autoimmune illnesses
 Metabolic illnesses
 GYN Cancer
 Narcotics

50. Neurotechnology
emerging technologies like synthetic biology and nanotechnology,
they are laying the foundation for a revolution in healthcare and
well-being that will be less resource intensive and more targeted
to individual needs.
 The brain/mind increasingly visible
 New pharmacology +
understanding of brain leads to
treatment of many mental
disorders
 Hybrid therapies

51. Impact Professional Practice

52. The Implications of Social and Digital Media
New approaches are needed to meet the challenge of
educating a growing young population and providing the skills
that are essential to the knowledge economy.
Smart phone
Skype™
Facebook
Youtube
Etc.

55. Asymptomatic Screenings
Lifestyle Modifications
Cessation of Addictive
Behaviors
Medical Regimen
Compliance
Precaution Adoption

56.  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.

57. 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 Sports
Gaming 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

58. International Tourist Arrivals to Thailand
(Jan 2012) = 1,944,130
The Americas = 110,994
South Asia = 85,593

59. Impact

61. GNI per capita)
Atlas method 1 2554
3,976
– 12,275 118,662
- 366,337 Atlas method

62. @ 2553



63. 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
:

65. -
12-15
-
16
-
14
12
10
8
6
4
2
0
2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550
65

66. 100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
25292531253325352537253925412542254325442545254725492550
66

67. 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

68. 100%
90%
80%
70%
60%
ช ท
นบ
50%
เมื ง
อ
40%
30%
20%
10%
0%
2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550
68

69. 14,000,000 18,000,000,000
16,000,000,000
12,000,000
14,000,000,000
10,000,000
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

70. 90 18000
-
80 16000
70 14000
60 12000
50 10000
40 8000
30 6000
20 4000
10 2000
0 0
2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550

71. -
90 35000
-
-
80
- 30000
70
25000
60
20000
50
40
15000
30
10000
20
5000
10
71
0 0
2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549

72. 14,000,000 40
35
12,000,000
30
10,000,000
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

73. -
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

74. % %
5 3 2.77 2.81
4.39 2.69 2.70
5 4.30
4 3
3.55 3.57
4 3.25 2.00
2
3
3 2
2
2 1
1
1
1
0 0
Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5
74
:

75. :
Q1)
เท บ ล
ศา นก ศา
อ เท บ ล
20000 15000
17,255 12,866
15000
10000
10000 8,528 6,277
6,071 5000 4,400
5000 2,990 4,489 3,106
2,218
0 0
Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5
:
75

76. 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

77. The Urbanization
2008
•World 50% Urban
•Thailand
32.3 % Urban
2010
•Thailand
34% Urban
UNDP

78. 85,750 90,500-92,750
24,250 -
40,000 40,000-41,250
21,500 22,750-23,000
9.0
6.8
15.3
0.9

79. 

 :
Q2)
%- 0.5%)

20%
Q1 % Q1
% Q2
 - %

81. 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 determinants
to 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)

82. China S. Korea Japan Thailand USA
Calorie/day/person
Vegetable 2333 2587 2187 2172 2727
Animal 618 478 572 295 1047
total 2951 3058 2761 2467 3774
Consumption/person/year (kg)
Cereals 166.6 151.7 113.8 122.3 112.5
Starchy roots 80.7 17.2 34.1 18.0 63.7
Vegetable oils 9.5 12.3 14.1 6.3 27.8
Fruits 47.3 66.8 56.3 87.8 110.3
Vegetables 254.1 209.2 106.5 42.1 127.7
Sugar 7.2 19.2 19.3 31.9 32.9
Meat 52.5 49.2 43.9 26.4 124.1
Milk 13.3 29.4 67.1 18.8 261.3
fish 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.

83. ± 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/

85. Source: http www nationmaster com country th Age_distribution

86. 2549-2552
( :
2549 2550 2551 2552
21,149 21,560 22,102 21,824
57,562 58,029 58,580 58,022
43,124 45,912 48,895 51,706
4,870 5,185 5,522 5,839
126,912 130,686 135,099 137,391

87. Household consumption: tobacco, alcohol and health
Median household expenditure per month
Sources: Analyses from 2006 SES
1000
867
650
Baht 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

88. Generation 2010 2020 2030
Baby Boomer
- -
Gen X
-
-
Gen Y
-
Gen M
- 6,462 22,204

89. Gen-B
Baby Boomer Generation
50 – 4 @
2012




Elvis


91. Gen-X
31 – 49

Gen-B



Managers


92. Gen-Y
-30 ±

style


 Gen-B

93. Gen-Y
-30 ±
 15
Gen-Y

Gen-Y

94.  18 ±






95. Impact


96. 


97. 



99. National Health and Welfare Survey 2551 – 2552

100. Life expectancy Male Female
At birth 66.1 74.1
At 60 years 18.0 20.9
At 80 years 10.0 10.2
Source: Population Gazette, 2005, IPSR Mahidol
100

102. National Health and Welfare Survey IV
2551 – 2552

103.  Social and economic (and sometimes
environmental) conditions that affect
people’s health

104. 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]

105. 



106. Prevalence of chronic disease on the rise
DALY

107. National Health and Welfare Survey 2551 – 2552

108. The Epidemiologic Transition

109. Transition DM & HT

110. 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

111. The approach in
communitarian community care:
•Partnership of the Public, Private & People
(3P) Sectors
•Joint responsibilities of the individual and
family, community
THE FUTURE

112.  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.

114. 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)

115. 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.