3. Issues and Challenges
- Complex adaptive system
- Government Policy:
- Inadequate Health Funding (approximately 4%GDP)
- Aspiration of Universal Coverage (capped budget
but unmet demand)
- Life expectancy (Male 70 Yrs; Female 75 Yrs)
- Infrastructure needs improvement
- Low socioeconomic status
- Health services management : poor coordination
- Financial management needs development
- Quality accreditation (multiplicity), different
standards
- Education and service delivery separated and not-well
coordinated
- Recruitment and retention of rural doctors
- High workload (average 1 doctor per 3500 population,
Bangkok 1:950, others 1:5000)
4. Comparisons
Advantage ( +
)
1. Rural medical school
(undergraduate)
2. Greater range and volume of
clinical teaching materials
3. Doctor : high valued career
choice
4. Better use of teleconference
technology
5. Less medical-legal
cases
6. Better flexibility in
workforce
Disadvantage ( - )
1. Thai hospitals assigned to
be comprehensive care providers without adequate primary care
services
2. Poor coordination of medical
education and health services
3. Finance: 1 bucket for all
health services
(+/-)
l No GP gatekeeper role (self-referred by
patients)
5. Future directions/
strategies
1.
Recruitment and retention of rural medical workforce
- Improve rural recruitment by involving local
government through funding of undergraduate rural students to stay
in rural areas
- Move the emphasis of clinical training from
university and regional hospitals to community hospitals and
primary care
- Promote career paths and continuing professional
development for rural doctors
2. Develop concept of GP role
· Domain of GP in
undergraduate education
· Gatekeeper
· Specialist status
· Potential Division of
GP
· Better coordination
approach to rural medical education
- Link National health priorities to medical
education
- Demonstrate those initiatives through local pilots,
models and action research
- Publish achievements
- Set up rural medical school club
- Establish similar colleges to Australian and
International networks
Special Thanks to:
- Mr. David
Briggs
- Prof. John Fraser
- University of New England
- Hunter New England Area Rural Training Unit
- Hunter New England Area Health Services
- ACHSE
- RACGP
- ACRRM
- Aboriginal Medical Centre
Members of the study tour
-
Professor Boonchob Pongpanich
- Professor Paichit Pawabutra
- Dr. Suwanna Teerawanit
- Dr. Krish Charuchart
- Dr. Seri Wuttinunchai
l
- Dr. Chaiwetch Thanapaisan
- Dr. Phichet Banyati
- Dr. Sawitree Tunjaroen
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