2016 Kyoto Global Conference for
Rising Public Health Researchers“Universal Health Coverageand Health Economics”
December 14-15, 2016

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Kyoto University
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Top Global University Project / Japan Gateway Kyoto University Top Global Program
Registration unnecessary / No participation fee / English only
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2016 Kyoto Global Conference for
Rising Public Health Researchers“Universal Health Coverageand Health Economics”
December 14-15, 2016

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Kyoto University
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Message from the Vice-President of
Kyoto University
Masao Kitano, PhD
Executive Vice-President for Education,
Information Infrastructure, and Evaluation
Kyoto University

The Top Global University Project was launched in 2014, based on
the Ministry of Education, Culture, Sports, Science and Technology
November 2013 national university reform plan. This project aims tostrengthen the international competitiveness of higher education in
Japan by prioritizing support, for a period of 10 years, of universities
carrying out a thorough internationalization and university reform,
including universities conducting top level research education, andthose encouraging the internationalization of universities in Japanthrough challenging, pioneering attempts.
Under this scheme, Kyoto University presented the “Japan Gateway:
Kyoto University Top Global Program (JGP)” . Through internationalization of undergraduate education, starting with the employment of
100 international faculty members at the Institute of Liberal Arts andSciences, and taking advantage of Kyoto University’ s strengths inbasic and applied research, with a number of world-class researchers including awardees of the Nobel Prize and Fields Medal, JGP
aims to establish agreements with world-class universities and implement international joint-education and joint-degree programs to produce a new generation of world-class researchers and further
strengthen the international competitiveness of research and graduate education.
Aiming to be between the top 10 universities in the world, Kyoto University is increasing the proportion of international co-authoredpapers and the promotion of joint research. In order to do so we arelooking to stimulate the exchange of students, faculty and research-ers by implementing, through the Super Global Courses, more international education programs, such as Joint/Double Degree Programs and international conferences and workshops.
In 2014, Kyoto University launched four project units: Mathematics,
Human Biosciences, Chemistry and Chemical Engineering, andSocial Sciences and Humanities, expanding programs in 2015 with
Global Environmental Studies, and Public Health.
The School of Public Health, which has been participating instrengthening the university’ s global expansion, introducing in 2014
double degree programs, has presented JGP with this project. Currently, they are actively working towards expanding joint and double
degree programs in order to internationalize the education of ouruniversity.
This international conference is part of such efforts, inviting risingpublic health researchers from 5 universities to exchange knowledge
in the very important topic of “Health Economics and Universal
Health Coverage” . I hope this project contributes not only to making
Kyoto University one of the centers of global network for publichealth research, but also to making a meaningful contribution to theimprovement of human health through the construction and development of a platform for long-term, concrete joint research cooperation.
I am confident this international conference, starting with Kyoto University’ s JGP, is another big step into internationalizing the researcheducation of each and every one of the universities present today.

2016 Kyoto Global Conference for Rising Public Health Researchers

01

Message from the Dean of Graduate Schoolof Medicine Kyoto University
Shinji Uemoto, MD, PhD

Takeo Nakayama, MD, PhD

Dean, Graduate School of Medicine
Professor, Department of Hepatobiliary
Pancreatic Surgery and Transplantation
Kyoto University
Kyoto University Graduate School of Medicine, symbolized by the fact that it has
produced a number of international prize winners, such as the Nobel Prize in Physiology or Medicine, and the Albert Lasker Award, is striving in its applications to advanced
medical care and disease prevention of findings in the fields such as fundamental
principle of life phenomena, and biomedical mechanisms and risk factors of diseases.
While pushing forward to expand such world top-level researches, Kyoto University
Graduate School of Medicine also endeavors to develop human resource with highethical standards and rich international mindset, having not only deep knowledge in a
specific area but broad transdisciplinary scope covering basic biology, clinical medicine, and social medicine.
In order to further develop such social mission, the Graduate School of Medicine
participates in the "Kyoto University Japan Gateway Initiative (JGP)" as the Human
Bioscience Subunit since 2014, while actively promoting efforts to the development ofinternational joint education and degree programs targeting world-class research
institutions such as McGill University, Imperial College London, Pasteur Institute,Bordeaux University, and others. Through these efforts, by encouraging activate
exchanges with overseas researchers and students and fostering an environment thatcan be friendly competitive with the world's top researchers, we aim to cultivate talent
with international competitiveness, who can contribute to the development of innovative pharmaceuticals, medical equipment and regenerative medicine products inJapan, and so aiming to further enhance the international reputation of the university.
The host of this conference, the Kyoto University School of Public Health, as the first
and to date the largest School of Public Health in Japan since its founding in 2000,
has been boasting remarkable achievements representing our country, such as up to1800 peer-reviewed papers and the acquisition of 16 billion yen in competitive funds.

