Buddhist Model of Health Care Reform

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Buddhist Model of Health Care Reform

• Mettanando Bhikkhu
• B.Sc., M.D. (Chulalongkorn), B.A.,MA. (Oxford),
• Th.M. (Harvard), Ph.D. (Hamburg)
• Ethics Committee, Faculty of Medicine,
  Chulalongkorn University,
• www.mettanando.com

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Introduction

• Debates on health care reform
• Participation of public
• Libertarian system free market economy, private
  hospitals, blooming medical industry
• Egalitarian system health services for every
  citizen equally (socialist system)
• Most reform is about changing way of government
  financial support

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Short History of Public Health in Thailand

• Ancient Khmer Civilization arogayasalas
• Sukhothai herbal hill
• Ayutthaya Western doctors, missionaries,
  terminated in 17 Century, at the end of King
  Narai
• Bangkok reentry of missionary in Rama III Rama
  V Westernization of bureaucracy
• After WWII libertarian, health insurance
  companies
• After 1975 egalitarian right to health care,
  30-baht Universal Coverage, etc.

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Existing Health Care System in Thailand

• 30-baht Universal Coverage
• Social Security Scheme
• Civil Service Medical Benefit Scheme

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Adverse Effects of 30-baht UC

• Demanding huge governmental budget
• Exodus of doctors from government-run hospitals
  to private sector
• Double standards of medication and treatment
• When fully implemented catalyzing family
  breakdown due to more individualism in community

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Poll on Current Health Care

• Matichon, February 5, 2007 (2550 BE) A survey
  report was conducted by the Office of Heath
  Systems Research Institute and ABAC Poll on 13,
  497 people from September 1, 2006- October 31,
  2006. 34 felt that the health care services
  provided by the government are inadequate. 72.9
  urge the government to solve the problem of over
  crowded tertiary care hospitals urgently. 59.3
  felt the government provided insufficient budget
  for public health 87.1 suggested the
  government to establish more health care centers.

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New Challenge for health care reform

• Aging population The success of family planning
  campaign of the Ministry of Public Health during
  the seventies throughout the end of the
  millennium has apparently decreased population
  growth rate from 1.3 in 1994 to 1.1 in 1996 and
  finally to 1.0 in 2000 where it remains stable
• aging population/total population is also
  increasing 0.3 in 1947 and to 0.8 in 1990, then
  rose to 12.2 in 1998. The projected proportion
  will increase to 19.6 in 2025

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Buddhas healing of a sick monk

• A monk suffering from diarrhea the Lord Buddha
  approached him and said to him Monk, what
  illness you are suffering from?
• The monk then replied Diarrhea, Sire.
• Dont you have any one to take care of you?
• No, Sire.
• What is the reason that other monks are not
  taking care of you?
• My Lord, I have not been good to other monks.
  Because of this, they do not take care of me.
• Then the Lord Buddha told the Venerable Ananda,
  Ananda, bring me some water, we will bathe this
  monk together.
• Those who want to care for me, should take care
  for the ill, Buddha.

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• If you are ill and you have a preceptor. Your
  preceptor should take care of your for the rest
  of your life or cured. If not a mentor should
  take care of his students for the rest of your
  life or cured. If not a fellow student should
  take care of his masters for the rest of their
  lives or cured. If not an inner student should
  take care of you for the rest of your life or
  cured. If not, students of the same preceptor
  should care of you for rest of your life or
  cured. If not, students of the same mentor
  should take care of you for rest of your life or
  cured. Without any preceptor, mentor, fellow
  student, inner student, apprentice of the same
  preceptor or mentor, the Community should take
  care of you, otherwise, this will befall every
  member of the Sangha for their misconduct.

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Analysis of the story

• Care for the ill is serving the Buddha
• One is serving the Buddha because he cares.
• Buddha Nature is in every human being
• Quality of life spiritual, educational and heath
• Sangha is a family of care and nurturing, failing
  to care for one another is misconduct of the
  Buddhist community, Sangha.

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Triangle of Quality of Life

Centers for the Quality of Life Run by local
volunteers
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Volunteer Recruitment

• 6 million Thai people registered with the
  Ministry of Culture as Volunteers
• Volunteering at the grass-roots
• Promoted by Office of Health Care Reform
• Prof. Prawes Wasi (Guru of National Health
  Reform, Rural Doctor Group)
• Volunteers are active in many areas of health
  care cancer, HIV/AIDS, etc.

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Monks in Health Care

• Buddhist monks who were versed in herbal medicine
  were responsible for health care of people since
  the 13th Century when Sukhothai was the capital
  of Siam.
• Throughout history of Thailand, monks have served
  as primary caregivers in local communities.
• Monks have been actively involved with spiritual,
  education and health as volunteers.
• Buddhist masters helped build many hospitals.

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Emerging Elements of Communitarian Health Care
System

• Decentralization of government administration
• Establishment of Office of Heath Care Reform
• Local leaderships with established community
  centers (best practices) 1 baht a day for
  membership, huge fundraising and payment for
  illness
• Local infrastructure village banking system
  (micro-economics)

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Problem in Buddhist Community

• Feudalistic administration needs reformation to
  allow local community to facilitate monastic
  administration
• Monastic education backward deprived of social
  and science its needs radical reform and
  modernization
• Popular culture of supernaturalism obstacle to
  modernization and against Buddhas teachings,
  especially amulet industry and astrology

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Suggestion

• Decentralization of monastic administration,
  transformation from feudalism to democratic
  system
• Modernization of Buddhist studies and training
• Promotion of socially-engaged Buddhism as
  mainstream Buddhist teaching
• Setting up of networks and social activism in
  urban and rural areas

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Conclusion

• Culture has been the forgotten resource for
  health care reform in Thailand.
• Culture of volunteer workers culture of care in
  community should be promoted
• Government supports knowledge, training, setting
  standards of activities and programs at the
  grass-roots and networking
• Aging population quality older people
• Better selection of medical students, nurses,
  etc.