Is motivation enough? Responsiveness, patient-centredness, medicalization and cost in family practice and conventional care settings in Thailand

Analysis of the characteristics of 148 taped consultations with simulated patients.The family practices performed better than public hospital OPDs with regard to responsiveness, patient-centredness and cost of technical investigations (M-W U: p < 0.001). Prescribing patterns were similar, but family practices prescribed fewer drugs and were less costly than private clinics and hospitals (M-W U: p < 0.001). The degree of patient-centredness was not significantly different. Private clinics and private hospitals scored better for responsiveness.In Thailand self-styled family practices, even without specific training, provide a service that is more responsive and patient-centred than conventional care, with less overmedicalization and at a lower cost. Changes in prescription practices may require deeper changes in the medical culture.Family practice is a new concept in Thailand. The (modern) Thai health care system is essentially based upon biomedical and hospital-centred care and has been so since its introduction, at the end of the nineteenth century. Both supply and demand are dominated by a reliance on technology and specialization: health care is essentially a commodity [1,2].Over the last 10 years there have been attempts to develop family practice in Thailand. This was largely a reaction against the lack of emphasis on the human dimension of health care. However, family practice is also supposed to address a number of other issues: to improve responsiveness, encourage patient-centred consultation, decrease unnecessary prescriptions, control costs and improve patient satisfaction. Attempts to develop the discipline of family practice in Thailand have largely been an initiative of public sector doctors, also because these saw it as a way to attract patients, who tend to prefer going to specialists in the private sector.One cannot yet speak of a fully developed professional identity for family practitioners. The College of Family Practitioners was created only in 19