02

2016 Kyoto Global Conference for Rising Public Health Researchers

Message from the Dean of Kyoto University
School of Public Health

Dean, Kyoto University School of Public HealthProfessor, Department of Health Informatics

They have been actively working on making their education and degree programs
international as well as interdisciplinary, with active participation in university-widecross-disciplinary education programs and introducing an international double degree
program. The Kyoto University School of Public Health is also actively engaged in thedevelopment of international joint education and degree programs in public healthfield since entering the JGP in 2015.
This international conference is part of such efforts, bringing together rising publichealth researchers from universities from all around the world. I also must congratulate
the School of Public Health for their success on the second KGC this year. The themeof this year is “Health Economics and Universal Health Coverage.” This is an extremely
important topic, as it is essential to pay the utmost attention to those most in need ofhealthcare, vulnerable and burdened by ill-health, limited from services or affected bypoverty and inequity. It is therefore important, as this conference allows us to gather
here today, to share and exchange experience on how to address the basic determinants and prerequisites for health in order to promote health for all while also learningfrom each other, encouraging knowledge transfers from developed and developing
countries, of the best models or what works for healthcare system of each specificsettings including the discussions on cost-effective treatment. The associatedprograms, such as poster session between students from KU and invited universities,
as well as the exchanges between researchers and students, will also be a very
important opportunity to foster future researchers with international competitiveness.
Finally, I am very much confident that this event will not only create a global network
for public health researchers with Kyoto University at its center, but also develop aplatform for long-term research cooperation and development of joint research
projects.

The 2016 Kyoto Global Conference for Rising Public HealthResearchers (KGC) invites elites in public/global health including
rising young researchers, and students from leading academic institutions around the world. Our project is part of the Japan Gateway
Kyoto University Top Global Program (JGP) sponsored by the Ministry of Education, Culture, Sports, Science and Technology (MEXT),
Japan. This program aims to enhance international competitivenessof Kyoto University by promoting international collaborative research
projects and globalization of educational programs.
Our annual KGC this year focuses on “Universal Health Coverageand Health Economics” , which is an important topic, globally challenging both developed and developing countries in their own
different context.
During the last several decades, Japan has experienced long-lasting economic recession, rapid socio-cultural changes, expandingsocial disparity, and the disproportionately growing aging population. These transformations inextricably affect Japanese society inmany aspects, especially the healthcare system, challenging theassurance of universal health coverage among the elderly and economically impoverished population amidst Japan’ s limited resources.
Though rapid economic growth and advancement in scientific andmedical technologies have been achieved worldwide during thepast decades, the topic still deserves great attention as the global
community has not yet been able to pursue the balance in ensuring

better healthcare services and the quality of life, and the escalating
medical costs associated with the innovations in medical technologies. Millions of people particularly in low- and middle- income
countries are still unable to access appropriate prevention andhealthcare services. This inequity further exacerbates their vulnerability to multitudes of adverse health outcomes, which are majorly
preventable. The global community, including low- and middle-income countries, is also currently facing the rapid population aging,
the rise of non-communicable diseases, along with the unfinishedagenda of maternal and child health and communicable diseases.
Healthcare system is thus one of the areas greatly challenged bythis health transition.
Health is a human right. We, Kyoto University School of Public
Health, along with other global actors, would like to contribute to theimprovement of the health and well-being for all, in believing that
this KGC will be a platform to promote the exchange of research,experience, challenges and hope for the future.
Along with the dialogue of these crucial global health concerns, I
would like all participants to enjoy their stay in Kyoto, a city whichfeatures both classic and innovative components of Japaneseculture and surely will be a place for you to enjoy and to be inspired.
I believe this conference will create lively discussions on these key
global issues among current and future leaders of public/global
health, as well as build new networks for innovative research, education and global leadership.

2016 Kyoto Global Conference for Rising Public Health Researchers

03

“Universal Health Coverage and Health Economics”
December 14 - 15, 20162016 Kyoto Global Conference for Rising Public Health Researchers

Schedule

Inamori Hall and Yamauchi Hall, Shirankaikan, Kyoto University

December 14 (Wednesday)
Opening Session – Welcome addresses
9 : 00 - 9 : 10
9 : 10 - 9 : 20
9 : 20 - 9 : 30

Vice President, Kyoto University
Masao Kitano

Dean, Kyoto University School of Public Health
Takeo Nakayama

9 : 30 - 10 : 15

Achieving Universal Health Coverage: The Contribution of Health Economics
Anne Mills: Deputy Director & Provost and Professor of Health Economics and Policy
London School of Hygiene & Tropical Medicine

10 : 15 -11:00

Achieving Universal Health Coverage in Light of Ageing Populations:
Health Economic and Political-economy Considerations
Alex Ross: Director, WHO Centre for Health Development, Kobe
- Break 15 minutes -Session 1 – Universal Health Coverage: Japan
Session chairs: Alex Ross (WHO Centre for Health Development) and Tosiya Sato (Kyoto University)

11 : 45 -12 : 15

Session 2 – Universal Health Coverage: Emerging Economies (1)Session chairs: Maznah Dahlui (University of Malaya) and Akio Koizumi (Kyoto University)
13 : 45 -14 : 15

Universal Health Coverage: Experience from Thailand
Sathirakorn Pongpanich: Chulalongkorn University

14 : 15 -14 : 45

Satisfaction with Universal Health Coverage Use Among Thaisin Bangkok Metropolitan Area, Thailand
Sukhonta Siri: Mahidol University

Dean, Graduate School of Medicine, Kyoto University
Shinji Uemoto

Keynote Speeches
Session chairs: Takeo Nakayama (Kyoto University) and Masahiro Kihara (Kyoto University)

11 : 15 -11: 45

By Kyoto University School of Public Health

Sustainable Development of Japanese Health Care System under the Universal
Health Coverage
Tetsuya Otsubo: Kyoto University

Session 3 – Poster Presentation
14 : 45 -16 : 00

Poster Presentation

Session 4 – Universal Health Coverage: Emerging Economies (2)Session chairs: Anne Mills (London School of Hygiene & Tropical Medicine) and Toshiaki Furukawa (Kyoto University)
16 : 00 -16 : 30

