System dynamics modelling of health workforce planning to address future challenges of Thailand’s Universal Health Coverage
Tóm tắt
System dynamics (SD) modelling can inform policy decisions under Thailand's Universal Health Coverage. We report on this thinking approach to Thailand's strategic health workforce planning for the next 20 years (2018–2037). A series of group model building (GMB) sessions involving 110 participants from multi-sectors of Thailand's health systems was conducted in 2017 and 2018. We facilitated policymakers, administrators, practitioners and other stakeholders to co-create a causal loop diagram (CLD) representing a shared understanding of why the health workforce's demands and supplies in Thailand were mismatched. A stock and flow diagram (SFD) was also co-created for testing the consequences of policy options by simulation modelling. The simulation modelling found hospital utilisation created a vicious cycle of constantly increasing demands for hospital care and a constant shortage of healthcare providers. Moreover, hospital care was not designed for effectively dealing with the future demands of ageing populations and prevalent chronic illness. Hence, shifting emphasis to professions that can provide primary care, intermediate care, long-term care, palliative care, and end-of-life care can be more effective. Our SD modelling confirmed that shifting the care models to address the changing health demands can be a high-leverage policy of health workforce planning, although very difficult to implement in the short term.
Tài liệu tham khảo
Tangcharoensathien V, Witthayapipopsakul W, Panichkriangkrai W, Patcharanarumol W, Mills A. Health systems development in Thailand: a solid platform for successful implementation of universal health coverage. Lancet. 2018;391:1205–23. https://doi.org/10.1016/S0140-6736(18)30198-3.
Wibulpolprasert S, Sirilak S, Ekachampaka P, Wattanamano N. Thailand Health Profile 2008–2010. Press TWVO of T, editor. Thail. Heal. Profile. Bangkok: Bureau of Policy and Strategy, Ministry of Public Health; 2011. http://www.moph.go.th/ops/health_50.
Office of the National Economic and Social Development Board. The Twelfth National Economic and Social Development Plan (2017–2021). Bangkok, Thailand; 2017. https://www.nesdc.go.th/nesdb_en/ewt_w3c/main.php?filename=develop_issue.
Campbell J, Buchan J, Cometto G, David B, Dussault G, Fogstad H, et al. Human resources for health and universal health coverage: fostering equity and effective coverage. Bull World Health Organ. Instituto de Cooperación Social Integrare, Calle Balmes 30, 3°-1, 08007 Barcelona, Spain. 2013;91:853–63. http://www.who.int/entity/bulletin/volumes/91/11/13-118729.pdf.
World Health Organization. Everybody business—strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva: The WHO Document Production Services, World Health Organization; 2007.
Health Insurance System Research Office. Thailand’s Universal Coverage Scheme achievements and challenges: an independent assessment of the first 10 years (2001–2010) synthesis report. Nonthaburi: Health Insurance System Research Office; 2012.
Valdmanis V, Kumanarayake L, Lertiendumrong J. Capacity in Thai public hospitals and the production of care for poor and nonpoor patients. Health Serv Res. 2004;39:2117–34.
Vennix JAM, Andersen DF, Richardson GP, Rohrbaugh J. Model-building for group decision support: issues and alternatives in knowledge elicitation. Model Learn. 1992;59:28–41.
Forrester JW. Lessons from system dynamics modeling. Syst Dyn Rev. 1987;3:136–49. https://doi.org/10.1002/sdr.4260030205.
Forrester JWF. Principles of systems. 2nd ed. Waltham: Pegasus Communications; 1968.
Marshall DA, Burgos-Liz L, IJzerman MJ, Osgood ND, Padula WV, Higashi MK, et al. Applying dynamic simulation modeling methods in health care delivery research—the SIMULATE Checklist_Report of the ISPOR Simulation Modeling Emerging Good Practices Task Force. Value Health. 2015;18:5–16. https://doi.org/10.1016/j.jval.2014.12.001.
