Department of Global Health and Development, Communicable Disease Policy Research Group, London School Hygiene and Tropical Medicine, London WC1E 7HT, UK.
Department of Community Medicine, Mahidol University, Bangkok, Thailand.
Health Policy Plan. 2020 Nov 20;35(9):1159-1167. doi: 10.1093/heapol/czaa063.
Thailand has successfully implemented Universal Health Coverage (UHC) and embedded the 2030 Agenda for Sustainable Development into its Thailand 4.0 policy. Breast cancer is a growing challenge in Thailand, as it is globally. It serves as a perfect medium through which to interrogate UHC and demonstrate areas of the health system which require further strengthening if UHC is to be sustainable in the longer term. We conducted a situation analysis and used a Systemic Rapid Assessment (SYSRA) framework to examine the challenges posed to UHC through the lens of breast cancer. We identified a number of challenges facing UHC including (1) continued political commitment; (2) the need for coordinated scale-up of strategic investments involving increased financing and fine-tuning of the allocation of resources according to health needs; (3) reducing inequities between health insurance schemes; (4) investing in innovation of technologies, and more critically, in technology transfer and capacity building; (5) increasing capacity, quality and confidence in the whole primary healthcare team but especially family medicine doctors. This would subsequently increase both efficiency and effectiveness of the patient pathway, as well as allow patients wherever possible to be treated close to their homes, work and family; (6) developing and connecting information systems to facilitate understanding of what is working, where needs are and track trends to monitor improvements in patient care. Our findings add to an existing body of evidence which suggest, in light of changing disease burden and increasing costs of care, a need for broader health system reforms to create a more enabling platform for integrated healthcare as opposed to addressing individual challenging elements one vertical system at a time. As low- and middle-income countries look to realize the 2015 Sustainable Development Goals and sustainable UHC this analysis may provide input for policy discussion at national, regional and community levels and have applicability beyond breast cancer services alone and beyond Thailand.
泰国成功实施了全民健康覆盖（UHC），并将 2030 年可持续发展议程纳入其泰国 4.0 政策。乳腺癌在泰国乃至全球都是一个日益严峻的挑战。它是一个很好的切入点，可以通过它来探讨全民健康覆盖，并展示如果要使全民健康覆盖在长期内可持续，医疗体系中需要进一步加强的领域。我们进行了情况分析，并使用系统性快速评估（SYSRA）框架，从乳腺癌的角度审视全民健康覆盖所面临的挑战。我们确定了全民健康覆盖所面临的一些挑战，包括：（1）持续的政治承诺；（2）根据卫生需求，协调增加战略投资的规模，包括增加资金和调整资源分配；（3）减少医疗保险计划之间的不平等；（4）投资于技术创新，更关键的是，投资于技术转让和能力建设；（5）提高整个初级保健团队的能力、质量和信心，尤其是家庭医生；（6）开发和连接信息系统，以促进了解哪些方面有效，需求在哪里，并跟踪趋势，监测患者护理的改善。我们的发现增加了现有证据的一部分，这些证据表明，鉴于疾病负担的变化和医疗成本的增加，需要进行更广泛的卫生系统改革，为整合医疗创造一个更有利的平台，而不是一次一个垂直系统地解决个别具有挑战性的要素。随着中低收入国家努力实现 2015 年可持续发展目标和可持续的全民健康覆盖，这一分析可能为国家、地区和社区各级的政策讨论提供投入，并不仅限于乳腺癌服务，也不限于泰国具有适用性。