Universal Health Coverage in Malaysia
Maznah Dahlui: University of Malaya

16 : 30 -17: 00

Health Care Systems in Taiwan: Current Problems to Future Challenges
Yawen Cheng: National Taiwan University

17 : 00 -17: 30

The Impact of Community Based Health Insurance in Enhancing Better Accessibility
and Lowering the Chance of Having Financial Catastrophe Due to Health Service
Utilization: A Case Study of Savannakhet Province, Laos
Somdeth Bodhisane: Chulalongkorn University

18 : 00 〜

Dinner Reception at Restaurant "La Tour", Clock Tower, Kyoto University

Visualization and Reform of Health and Social Care Systems in a Super-Aging Society
Yuichi Imanaka: Kyoto University- Lunch break 1.5 hour -04

2016 Kyoto Global Conference for Rising Public Health Researchers

2016 Kyoto Global Conference for Rising Public Health Researchers

05

“Universal Health Coverage and Health Economics”
December 14 - 15, 20162016 Kyoto Global Conference for Rising Public Health Researchers

Schedule

Inamori Hall and Yamauchi Hall, Shirankaikan, Kyoto University

December 15 ( Thursday )By Kyoto University School of Public Health

Session 5 – Cost-effectiveness of Health Care (1)Session chairs: John Cairns (London School of Hygiene & Tropical Medicine) andChang-Chuan Chan (National Taiwan University)

Session 7 – Cost-effectiveness of Health Care (2)Session chairs: Sathirakorn Pongpanich (Chulalongkorn University) and Tetsuya Otsubo (Kyoto University)

9 : 30 -10: 00

Utilization of Reproductive Health Services: Time Trends & Equity
Jenny Cresswell: London School of Hygiene & Tropical Medicine

13 : 00 -13 : 30

Beyond Accuracy: Assessing and Projecting the Public Health Impacts of
New Diagnostics for Tuberculosis
Hsien-Ho Lin: National Taiwan University

10 : 00 -10:30

Financial Difficulty and Catastrophic Health Expenditure forColorectal Cancer Treatment
Tin Tin Su: University of Malaya

13 : 30 -14 : 00

Using Cost-effectiveness Evidence to Inform Health Care Decision Making
John Cairns: London School of Hygiene & Tropical Medicine

10 : 30 -11: 00

Treatment Cost of Genital Warts on Provider and Patient Perspectives vsGovernment Expenditure Analysis on Prevention Control and Treatmentof the Sexually Transmitted Disease (STDs) in Thailand
Sukhontha Kongsin: Mahidol University

Session 6 – Poster Presentation
11 : 00 -12:00

Closing
14 : 00 -15 : 00

Panel Discussion
Facilitated by John Cairns (London School of Hygiene & Tropical Medicine) andYuichi Imanaka (Kyoto University)

15 : 00 -16 : 00

Best Poster Presentation Award Ceremony and Closing
Moderated by Takeo Nakayama (Kyoto University)

Poster Presentation
Voting for “Best Poster Presentation” award closes at 13:00- Lunch Break 1 hour -062016 Kyoto Global Conference for Rising Public Health Researchers

2016 Kyoto Global Conference for Rising Public Health Researchers07

Achieving Universal Health Coverage:
The Contribution of Health Economics
Keynote SpeechAnne Mills

Achieving Universal Health Coverage in Light of Ageing Populations:
Health Economic and Political-economy Considerations
Keynote Speech

Deputy Director and Provost, London School of Hygiene & Tropical Medicine
Professor, Department of Global Health and Development
London School of Hygiene & Tropical Medicine / UK

Alex Ross

Anne has researched and published widely in the fields of health economics and health systems in low and middle income
countries. She continues to be involved in research on universal coverage developments in Tanzania, South Africa andThailand, and on strengthening services for mothers and children. She has had continuing involvement in supporting capacity
development in health economics in low and middle income country universities and research institutes. She has advised
multilateral, bilateral and government agencies on numerous occasions; was a member of WHO’ s Commission on
Macroeconomics and Health; and co-chaired one of the two Working Groups for the 2009 High Level Taskforce on Innovative
International Finance for Health Systems co-chaired by Gordon Brown.
In 2006 she was awarded aCBEfor services to medicine and elected Foreign Associate of the US Institute of Medicine. In 2009
she was elected Fellow of the UK Academy of Medical Sciences and received the Prince Mahidol Award in the field of medicine.
She was President of the International Health Economics Association (iHEA) for 2012-13. In 2013 she was elected a Fellow of theRoyal Society and in 2015 she was made a Dame in the Queen’ s New Year’ s Honours, for services to international health.

ABSTRACT
Economics was termed the ‘dismal’ science by Thomas
Carlyle in the 19th century. However, in the 20th century it
has been harnessed in the interests of improving public
policy. This talk reviews how health economics hasdeveloped since the late 1960s, and especially draws out its
contribution to the design of universal health coveragearrangements. Areas of health economics covered include
economic evaluation, and the ways of financing andorganising a health system, including topics such as theimpact of paying for health care on households, the relative
merits of various ways of ensuring financial protection, therole of the private sector, and the value of contractual
relationships.

