Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand.
Faculty of Business Administration, Stamford International University, Bangkok, Thailand.
Hum Resour Health. 2021 Mar 10;19(1):31. doi: 10.1186/s12960-021-00572-5.
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. of health workforce planning, although very difficult to implement in the short term.
系统动力学（SD）建模可以为泰国全民健康覆盖政策决策提供信息。我们报告了这种思维方法在泰国未来 20 年（2018-2037 年）战略卫生人力规划中的应用。
2017 年至 2018 年期间，我们组织了一系列涉及泰国卫生系统多部门的 110 名参与者的小组建模会议。我们促成了政策制定者、管理者、从业者和其他利益攸关方共同创建一个因果循环图（CLD），以共同理解泰国卫生人力需求和供应不匹配的原因。还共同创建了一个存量和流量图（SFD），以通过模拟建模测试政策选择的后果。
模拟建模发现，医院利用创造了一个不断增加医院护理需求和医疗保健提供者持续短缺的恶性循环。此外，医院护理的设计无法有效应对人口老龄化和普遍存在的慢性疾病的未来需求。因此，将重点转移到能够提供初级保健、中级保健、长期护理、姑息治疗和临终关怀的专业人员可以更有效。
我们的 SD 建模证实，将护理模式转变为应对不断变化的健康需求可以成为卫生人力规划的一项高杠杆政策，尽管在短期内实施非常困难。
