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Table 1 Timeline of policy development, affiliates, and its actions

From: Three decades of a lesson learned from Thailand: compulsory service for dentist workforce distribution

Year

Policy

Rationale

Affiliates

Actions

National Economic and Social Development Plan of Thailand

1966

Propose 2-year compulsory service restriction for physicians [3]

Tackle external brain drain

Medical school

Cabinet disapproved

1st Plan (1964–1966)

Focus on disease prevention and infirmary settlement across countries

1967

1. Establish 3-year compulsory service restriction for physicians [4]

Tackle external brain drain

MoPH

The government partially provided financial subsidies for 6-year undergraduate medical students. Indicate a fine of 200,000 baht if breaking the compulsory service restriction

2nd Plan (1967–1971) Focus on workforce production and distribution from educational systems to healthcare service, especially in rural areas with difficulty in health service accessibility

2. Assign mandated physicians as civil servants [5]

Motivate physician retention in public hospitals

OCSC

1968

1. Propose 3- to 5-year compulsory service program for physicians [6]

1. Tackle external brain drain

MoPH

1. Indicate a 3-year compulsory service program for physicians

2. Increase physician production in provincial area [9]

2. Increase physician production and distribution to rural areas

2. Distribute mandate physicians to rural hospitals

3. Develop central curriculum and examination for all medical institutions [10]

3. Control standard of the medical profession

3. Establish central examination to obtain a medical license

1973

Modify the official compulsory service restriction [11]

Tackle external brain drain

MoPH

Increase fine to 400,000 baht if breaking the compulsory service restriction

3rd Plan (1972–1976) Increase production and distribution of public transportation to reduce inequalities between urban and rural areas

1978, 1981

Establish the Project of Increased Rural Physician Production [12, 13]

Increase physician production and distribution to a rural area

NESDC MoPH, MoF

Starting point of the project of rural physician production

4th Plan (1977–1981) Increase workforce production, starting from the educational system, to meet the population's needs

1982

Establish 3-year compulsory service program for dentists [17]

Reduce the increasing oral diseases in a rural area

MoPH, OCSC

All junior dentists of the year 1989 have to enter compulsory service in public hospitals

5th Plan (1982–1986) Focus on health service systems, from to district levels to subdistricts and villages

Increase dentist production and distribution to a rural area

Tackle external brain drain of the dentist

1987

Approve financial welfare for physicians, dentists, and pharmacists [27]

Motivate health workforce retention in public hospitals

MoPH, MoF

Additional allowance for physicians according to levels of remote area

6th Plan (1987–1991) Focus on economic development

1988

Allocation of dentists to rural areas [44]

Increase dentist distribution to rural areas

MoPH, OCSC

Allocation of junior dentists to primary care hospitals, public universities, and other state enterprises

 

1992

1. Increase financial compensation for health workforces [45]

1. Motivate health workforce retention

MoPH, MoF, BB MoI

1. Additional allowance for physicians and dentists (Professional allowance, Shift allowance) and non-private practice allowance only for physicians

7th Plan (1992–1996) Focus on economic development

2. Establish Health Systems Research Institute

2. Knowledge management for health system development

MoPH

1993

Increase financial compensation for health workforces [46]

Motivate health workforce retention

MoPH, MoF

Additional allowance for dentists and pharmacologists (non-private practice allowance)

 

Solving financial injustice in 1992

1994

Establish the Collaborative Project to Increase Production of Rural Doctor (CPIRD) [19]

Increase physician production and distribution to rural areas

MoPH

Indicate the criteria for the CPIRD applicants

 

1997

Indicate compensation criteria for the health workforce [47]

Motivate health workforce retention

MoPH, MoF

Increase allowance for dentists in remote areas

8th Plan (1997–2001) Focus on economic development

1999

Fulfilled university staff positions

Adjust a positioning of university staffs due to an internal education restructure

MoPH, MoUA

Reposition of civil servants in universities to state enterprise employees

2001

Modified the compensation criteria according to the levels of remote area [28]

Motivate health workforce retention in remote areas

MoPH, MoF

MoPH regulation on the compensation payment 2001 (No.1)

2004

1. Modified the compensation criteria according to the level of remote areas

Motivate health workforce retention in remote areas

MoPH, MoF

1. MoPH regulation on the compensation 2001 (revised editions)

9th Plan (2002–2006) Focus on economic development

2. Provided incentive for risking area/South boundary provinces [48]

Motivate health workforce retention

MoF, OCSC

2. Benefits for the provincial risk areas under the martial law

2005

1. The One District One Doctor (ODOD) project [49]

1. Increase dentist distribution to rural areas

1. MoPH, OCSC

1. The ODOD project (12-year CS and 2 million THB fine

2. The Project of Increased Rural Dentist Production [20]

2. Increase dentist production and distribution to rural areas

2. MoPH, MoE

2. 10-year project from 2005 to 2014

2005

Modified the compensation criteria

Motivate health workforce retention

Adjust compensation payment rate and criteria according to each rural area

MoPH, MoF

MoPH regulations on the compensation payment 2005 (No.2); increase non-private practice allowance

2009

Modified the compensation criteria

Motivate health workforce retention

Adjust compensation payment rate and criteria according to each rural area

MoPH, MoF

MoPH regulations on the compensation payment 2009 (No.5): indicate compensation rate of shift allowance, off-site allowance, pay for performance

10th Plan (2007–2011) Focus on economic development

2012

CPIRD 2013–2017 [50]

Increase physician distribution to rural areas

MoE, SoC

CPIRD 2013–2017

11th Plan (2012–2016) Focus on economic development

2013

Modified the compensation criteria

Motivate health workforce retention

MoPH, MoF

MoPH regulations on the compensation payment 2013 (No.8): indicate non-private practice allowance

2013

Modified the compensation criteria

Motivate health workforce retention

MoPH, MoF

MoPH regulations on the compensation payment 2013 (No. 9): specify the criteria, methods, and conditions of compensations

2016

Modified the compensation criteria

Motivate health workforce retention

Adjust compensation payment rate and criteria according to each rural area

MoPH

MoPH regulations on the compensation payment (No. 11): specify the criteria, methods, and conditions of remote area allowance

  1. CS, compulsory service; OCSC, Office of Civil Service Commission; MoE, Ministry of Education; MoF, Ministry of Finance; MoPH, Ministry of Public Health; MoUA, Ministry of University Affairs; NESDC, Office of the National Economic and Social Development Council; SoC, the Secretariat of the Cabinet
  2. Health workforce includes physicians, dentists, and pharmacists
  3. Noted that italic indicates the policies directly related to medicine; bold indicates the policies directly related to dentistry; and bolditalics indicates the policies related to medicine, dentistry and pharmaceutical sciences.