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Current Psychiatry Reviews, 2017, 13, 246-251 REVIEW ARTICLE 246 Send Orders for Reprints to [email protected] Current Psychiatry Reviews, 2017, 13, 246-251 REVIEW ARTICLE ISSN: 1573-4005 eISSN: 1875-6441 Comparison of the Determinants of the Health Service System and the Health Status of the People in the Greater Mekong Subregion (GMS) BENTHAM SCIENCE Kanjanee Phanphairoja,b,* and Ritzmond Loaa,c aFaculty of Nursing, Thammasat University, Pathum Thani, Thailand; bChulalongkorn University, Bangkok, Thailand; cCollege of Nursing, University of Santo Tomas, Manila, Philippines Abstract: Background: Health is influenced by numerous factors that affect the health service sys- tem and health status of the people in every country. This article aims to compare the determinants of the health service system and the health status of the people in Thailand, the Lao PDR, Vietnam, and Cambodia; and to recommend policies that impact the population’s health and the country’s development. Methods: A comprehensive search of the literature from a variety of online search and academic databases, and synthesis of previous study was used in this paper. Data on country indica- tors were taken from published online databases of the Ministry of Public Health of Cambodia, Lao PDR, Thailand,and Vietnam; the World Health Organization, and the World Bank. A R T I C L E H I S T O R Y Results: In Thailand, the determinants of the health service system and health status of the people are medical information and technology because of the government initiatives to improve the quali- Received: December 20, 2016 ty of healthcare services through the use of modern technology. In Vietnam, the society and culture, Revised: January 23, 2017 Accepted: May 15, 2017 and the strengths and weaknesses of the hospital significantly affect the health status and health service system there because of the religious beliefs of the people. However, in Cambodia, the DOI: 10.2174/1573400513666170720145042 strengths and weaknesses of the hospital are the primary determinant of the health service system and health status of the people due to the condition of the hospitals, the availability of new medical devices, and the number of healthcare professionals. In the Lao PDR, trade and investment, and medical information and technology, significantly influence the health service system and health status of the people because of the government efforts to outsource capital expenditures and medical technology. Conclusion: The strengths and weaknesses of the hospital are the key determinants of the health service system and health status of the people in all GMS countries. Understanding the determinants of health is essential in order to develop policies and programs that impact the population's health and the country's development. Keywords: Health determinants, health service system, health status, medical information and technology, living and work environment, society and culture, trade and investment. 1. INTRODUCTION related to age, sex, and hereditary factors. Although these factors are considered important for health, they are viewed A population's health and health service system is in- to be immutable to health interventions. Outside the core are fluenced by many factors. The different conditions of the individual lifestyle factors, sometimes referred to as lifestyle individual, society, the economy, culture, and the environ- choices. These individual lifestyle factors consist of indivi- ment that influence health are referred to as the determinants dual health behaviors that put the individual at risk of deve- of health [1]. Dahlgren and Whitehead’s (1992) model used loping disease conditions such as misuse of alcohol and a multifactorial approach in describing the determinants of drugs, unprotected sex, smoking, unhealthy diet, and lack of health [2]. physical activity or exercise. Outward from the core is the The model consists of a core surrounded by a set of la- second layer known as social and community networks. This yers representing the determinants of health [2]. The core of refers to the relationship of the individual with his or her the model consists of the inherited attributes of the individual family, friends, and significant others in the local community [2]. *Address correspondence to this author at the Faculty of Nursing, Thamma- The third layer outside the core is the living and working sat University, 99 Klong Neung, Klong Luang, Pathum Thani 12120, conditions. These conditions refer to access and opportuni- Thailand; Tel: +66-029869213; E-mail: [email protected] ties to housing, healthcare services, employment, a safe wor- 1875-6441/17 $58.00+.00 © 2017 Bentham Science Publishers Current Psychiatry Reviews Comparison of the Determinants of the Health Service System and the Health Status Current Psychiatry Reviews, 2017, Vol. 13, No. 4 247 king environment, water and sanitation, education, and basic stakeholders in developing a comprehensive, integrated, and goods such as food, clothing, and fuel. The last layer outside unified health programs for the GMS people. the core is society, the economy, culture, and the environ- ment, which affect the health and well-being of the indivi- 2. PURPOSE dual such as income and wages, the availability of jobs, taxes, and the price of basic commodities, and transport ser- The purpose of this paper is (1) to compare the health vices [2]. These factors affect government priorities in terms determinants of the health service system and the health of spending and the development of social policies and pro- status of the people in the Greater Mekong Subregion, spe- grams for the health of the people. Dahlgren and Whitehead's cifically in Thailand, the Lao PDR, Vietnam, and Cambodia; framework indicated that within these factors are conditions and (2) to recommend policies that impact the population's that function within the individual and the society. The com- health and the country's development. posite interaction of these different factors affects the health service system and the health status of the people in each 3. METHODS country. The health service system refers to all of the activi- ties provided by the healthcare professionals or by the In this article, the determinants were based on the previ- healthcare organizations in order to improve health [3]. On ous study "An examination of determinants affecting the the other hand, health status refers to the range of symptoms, health service systems and health status of the people in the functions, and quality of life [4]. Thus, understanding the Greater Mekong Subregion” by Ruchiwit, Cowawintawee- determinants of the health service system and the health sta- wat, Pootong, Wareenil, Pawloski (2016). The data for the tus of the people is essential in order to develop policies and country indicators were taken from the published online da- programs that impact a population's health and a country's tabases of the Ministry of Public Health of Cambodia, Lao development [5]. PDR, Thailand, and Vietnam, the World Health Organization The World Health Organization (WHO) discussed the (http://www.who.int/gho/publications/world_healthstatistics/ essential role of the determinants of health in addressing the en/), and the World Bank (http://data.worldbank.org/). Moreover, health issues and problems that have an impact on the deve- a comprehensive search of the literature was conducted and lopment of each country [6]. In 1992, with assistance from used keywords related to health determinants. The search the Asian Development Bank (ADB), six countries bordering terms used were in English and articles were selected from the Mekong River engaged in the Greater Mekong Subregion 2000 to 2016. This literature review used a simple method as (GMS) Economic Cooperation Program. The six countries follows: 1) collecting data from a variety of online search were Cambodia, the People's Republic of China (specifically and academic databases such as PubMed, ScienceDirect, Yunnan Province and Guangxi Zhuang Autonomous Re- Wiley Online, SpringerLink, and Sage Journals; and 2) synthesis gion), the Lao People's Democratic Republic, Myanmar, of previous studies. Thailand, and Vietnam. The GMS Economic Cooperation Program aims to support the development efforts of its 4. DISCUSSION member countries by promoting sub-regional cooperation in different sectors. In order to achieve its vision of sustainable The determinants of the health service system and the development, the GMS Economic Cooperation Program health status of the people fall under several broad catego- adopted the Regional Investment Framework (RIF), which ries; namely, the strengths and weaknesses of the hospital, provides financial support to different projects in sectors of medical information and technology, the living and work the society, and for the economy, the environment, and environment, society and culture, and trade and investment health. Among the high-priority projects for the year 2014 to [8]. 2018 are the improvement of health and social services, la- bor and migration agreements, as well as educational oppor- 4.1. Strengths and Weaknesses of the Hospital tunities. It is expected that the GMS Economic Cooperation Program will promote cooperation among its member coun- The hospital is an integral part of the healthcare system. tries in the creation of policies and programs for sustainable It embodies the healthcare system because it dominates the development [7]. total healthcare expenditures of each country [9]. The hospi- tal utilizes manpower, machines, materials,
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