Transcript Buddhist Model - Center for Ethics of Science and Technology

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
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
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.
Existing Health Care System in Thailand
• 30-baht Universal Coverage
• Social Security Scheme
• Civil Service Medical Benefit Scheme
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
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.
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
Buddha’s 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”.
•
“Don’t 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.
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.
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.
Triangle of Quality of Life
•
Spirituality
Quality of Life
Education
Health Care
Centers for the Quality of Life: Run by local volunteers
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.
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.
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 (microeconomics)
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 Buddha’s teachings,
especially amulet industry and astrology
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
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 grassroots and networking;
• Aging population: quality older people
• Better selection of medical students, nurses, etc.