Proposal to break the shutdown ‘Aging society – fewer children being born’ Change financial methods – reduce unnecessary C-sections |

An aging society and changes in population structure Directly related to the direction of national development. Especially in Thailand which is in crisis. ‘Few children being born’ which will cause a lack of manpower to drive the economy.

End of the year 2023 Office of the National Economic and Social Development Council Preview a picture of the size of the problem. If we count back about 20 years and continue to the present day, we find that the number of ‘children and workers’ in Thailand tends to decrease continuously. In contrast, the proportion of ‘older people’ will increase, and in 2021 it will be the first time that the death rate will exceed the birth rate.

NESDB points out the issue that The lack of workers leads to fiscal challenges This is because the government will be able to collect less taxes in the future. It is one of the solutions “A good foundation must be built early in life.” which affects the development of human resources that can start from ‘birth’

The decision to choose ‘Giving the natural way’ This is the first gift of health that a mother can give to her child while the child is still in the womb. And it will be an important foundation that will help your child grow to their full potential throughout their lives.

different from ‘Unnecessary caesarean section’ which in medical terms It will have a negative impact on both the mother and the child in the short term and in the long term. But the situation in Thailand Instead, up to 40% of mothers decide to have a cesarean section.World Health Organization (WHO) The optimal cesarean section rate is set at just 15%.

For any reason But the decision to choose a ‘caesarean section’ can lead to risks and adverse health effects for the mother. That is, there may be short-term and long-term complications from surgery, such as blood loss, infection, and placental adhesions. Including reduced success in breastfed children For babies born via caesarean section Problems can occur, especially in the respiratory system. Including the impact on development and growth.

at the national level Greater decision to choose a caesarean section Share directly with the increased budget loss. Including the opportunity cost of operating room staff. and the use of operating rooms for emergency patients in the health system as well.

Completely opposite to the ‘Natural Birth’ where mothers recover quickly after giving birth Less blood loss and wound pain You can also feed your baby immediately. Includes children who receive healthy micro-organisms that help to increase initial Immunity through the ​​vacuum Makes good immunity Does not get sick easily and does not high cost

The important thing is that giving birth the natural way increases the mother’s chances of having children in the future. It goes through a cesarean section. This is considered good guidance and in line with the policy to encourage child rearing. Solve the government’s problem of low birth rates as well.

However From a study and study by the WHO, it was found that the rate of cesarean sections around the world is increasing, and this is true in Thailand.

Information from the Department of Health The Ministry of Public Health (MOPH) said that in 2023 the rate of caesarean section in government hospitals will be 30 – 50%, and data in the National Health Security System (Gold Card) indicated that 35 Thai women were receiving caesarean section services. , both of which are higher than the WHO ideal caesarean section rate of 15%.

In the past, Thailand has tried to prove measures in many areas. To reduce unnecessary caesarean sections But it has not yet come to fruition.

latest Researchers from the Health Technology Assessment and Policy Project (HITAP) who studied “Proposal to change the cash payment in the case of hospital birth to reduce the rate of unnecessary cesarean section and encourage childbirth in Thailand. “ Recommend solutions to problems with academic information. along with supporting policies to encourage child rearing in Thailand

Regarding the meaning of the results of the study, it is said that The factors that do not encourage hospitals to solve the problem of unnecessary caesarean sections are costs and reimbursement rates that are almost three times higher.

That is, the average cost of a cesarean section is 11.3 thousand baht per person per hour. Meanwhile, the average cost of vaginal birth is only 3,970 baht per person per hour. which when calculated If there is a change in the reimbursement rate for cesarean section and natural birth is ‘equal’ 7,000 baht per person per hour It will help encourage hospitals to solve the problem of unnecessary cesarean sections.

Because if the payment level is maintained at this price Hospitals that are able to reduce caesarean sections to ‘below’ 40% of all births will have a profit, that is, the difference in the budget that can be used to improve services and increase the number of staff in the delivery room. But if a hospital has a caesarean section rate of 40%, it gets a budget. ‘equal to the cost’ of providing the service

For example, if a hospital delivers 1,000 births per year with a caesarean section rate of 40%, the hospital will incur total costs. (vaginal birth + cesarean section) 6,902,000 baht, but it can be paid for 7 million baht, which means that the difference between the budget paid will only be 98,000 baht.

But if the hospital can reduce the cesarean section rate to only 20% of births. Total costs will be borne by the hospital. (Vaginal birth + cesarean section) is 5,436,000 baht That means the hospital will receive the difference between the budget paid up to 1,564,000 baht.

Therefore, changing the reimbursement rate should be one of several measures that help promote a positive environment for the practice of obstetricians who want to reduce unnecessary cesarean sections in Thailand. For the safety of mothers and babies And it can also help improve children in Thailand.

However, there may be exceptions in the case of women with high-risk pregnancies. And in the case of cesarean section for pregnant women transferred from other hospitals, reimbursement will be made at the same rate.

Policy recommendations from this research It will help the government to have the tools to create an effective ‘workforce’ to lead the country. It is a parallel solution along with encouraging child rearing. which is considered one of the focus areas of the government under the leadership of the Mr. Settha Thaweesin prime minister