Discussion in potential implications of hospital autonomy on human resources management : a Thai case study

Abstract

Management of human resources in health is a major challenge to health systems development in Thailand. This includes planning for, production, deployment and utilization of health personnel. Although a number of measures have been instituted to meet this challenge, considerable gaps still remain. Recently, hospital autonomy was introduced with a major emphasis to improve efficiency in the delivery of health services by the public sector. The term autonomy carries a number of connotations such as good governance, contractual relationships between public hospitals and the government, market exposure. It also means different things in different contexts. Different conclusions with regard to improving system efficiency have been derived from the experiences of several countries adopting hospital autonomy. Yet, there are a number of reports devoted to discussing the implications of hospital autonomy on the management of human resources in health. Using Thailand as a case study, this paper aims to explore the potential implications of integrated health system intervention. Within the Thai context, it is argued in this paper that autonomy of a network of public providers, rather than autonomy of individual hospitals, should be encouraged if management of health manpower is to be optimized. Other issues related to autonomy are also discussed in varying detail.