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Devolution of health centers and hospital autonomy in Thailand : a rapid assessment (English)

This rapid assessment was conducted for the Thailand Ministry of Public Health with the support of the World Bank in partnership with the Thailand International Health Policy Program and the Thailand Health Systems Research Institute. This work was done under the World Bank's Country Development Partnership Agreement with the Government of Thailand. Thailand's health system has some features that lead to complexity and local variation in the scope of health responsibilities of Health care (HCs) and the accountabilities and incentives of HCs before and after devolution. HC staff and Tambon Administrative Organization (TAO) leaders in three of the devolved health centers (Naphu, Salabangpoo, and Pakpoon) have positive perceptions of improvement in management flexibility, in the sense that future decision making is expected to be faster and there should be greater scope for initiative. Three devolved health centers (Naphu, Salabangpoo, and Pakpoon) could point to a number ways in which service delivery had already improved and new services had been provided in response to the needs and preferences of the community. These include a stronger client service orientation, increased curative care services, and increase in promotion and prevention (P&P).


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    Hawkins, Loraine Srisasalux, Jaruayporn Osornprasop, Sutayut

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    Other Health Study

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    East Asia and Pacific,

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    Devolution of health centers and hospital autonomy in Thailand : a rapid assessment

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    health promotion and disease prevention;primary health care;Procurement and Logistics Service;decentralization of service delivery;provincial administration;Health Service;primary care;human resource policy;human resource policies;Public Health Emergency;local government health;economies of scale;curative care services;Health Service Delivery;local government sector;source of revenue;risk of cost;shared tax revenue;prospects for promotion;loss of job;benefits and allowance;level of support;curative health care;public service delivery;soft budget constraint;public health system;cost of salaries;local government staff;public health service;public health care;fund for health;health service provision;public health expenditure;source of financing;local government service;allocation of capital;national policy objective;line of accountability;central government budget;long term risk;pay for performance;health service use;public health activity;curative outpatient care;health promotion activity;form of decentralization;public health matter;chain of authority;local health plan;allocation of resource;primary care services;transfer of responsibility;health care capacity;performance bonus scheme;health promotion activities;health financing scheme;types of service;regulation and supervision;civil service pension;community health status;social health insurance;rapid assessment;hospital autonomy;Capital Investments;regulatory power;budget allocation;fiscal transfer;devolution process;capital expenditure;community participation;civil works;accountability relationship;health facility;multiple sources;catchment area;financial control;purchase mechanism;fiscal consolidation;career service;informal cooperation;staff support;transitional problem;field visits;mitigation measure;job mobility;stated objective;career path;funds flow;general revenues;pension right;financial decision;organizational change;personnel management;patient choice;national rules;supplementary resource;increased spending;creating incentives;health good;fiscal pressure;current expenditure;purchaser-provider split;donor support;national institute;physical accessibility;hospital service;career opportunity;health determinant;health check;intergovernmental transfer;future contract;grant allocation;resource mobilization;financial leverage;public expenditure;grass root;accountability arrangement;government expenditure;administrative supervision;job description;political intervention;hospital staff;regulatory change;project finance;smaller share;financing source;discretionary resource;financial crisis;drug budget;hard budget;financial supervision;formal sector;delivery service;managerial autonomy;personnel cost;staff productivity;market exposure;transfer risk;unbiased advice;detail level;regulatory issue;negative changes;local revenue;Technical Training;physical asset;professional work;salary payment;medical benefit;dual accountability;budget fund;direct supervision;administrative matter;outpatient department;radical reform;policy researchers;regional network;complementary resource;university hospital;risk pool;cost shifting;inventory management;health issue;complementary financing;formal basis;simulation exercise;mandatory transfer;logistics management;expiry date;Health Workers;modest increase;political influence;binding constraint;job classification;capacity constraint;contractual agreement;good governance;national budget;health care facilities;minimum share;independent supervision;financial policies;limited capacity;community mobilization;financial matter;institutional failure;future risks;pooled procurement;essential medicines;legal basis;local planning;treatment capacity;Disease Control;decentralized system;health decentralization;joint service;grade structure;output level;information provision;standards compliance;quality improvement;professional association;universal coverage;enforcement provision;organizational structure;strategic purchasing;working relationship;court action



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Hawkins, Loraine Srisasalux, Jaruayporn Osornprasop, Sutayut

Devolution of health centers and hospital autonomy in Thailand : a rapid assessment (English). Washington, D.C. : World Bank Group.