Chang AY, Ogbuoji O, Atun R, Verguet S. Dynamic modeling approaches to characterize the functioning of health systems: a systematic review of the literature. Soc Sci Med. 2017;194:160–7.
Liu S, Xue H, Li Y, Xu J, Wang Y. Investigating the diffusion of agent-based modelling and system dynamics modelling in population health and healthcare research. Syst Res Behav Sci. 2017;35:203–15.
Maani KE, Cavana RY. Systems thinking and modelling: understanding change and complexity. Auckland: Prentice Hall; 2007.
Andersen DF, Richardson GP. Scripts for group model building. Syst Dyn Rev. 1997;13:107–29. https://doi.org/10.1002/%28SICI%291099-1727%28199722%2913%3A2%3C107%3A%3AAID-SDR120%3E3.3.CO%3B2-Z.
Hovmand PS, Rouwette EAJA, Andersen DF, Richardson. GP. Scriptapedia. 2015. https://en.wikibooks.org/wiki/Scriptapedia.
World Health Organization. Health systems strengthening glossary. https://www.who.int/healthsystems/hss_glossary/en/index5.html.
Sterman JD. Business dynamics: systems thinking and modeling for a complex world. Boston: McGraw-Hill Companies, Inc.; 2000.
Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care. 2013. https://doi.org/10.5334/ijic.886/.
Toro N. Who global strategy on integrated people-centred health services (IPCHS)/Estrategia mundial en servicios de salud integrada centrado en las personas (IPCHS). Int J Integr Care. 2015. https://doi.org/10.5334/ijic.2413/.
Kim JY, Farmer P, Porter ME. Redefining global health-care delivery. Lancet. 2013;382:1060–9.
Porter ME. A strategy for health care reform—toward a value-based system. N Engl J Med. 2009;361:109–12. https://doi.org/10.1056/NEJMp0904131.
Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288:2469–75.
Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. J Am Med Assoc. 2002;288:1775–9.
Martineau T, Buchan J. Human resources and the success of health sector reform. Hum Resour Heal Dev J. 2000;4(3):174–83.
Bell D, McNaney N, Jones M. Improving health care through redesign. Br Med J. 2006. https://doi.org/10.1136/bmj.332.7553.1286.
Lucas H. Information and communications technology for future health systems in developing countries. Soc Sci Med. 2008;66(10):2122–32. https://doi.org/10.1016/j.socscimed.2008.01.033.
Berg M, Aarts J, Van der Lei J. ICT in Health Care: Sociotechnical Approaches. Methods Inf Med. 2003;42(4):297–301.
Kauffman KS, Myers DH. The changing role of village health volunteers in northeast Thailand: an ethnographic field study. Int J Nurs Stud Engl. 1997;34(4):249–55. https://doi.org/10.1016/s0020-7489(97)00012-6.
Milstein B, Homer J, Hirsch G. Analyzing national health reform strategies with a dynamic simulation model. Am J Public Health. 2010;100:811–9. https://doi.org/10.2105/AJPH.2009.174490.
Chiangchaisakulthai K, Tisayathikom K, Wongsilp U, Suppradit W, Samphak N. Report on cost analysis of primary care cluster (PCC). Nonthaburi, Thailand: The Human Resources for Health Research and Development Office (HRDO), The International Health Policy Development Agency (IHPP), Ministry of Public Health; 2018. (in Thai).
Pongpattrachai D, Sakulpanich T, Thamawanna P, Wongsilpa U. Report on cost of health services in medical Schools: a study to compare the cost of treatments of Teaching and Non-teaching Hospitals by diagnosis-related group (DRG). Nonthaburi, Thailand: Health Insurance System Research Office (HISRO); 2012. (in Thai).
Chiangchaisakulthai K, Sirikanokwilai N, Ruangratanatai W, Phosuwan P. Report on wages for public health personnel working in hospitals under the Office of Permanent Secretary, Ministry of Public Health. Nonthaburi, Thailand: The Human Resources for Health Research and Development Office (HRDO), The International Health Policy Development Agency (IHPP), Ministry of Public Health; 2017. (in Thai).