082016 Kyoto Global Conference for Rising Public Health Researchers

Director
World Health Organization Centre for Health Development(WHO Kobe Centre) / Japan

Dr. Alex Ross is the Director of the WHO Centre for Health Development in Kobe, Japan (WKC). As a WHO global centre, it focuses on research into health,social, and economic factors that contribute to health and development. WKC is leading work on universal health coverage, innovation and ageing. One ongoing
initiative is encouraging more frugal technological and social innovations for ageing populations.
Dr. Ross is a public health policy expert trained at the University of California in Los Angeles (UCLA) with specializations in health systems. Prior to his joining theCentre, he served as Director for Partnerships and UN Reform at WHO Headquarters (Geneva), as well as in senior advisory posts to Assistant Director-Generals
for Communicable Diseases and for HIV/AIDS, TB and Malaria. Dr. Ross led development of WHO’ s partnerships policy, nurtured WHO’ s engagement with
global health initiatives, UN agencies, non-governmental organizations and the private sector. Dr. Ross was very involved in developing innovative healthfinancing approaches, such as the Solidarity Tobacco Contribution and financing component of the Pandemic Influence Preparedness Framework. Dr. Ross was
also very engaged in the creation of the Global Fund to Fight AIDS, TB and Malaria and UNITAID. Before joining WHO, Dr. Ross served in senior domestic andinternational health positions for the UK Department for International Development between 2001 and 2003 (health policy and systems), and in several U.S.
Government agencies between 1987 and 2001 (USAID, US Department of Health and Human Services, and US Congress as a professional staff).

ABSTRACT
Keynes wrote that ‘the ideas of economists....both when they
are right and when they are wrong, are more powerful than iscommonly understood’ . Providing helpful health policy
advice, and in a form that decision makers can act on, hasbeen one of the less dismal contributions of economics.

The SDG Target on Universal Health Coverage (UHC) presents major
opportunities for countries and communities to deliver, in an equitablemanner, a broad range of quality health services for all people andcommunities, without creating financial hardship. Health financing
and economics play a central role in ensuring the attainment of UHC
through use of many approaches, incentives, and financial protection
mechanisms.
The SDGs and UHC have also elevated the focus on understanding
and addressing health inequities, inclusive of their various
determinants. Country planning for UHC that is sustainable must
consider the impact of emerging demographic and epidemiologic
trends. Rapid, and unprecedented, population ageing will
fundamentally alter how countries design, implement, structure,
regulate and finance their health and social systems, assistive healthtechnologies, health workforce, as well as manage competingpressures on resource allocation. Japan provides many insights andlessons from its nearly six decades of experience that achieved UHC,
equity, and significant increases in healthy longevity. As a super aged

society, Japan faces many challenges in managing increasing costs
associated with health/social services, technologies, whilst ensuring
care and support for the 40% of the population that will be over 65 by
2050. Japan is by no means alone, with countries such as Korea,
Germany, Finland, China just behind—and where 90% of future rapid
ageing will take place in middle income countries. Planning for UHC
is compounded by the rapid speed of population ageing occurring in
the next 15-20 years for many countries. Decisions taken today on the
structure of systems, financing, and availability of services will haveenormous impact on all aspects of UHC and health systemstrengthening tomorrow and in the future.
This talk will discuss the key health economic and political-economy
issues that countries are and will be facing over the next 15-35 years.
It will draw from examples of Japan, Asian, European and middle
income countries, as well as from WHO, World Bank, OECD, AsianDevelopment Bank perspectives. Priority issues requiring greaterattention will be presented for further discussion.

2016 Kyoto Global Conference for Rising Public Health Researchers09

Sustainable Development of Japanese Health Care
System under the Universal Health Coverage
Tetsuya Otsubo

Visualization and Reform of Health and Social
Care Systems in a Super-Aging Society

Assistant Professor
Department of Healthcare Economics and Quality Management
School of Public Health, Graduate School of Medicine, Kyoto University / Japan

Yuichi Imanaka

Dr. Tetsuya Otsubo is an Assistant Professor at the Department of Healthcare Economics and Quality Management, School of Public Health, Graduate
School of Medicine, Kyoto University, Japan. He obtained a Masters of Engineering degree from Waseda University, Japan, and completed his Doctoral
degree in Public Health (Healthcare Economics and Quality Management) at Kyoto University. He then worked for one year as Assistant Professor by Special
Appointment before being appointed as an Assistant Professor in 2010. His primary research focus is the use of an applied systems approach in the field ofhealth economics and policy. Specifically, these interests include the economics of health care delivery systems, national health insurance, health careutilization, cost accounting and management, and health care financing. His research is broadly based on the manipulation of administrative databases,
such as claims data. Dr. Otsubo has supported local governments in the design of regional health care system from 2009. His current research interests
include investigating regional variations in spending, outcomes, and access of care. Research results are consistently provided in feedback to hospitals andlocal governments, and in- ‐ depth discussions with clinicians, hospital management staff, and policymakers supports a dynamic approach to research
themes; ensuring that research with real- ‐ world applications is conducted. He was on academic sabbatical at The Dartmouth Institute for Health Policy &Clinical Practice from January to June 2014. He studied at the Institute for Clinical Evaluative Sciences in Toronto from July until Dec 2014.

ABSTRACTThe main components of universal health coverage are thesimultaneous achievement of quality, essential health service
coverage and financial protection coverage and the extension
both to the whole population. Furthermore, the system needs
to be maintained to reflect social conditions in each period.
Japan is experiencing unprecedented population aging,which is changing the constitution of healthcare demand. In
addition, birth rates are decreasing, and severe population
decline is predicted. Therefore, within the context of limited
healthcare resources, the reengineering of a sustainable
healthcare system with a positive synergy between healthcare
quality and health economics is an urgent issue.

