Direction of the Thai Health System and Demand Projections of Physicians for Rural Health Facilities of the Permanent Secretary Office, Ministry of Public Health, 2022–2026: Policy Recommendations

Abstract

The study aimed to analyze and determine desirable health-care system in the years 2022 - 2026, and forecast the future demand for physicians of the Ministry of Public Health’s Permanent Secretary Office (PSO) in the future, as well as to recommend a physician staffing pattern for the PSO’s provincial administration. Using a mixed-methods approach during October 2021 to July 2022, this study collected quantitative data from PSO’s provincial or rural health-care facilities through a web-based survey and secondary data from relevant databases, using an Excel spreadsheet prepared by the researchers. Qualitative data were collected from focus group discussions with 21 experts on desirable health-care system in 2026 as well as in-depth interviews with another 10 experts. Another group discussion was held with 20 experts to develop or draft a staffing pattern for physicians. As for data analyses, descriptive statistics were used for quantitative data and content analysis for qualitative data. The results revealed that the outlook of desirable health-care system for 2022–2026 would cover 10 major issues, namely, (1) management system for Health Regions, (2) integrated primary care delivery, (3) high-level decentralization of health-care system, (4) decentralization to local administrative organizations, (5) participatory approach for health promotion and disease prevention, (6) adequate health workforce in terms of quantity, quality and distribution, (7) system for health workforce production planning, (8) preparedness system to cope with health emergencies, (9) well-connected health system databases, and (10) Thai people with health literacy. Regarding service workload for 2026, it was forecasted that the numbers of outpatient and inpatient visits would be 180.1 million and 40.6 million, respectively. Physicians were expected to have 14 service workload or core activities. The numbers of physicians required for 2026 would be 28,307 for health demand or all 14 core activities and 4,245 for non-service or allowance-based work (15% of total workload), 6,150 for population-ratio-based services, and 180 for service-target-based medical education work, totaling 38,882; compared to the existing physician number of 24,649 against the requirement of 24,668 (data as of 10 July 2022). Thus, this study suggests that: (1) in preparing a physician staffing pattern in the future, two planning elements should be created, (a) the criteria established by the central administration and (b) the conditions set up as appropriate specifically for each locality; (2) skills and capacities should be enhanced for family physicians so that they can provide proactive health services and use modern technology efficiently; and (3) laws on health workforce should be developed to facilitate flexible staff employment and create an alternative system for physician employment and retention in the government system.