Family Medicine and Community Orientation as a New Approach to Quality Primary and Person-centered Care in Thailand

Thailand’s health system, dating back to the 1880s, was traditionally anchored in hospital medicine. Thus, when the family medicine concept was introduced in the 1980s, it was immediately perceived as relating to a hospital-based doctor without a specific specialization. Workforce is a crucial issue for the reform. Overall shortage of human resources is not the only issue. In each facility there should be staff fit to function. The question of human resources can indeed  be tackled only when there is an agreement on what is expected from first line services that are close to the population. When the push for universal health coverage gained political momentum starting in Ayutthaya province, in the 1990s, primary care reform  became necessary and urgent . It was within this context that person-centered care, family medicine, and community-based care finally made headway in Thailand’s hospital-centred medical culture.  A strategy which proved instrumental in facilitating the reforms was that of ‘demonstration’ and ‘diffusion’. The idea behind the ‘demonstration health centers’ was to develop and demonstrate the family practice concept in a few selected areas in order to stimulate interest and demand for primary health care towards person- and people-centered care [1,2].  When the universal coverage policy was adopted some years later, family practice as a cornerstone for health sector development had already proven its worth and was therefore taken up as a tested model of care.