102016 Kyoto Global Conference for Rising Public Health Researchers

Professor
Department of Healthcare Economics and Quality Management
School of Public Health, Graduate School of Medicine, Kyoto University / Japan

Yuichi Imanaka, MD, PhD is Professor and Head of the Department of Healthcare Economics and Quality Management, School of Public Health, Graduate
School of Medicine, Kyoto University (http://med-econ.umin.ac.jp/int/) since 2000. He was trained in the University of Tokyo (M.D., DrMedSci), and the
University of Michigan (MPH, Ph.D). Clinically trained in internal medicine, with certification for pathological autopsy practice.
His main theme is to visualize and design the health social care system and its future, particularly in this super-aged and rapidly-aging society. He is
engaged in several national and wide-regional projects which methodologically include large-scale database analytics, system design and simulation,
multidimensional performance measurement and improvement of institutions and of regions.
He has been actively engaged in international collaboration and has accepted graduate students from Singapore, Korea, China, Thailand and the UnitedStates. He is an Executive Board Member (1997-2003, 2015-current) of the International Society for Quality in Health Care, and has been an Executive
Board Member of Japan Council for Quality Health Care (2000-current). He is also on the boards of national academic societies for Health Administration,
Public Health and Health Economics. He served as a member of OECD ageing-related diseases projects, International Hospital Federation & WHO study
group on hospital sector reform, and as a member of OECD & WHO Health Care Quality Improvement Network in the Asia Pacific Region.

ABSTRACTIn recent years in Japan, the market oriented improvement is
expected to reshape health care delivery through sharing
visions and temporal goals shaped by national and local
governments. In this political movement, knowledge andevidence become more important to support the autonomy ofstakeholders.
This session will introduce the Japanese healthcare systemand discuss the outlook of health services research in Japan.

Background and Aims: In the super aged and aging society with financial and resource
constraints, the Japanese health and social care systems need to be effectively reformed for theirsustainability and continuous improvement. On the other hand, the performance of regional
health and social care systems is dependent on multiple regional factors including
socioeconomic, demographic and resource variables. Visualization of regional performancevariation and clarification of the mechanisms of its performance is the key to manage
multifaceted, complicated and uncertain processes of reforming health and social care systems.
Our studies aim to visualize performance of health and social care systems at each region, and todevelop frameworks to link information creation to system re-designing process by large-scale
administrative database analytics and multi-stakeholder collaboration.
Methods: The databases used were administrative data of health care and social care (long-termcare) of the national and regional levels in Japan. In addition, a database integrating
socioeconomic, demographic and healthcare resource indicators of regions were constructed.
Quality indicators were measured at each regional level, including process quality indicators andrisk-adjusted outcome indicators. Their associations with social and resource indicators werealso examined at regional levels.
Results and Discussion: Region’ s healthcare quality indicators were often correlated withresource intensity and inversely with the rurality of the regions. This relationship was quantitatively

well illustrated in AMI care and ischemic stroke care in Japan. On the other hand, there are somecases when centralization and networking of professional resources were realized effectively.
On the other hand, region’ s social-care quality Indicators were not inversely correlated withrurality. It can be very high or very low in rural areas. Some new towns with growing population
did not show high social care quality. Some rural towns that have strong emphasis on community
policies and activities including landscape conservation and dementia supporter caravan showed
high social care performance. Health care quality indicators of regions are considered to berelated to regional economic/demographic indicators, with substantial modification due to theresource deployment such as centralization and networking. Social-care quality indicators do notseem to be related, but can be linked to community’ s organized activities.
Conclusions and Implications: Quality of health and social care systems can be measured atregional levels and are found to be substantially varied. The variations are considered to be
dependent at least on resources and their deployment. For effective and efficient regional
healthcare and social care systems, although these two systems were inter-connected andpartially overlapped, we should recognize that approach foci are considered different between
the two systems, and that stakeholder collaboration is required among providers, governments
and citizens based on the common understanding the visualized performance of regional
systems.

2016 Kyoto Global Conference for Rising Public Health Researchers

11Universal Health Coverage:
Experience from Thailand
Sathirakorn Pongpanich

Satisfaction with Universal Health Coverage Use Among
Thais in Bangkok Metropolitan Area, Thailand
Professor
College of Public Health Sciences
Chulalongkorn University / Thailand

Sukhontha Siri

Sathirakorn Pongpanich, Ph.D. is a Professor in Health Economics and Dean at the College of Public Health Sciences, Chulalongkorn
University and is also invited to be a visiting professor at Brown University, School of Public Health and has served there as thesis
external examiner since 2010. He has authored and edited 3 books, as well as numerous research articles. In addition, he conductedmany researches in Public Health for Thailand Ministry of Public Health, Thai Health Promotion Foundation, World Health Organization(WHO) and others. His areas of interest include Cost of Treatment of Diseases, National Health Account, Universal Health Coverage,
Tobacco Reduction Campaign, Negotiation and Public Health Administrations, Free Trade Agreement on Health and etc. He is, aswell, known as one of experts in negotiation who is participating in important national and international negotiation arenas and offering
negotiation training to health professionals in South and Southeast Asian regions. He is currently an editor of Journal of HealthResearch at College of Public Health Sciences, Chulalongkorn University. Professor in Health Economics. Post Doctoral Training(Health Policy and National Health Account), Harvard University. Ph.D.(Health Services and Health Economics), University ofCalifornia, Los Angeles (UCLA). MA (Health Economics), Johns Hopkins University. B. Econ, Chulalongkorn university

