Introducing a human dimension to Thai health care: The case for family practice

In Thailand scientific medicine was introduced in 1888. From its inception
it was based on a biomedical model organized through hospital care provided
by specialized physicians. Thai Doctors were and generally continue to be hospital
doctors. In 1991 family medicine was introduced. In 2001, Primary Care Units
(PCUs) were set up nationwide, based on the experience of the first family practices.

This thesis presents the rationale for the introduction of family medicine
and describes the process through which small scale experimental introduction
eventually developed into a national policy. It focuses on the performance of
doctors in the different ambulatory settings. Health care provider behavior
is observed through simulated patients and patient satisfaction assessed through
exit surveys. Several complementary studies with randomly chosen facilities
and doctors in Bangkok as well as throughout provinces provide an empirical
basis to build health policy upon.

The added value to the Thai health care system resulting from the introduction
of family medicine can be summarized as follows:

(i) family practices appeared to increase patient-centredness, with improvement

in responsiveness and control of cost; particularly in family-practice-healthcentres

rather than outpatient-departments of hospitals;

(ii) family practices were perceived by patients as better than non-family
practices in the public as well as in the private sector.

To change the paradigm of health care delivery several constraints a.o. in
medical education, career perspectives offered and career choice still have
to be overcome.