IN PURSUIT OF EXCELLENCE: A COMPARISON BETWEEN THE …

IN PURSUIT OF EXCELLENCE: A COMPARISON BETWEEN THE UNITED STATES AND THAI HEALTH SYSTEMS

AND ACCESS TO CARE

by Alexandra Victoria Dulin B.S., Ohio State University, 2014

Submitted to the Graduate Faculty of Department of Health Policy and Management Graduate School of Public Health in partial fulfillment

of the requirements for the degree of Master of Public Health

University of Pittsburgh 2016

UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

This essay is submitted by

Alexandra Victoria Dulin on

April 20, 2016 and approved by

Essay Advisor:

Wesley M Rohrer, III, MBA, PhD

______________________________________

Assistant Professor

Assistant Professor, Vice Chair of Education and Director of MHA Program

Behavioral and Community Health Sciences, Health Policy and Management

Graduate School of Public Health

University of Pittsburgh

Essay Reader:

Joanne Russell, MPPM

______________________________________

Assistant Professor

Assistant Dean

Behavioral and Community Health Sciences, Global Health Programs

Graduate School of Public Health

University of Pittsburgh

Essay Reader: Beaufort B Longest, MHA, PhD Professor Health Policy and Management Graduate School of Public Health University of Pittsburgh

______________________________________ ii

Copyright ? by Alexandra Victoria Dulin 2016

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Wesley M Rohrer, III, MBA, PhD IN PURSUIT OF EXCELLENCE: A COMPARISON BETWEEN THE UNITED STATES AND THAI HEALTH SYSTEMS AND ACCESS TO CARE

Alexandra Victoria Dulin, MPH University of Pittsburgh, 2016

ABSTRACT

Globally, the notion of health as a human right has a variety of interpretations. The interpretation of this ideal leads to how healthcare systems are organized, specifically in terms of an individual's true access to healthcare services. In this comparative analysis of healthcare systems in the Kingdom of Thailand and the United States of America, healthcare access is evaluated using the Lovett-Scott and Prather model, in which systems are broken into eight categories: historical reference; structure; finance; interventional services; preventative services; resources; major health issues; and health disparities. When viewed superficially, the nations' healthcare systems appear to be vastly different; however, an exhaustive comparison identifies several similarities as well as areas for further development. Additionally, this study emphasizes the need for health promotion, preventative services and the adoption of universal healthcare coverage.

In an ever expanding world, comparing global healthcare delivery strategies can lead to improved systems and increased access to healthcare services. This comparison has public health relevance as healthcare reform that results in increased access to preventative and interventional services can produce healthier individuals and communities. Nations with healthier populations are able to not only divert national spending on healthcare towards preventative services, thus decreasing costs, but also improve the economy by investing in citizens who contribute to the workforce.

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TABLE OF CONTENTS

PREFACE.................................................................................................................................... IX

LIST OF ACRONYMS ............................................................................................................... X

1.0

INTRODUCTION........................................................................................................ 1

1.1

COMPARING GLOBAL HEALTHCARE SYSTEMS................................... 3

2.0

THE HEALTHCARE SYSTEM IN THE KINGDOM OF THAILAND ............... 6

2.1

OVERVIEW OF THE KINGDOM OF THAILAND ...................................... 6

2.2

HISTORICAL...................................................................................................... 7

2.3

STRUCTURE....................................................................................................... 8

2.4

FINANCE ........................................................................................................... 12

2.5

INTERVENTIONAL ........................................................................................ 15

2.6

PREVENTATIVE.............................................................................................. 16

2.7

RESOURCES ..................................................................................................... 17

2.8

MAJOR HEALTH ISSUES.............................................................................. 18

2.9

HEALTH DISPARITIES.................................................................................. 20

2.10 FUTURE CONCERNS ..................................................................................... 21

3.0

THE HEALTHCARE SYSTEM IN THE UNITED STATES OF AMERICA ... 22

3.1

OVERVIEW OF THE UNITED STATES OF AMERICA........................... 22

3.2

HISTORICAL.................................................................................................... 23

3.2.1 The Patient Protection and Affordable Care Act .................................... 25

3.3

STRUCTURE..................................................................................................... 26

3.4

FINANCE ........................................................................................................... 28

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3.5

INTERVENTIONAL ........................................................................................ 30

3.6

PREVENTATIVE.............................................................................................. 31

3.7

RESOURCES ..................................................................................................... 32

3.8

MAJOR HEALTH ISSUES.............................................................................. 32

3.9

HEALTH DISPARITIES.................................................................................. 33

3.10 FUTURE CONCERNS ..................................................................................... 34

4.0

CONCLUSION........................................................................................................... 36

5.0

RECOMMENDATIONS........................................................................................... 40

6.0

PUBLIC HEALTH SIGNIFICANCE ...................................................................... 43

APPENDIX A: WORLD HEALTH ORGANIZATION'S CONSTITUTION PREAMBLE

....................................................................................................................................................... 44

APPENDIX B: THE UNIVERSAL DECLARATION OF HUMAN RIGHTS PREAMBLE,

ARTICLE 25 SECTION 1 ......................................................................................................... 45

BIBLIOGRAPHY ....................................................................................................................... 46

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LIST OF TABLES Table 1. Health Insurance System in Thailand ............................................................................. 13 Table 2. Leading Causes of Years of Life Lost to Premature Death in the Thailand, 2013 ......... 19 Table 3. Leading Causes of Years of Life Lost to Premature Death in the United States, 2013.. 33 Table 4. Strengths and Weaknesses Comparison, United States and Thailand ............................ 40

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LIST OF FIGURES Figure 1. Levels of health service delivery system in Thailand ..................................................... 9

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