ABSTRACT
Before 2002, 30% of the entire Thai population of 63 million
people remained uninsured. With the advent of the Universal
Coverage Scheme (UCS) that combined a medical welfare
low income card scheme and a government-subsidized
voluntary health card scheme with a coverage extension to
the remaining uninsured, Thailand achieved the status ofuniversal health coverage (UHC) in 2002 in terms of
insurance entitlement, when the gross national income percapita was US$ 1,900.
Since then, Thailand has received widespread internationalrecognition as one of several middle-income countries thathave made enormous progress in building a UHC system
and in achieving “good health at low cost” . Although its per
capita GDP is low, Thailand has not only massively improved

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2016 Kyoto Global Conference for Rising Public Health Researchers

Assistant Professor
Department of Epidemiology, Faculty of Public Health
Mahidol University / Thailand

Dr. Sukhontha Siri is an Assistant Professor in the Department of Epidemiology. She obtained a Bachelor of Public
Health (second class honors) and completed a PhD in Tropical Medicine at Mahidol University, Thailand. She has since
been working at the Department of Epidemiology, Faculty of Public Health, Mahidol University. With nearly 10 years of
research experience, she has been conducting public health research in mental health and quality of life among Thais,access to health services and health seeking behavior. She has many publications in topics such as prevalence andassociation between activities and cognitive impairment among the elderly, factors related with cervical cancer
screening test among Thai Muslim women in Satun province and community participation of cross-border migrants forprimary health care in Thailand, health policy plan, and others.

ABSTRACT
health outcomes (e.g. infant mortality 9.8/1 000) but madegreat improvements in social security objectives (>99%
population coverage, high level of financial risk andimpoverishment protection). It has low out-of-pocket
payments and health-related catastrophic expenditure has
fallen from 2.7% to 0.49%, but there is some room for
improvement for urban poor populations.

This descriptive research was conducted to examine levelsof satisfaction towards universal health coverage (UC) use
among Thai residents in Bangkok. Data concerning healthinsurance and satisfaction with UC regarding perception ofcoverage, availability, accessibility, accommodation,affordability and acceptability were collected using
self-reporting questionnaires from 10,000 subjects withmulti-stage sampling.
The median age of subjects was 43 years (IQ2, IQ3:18, 56).
Approximately 62.5% of Bangkok residents had a healthinsurance scheme and about 13.7% didn’ t know their typesof health insurance. About the residents, 52.7% hold UC
and 15.2% hold social security scheme. About 75% of UC
holders used it during the past year and 71.5% reported they

were satisfied with it. UC customers were most satisfied with
UC information provided by health workers, accommodation
and acceptability and the least satisfied concerning
affordability and coverage. Factors associated withsatisfaction of UC use included sex, age, education, income
and physical and mental health status (p< 0.05).
Satisfaction with UC among Bangkok residents was high.
However, the Bangkok Metropolitan Administration shouldemphasize advocacy to increase understanding and expand
perceptions regarding UC affordability and coverage.
Keywords: satisfaction, universal health coverage, Thai
residents, Bangkok

2016 Kyoto Global Conference for Rising Public Health Researchers

13

Universal Health Coveragein Malaysia
Maznah Dahlui

Professor
Department of Social and Preventive Medicine, Faculty of Medicine
University of Malaya / Malaysia

Professor Dr Maznah Dahlui is a Public Health Medicine Specialist who had served for several years with the Ministry of Health,
Malaysia and was an Enterpreneur before becoming an academician in the University of Malaya. Her speciality is health economics,
with a major interest in the evaluation of health programs. She had conducted many economic evaluations of the country’ s policies andprograms, working with various ministries in Malaysia such as Ministry of Health, Ministry of Labor and Prime Minister’ s Department.
She has good linkages with international institutions such as the UNFPA, UNESCO, World Bank, WHO which have led to several
consultancy projects centered on the evaluation and monitoring of health programs.
Maznah’ s research interest extends to cancer screening, infectious diseases such as HIV and Hepatitis C, adolescents health andobesity prevention; applying the economic evaluation approaches. She has been actively engaging NGOs (such as Breast Cancer
Welfare Society and MAKNA) and the communities (the urban poor community and rural populations) for breast cancer screening andcombating chronic diseases such as hypertension and diabetes. Her international research experiences include working withcollaborators from Sanger Institute, University Cambridge, United Kingdom on the Salt Reduction Study, Kirby Institute, University of
New South Wales, Australia on Return of Investment of Harm Reduction Program, University of Usmanu Danfodia, Sokoto, Nigeria on
sexual reproductive health issues under the auspices of the Africa-Asia Development University Network (AADUN), and several others.
Maznah was appointed as the Regional Director of APACPH (Asia Pacific Academic Consortium for Public Health) in 2013 and used
this as an avenue for her to initiate research collaborations on community obesity prevention with several of the 87 APACPH member
institutions. With the backing of her university, in 2012 the APACPH Secretariat was successfully transferred to the University of Malaya
where she had been the Secretary until now. Her appointment as the Chair for the National Clearinghouse for Adolescent Health in
Malaysia is an acknowledgment of her close working relationship with the Ministry of Health.
Her outstanding contributions to public health in such a short span of time contributed significantly to her election as a Fellow of Public
Health Medicine Specialist Association, Malaysia and of the Faculty of Public Health, Royal College of Physicians in the UK, one of only
a handful of fellows from Malaysia. Maznah’ s leadership capabilities has been acknowledged by the university with her appointment as
the head of department of public health (2011 to 2016), and her recent promotion as the Deputy Dean of Faculty of Medicine.

ABSTRACT
Malaysia has a dual healthcare system with the public andprivate sectors contribute to almost the same proportions inachieving a fairly acceptable health status of a middle
income country. The current health financing for public
sectors relied heavily on taxation while healthcare services
are mainly provided by the government. Financing ofhealthcare has a progressive distribution and average
household out-of-pocket payments are relatively small,especially for poorer households. Overall, the population
enjoys high levels of financial risk protection and the use of
public healthcare services is equitably distributed. The poor

14

2016 Kyoto Global Conference for Rising Public Health Researchers

Health Care Systems in Taiwan:
Current Problems to Future Challenges

are spared a high burden of out-of-pocket payments due tothe extensive network of public health facilities which
provides a wide range of very cheap healthcare services tothose in need. Direct household out-of-pocket healthpayments are in fact almost exclusively for the purchase ofprivate care. The changing demographics and the poor
lifestyles of the people poses great challenges inmaintaining the health status should there be no innovationsin the health financing system. It is about time that toconsider social health insurance as another means offinancing healthcare in Malaysia.

Yawen Cheng

Professor
Institute of Health Policy and Management, College of Public Health,National Taiwan University / Taiwan

Dr. Cheng obtained her doctoral degree of epidemiology from the Harvard School of Public Health. She has been afaulty member in the Institute of Health Policy and Management of NTU since 2003. Combining social epidemiology
and policy analysis approaches, Dr. Cheng has consistently devoted to research concerning job stress, psychosocial
hazards at work, social determinants of health, and occupational safety and health policies. Measurement scales
developed by her research team have been widely used both locally and internationally in Chinese speaking
populations. In Taiwan, these scales have been incorporated into national surveys, aiding the government to better
comprehend the extent of job stress problems, the distributions of major psychosocial work hazards and high risk
groups of stress-related health problems.

ABSTRACTThe National Health Insurance (NHI) system of Taiwan wasestablished in 1995, which was a political decision
undertaken during the time of democratization. Over the
past 21 years, the NHI has been regarded as one of themost widely supported social policies in Taiwan. The key
features of Taiwan’ s NHI include compulsory social
insurance, universal coverage, single-payer system, revenue
based on insurers’ ability to pay, equal access tocomprehensive and high quality health care services,
uniform benefits, low co-payments, easy access, shortwaiting time, no gatekeeper and active participation ofinterested parties in decision making process. However, theNHI faces many challenges. The major challenge has been
the rising health care expenditures due to rapidly aging
population, advance in medical technology and over use
problems facilitated by easy access without a gate keeper
mechanism. Cost pressure imposed by cost-containment
policies on health care providers is passed down to front-line

health care workers, resulting in heavy workloads andstressed out workers especially in tertiary medical centers.
Furthermore, an increasing trend of privatization and a
profit-oriented tendency of health care providers along withthe diminishing role of the government in providing direct
health services have greatly undermined the fundamental
principles of social equity and economic efficiency in healthcare services.

2016 Kyoto Global Conference for Rising Public Health Researchers

15

The Impact of Community Based Health Insurance in Enhancing Better Accessibility andLowering the Chance of Having Financial Catastrophe Due to Health Service Utilization:
A Case Study of Savannakhet Province, Laos

Somdeth Bodhisane

Utilization of Reproductive Health Services:Time Trends & Equity

Postdoc Researcher
College of Public Health Sciences
Chulalongkorn University / Thailand

Jenny Cresswell

Dr Jenny Cresswell is an epidemiologist with a background in demography based in the MARCH Centre for Maternal, Adolescent, Reproductive& Child Health at the London School of Hygiene & Tropical Medicine. Her research interests include the prevention of unintended pregnancies
and measurement of maternal morbidity and quality of care outcomes, with a particular focus on vulnerable populations such as adolescents.
Currently, Dr Cresswell is predominantly working on two research projects: a DFID-funded evaluation of large-scale programme aiming toprevent maternal deaths from unwanted pregnancies in fourteen African and Asian countries through increased use of contraception andreduced recourse to unsafe abortion, and a cluster-randomised trial evaluating the impact of the Alive & Thrive intervention to promote exclusive
breastfeeding among infants under six months in Burkina Faso.
Other recent and ongoing projects include a mixed-methods prospective cohort study on the relationship between women’ s work, reproductive
health and family planning in Burkina Faso, an evaluation of the impact of government policies to remove or subsidies fees for maternity care inWest Africa on utilisation and quality of care, and systematic reviews of the burden of maternal morbidity and the impact of maternal morbidity
on health-related functioning.

Somdeth Bodhisane Ph.D., earned his bachelor and master degree in economics from Faculty of Economics,
Chulalongkorn University, where his study focused on international trade and industrial organization respectively.
He started working in the public health field in 2011 by pursuing a doctor of philosophy degree in public health. His
research is mostly focus on health financing which includes a Ph.D. dissertation entitled “Social insurance policy
formation on financial protection and health service utilization: A study of Community Based Health Insurance (CBHI) in
Savannakhet province, Lao P.D.R.”
He is currently working as a post-doctoral researcher in College of Public Health Science (CPHS), Chulalongkorn
University, in which his research emphasizes on Lao health care system, hospitalization, and Laos’ CBHI policy
formation to ensure the improvement of risk pooling condition and financial sustainability in the long run.

ABSTRACTABSTRACT
Background: Lao population is mostly relying on
out-of-pocket expenditures for health care services. This
study aims to determine the role of CBHI in health careservices accessible as well as preventing financial
catastrophe resulting from personal payment for IPD
services.
Method: A cross-sectional study design was applied in thisresearch. The data collection process was retrieved from
126 insured and 126 uninsured households in the identical
study sites. Two logistic regression models were used to
predict and compare the probability of hospitalization andfinancial catastrophe occurred in both insured anduninsured households within the previous year.
Result: The findings show that the insurance status does not
significantly improve accessibility and financial protection
against catastrophic expenditure. The reason for this isrelatively simple, as catastrophic health expenditure refers toa total out-of-pocket payment equal to or more than 40% of

162016 Kyoto Global Conference for Rising Public Health Researchers

Research Fellow
Maternal Health Epidemiology
London School of Hygiene & Tropical Medicine

households income minus subsistence. When householdincome declines as a result of inability to work due to illness,the 40% threshold is quickly reached.
Conclusion : Despite the result suggests that the insured
households do not significantly better off from CBHI scheme.
However, compared to the uninsured households, insured
households do have better accessibility and lesser
probability of reaching financial catastrophe threshold.

Background: The Sustainable Development Goals have a target to achieve Universal
Health Coverage (UHC) by 2030. This includes protection from financial barriers touse of care and access to care which is of high quality. In order to measure progress
towards achieving UHC, the WHO and World Bank have suggested a number ofindicators: two of which are health service coverage, and equity across the
population. In this talk I shall discuss what UHC means in the context of reproductive
health: measuring coverage of emergency obstetric care, typically done throughcaesarean rates, is particularly challenging since there is no consensus on theappropriate caesarean rate to meet “necessary” care. I focus on case studies of Beninand Morocco. Each country has recently introduced government policies to remove
financial barriers in the form of user fees for caesarean delivery in the public sector.
Methods: I use two sources of data: nationally-representative household surveys androutine statistics compiled by the respective Ministries of Health. Analysis focuses
caesarean delivery rates; overall and stratified by geographic region, relative wealthquintile and public/private sector. Segmented regression was used to assess whether
trends changed at key events such as policy introduction.
Findings: In Benin in 2001, 2% of all deliveries were by caesarean. Before theexemption policy was introduced in 2009, the caesarean rate was increasing by anaverage of 0.2% per year. After the user fee exemption, the caesarean rate
significantly increased by a further 0.3% per year over and above the pre-existing
secular trend (p=0.016). In Morocco, caesarean delivery increased across all wealthgroups between 1987 to 2012. There was a significant interaction between time andrelative wealth quintile (F = 2.91; P = 0.0207) with caesarean rates rising relatively
faster among the poorest. However, by 2012 the caesarean rate had reached 28%
among the richest quintile, most caesareans in this group took place in the private
sector.
Conclusions: In both Benin and Morocco, coverage of caesareans is increasing.
However, inequity remains with differential utilisation among population subgroups. In
particular, in Morocco, impressive progress has been made among the poorest
women although more still needs to be done. The poorest women tend to be the least
educated and live in the most remote parts of Morocco, with long distances to healthfacilities and poor transport systems. Health system improvements beyond financial
barriers, such as strengthening the availability of qualified medical staff in remoteareas and further improving referral links need to remain a priority. Although the
optimal caesarean rate remains a matter of debate, a rate of 28% among the richest is
likely to reflect a substantial number of medically unnecessary caesarean sections.

2016 Kyoto Global Conference for Rising Public Health Researchers

17

Financial Difficulty and Catastrophic Health Expenditure
for Colorectal Cancer Treatment
Tin Tin Su

Treatment Cost of Genital Warts on Provider and Patient Perspectives
vs Government Expenditure Analysis on Prevention Control andTreatment of the Sexually Transmitted Diseases (STDs) in Thailand

Head, Centre for Population Health
Associate Professor, Health Policy and Management
Department of Social and Preventive Medicine / Faculty of Medicine, University of Malaya

Sukhontha Kongsin

Sukhontha Kongsin, Ph.D., is an Associate Professor in Health Economics in the Department of Public Health Administration at Mahidol University in Bangkok, Thailand, where she is also the Directorof Research Centre for Health Economics and Evaluation at the Faculty of Public Health, Mahidol University, Thailand. Sukhontha’ s research focuses on the evaluation and optimisation of health- andhealth system-related strategies and interventions in developing countries. Specifically, she has worked to identify health costs and economic impacts of HIV/AIDS at both the national level andinternational level. Her expertise includes demand-side incentives and financing of Thailand’ s public sector HIV/AIDS services, with a specific focus on patient access and utilisation of services.
Sukhnontha has worked on projects with the Thai Ministry of Public Health and has coordinated numerous regional workshops on issues related to disease burden and health economics in Southeast
Asia. She has extensive experience in the field of HIV and with vulnerable populations such as key affected populations.
Sukhontha received the Young Investigator Award from the International AIDS Conference in Vancouver (1996), awarded the Franz Redeker Prize at the 29th World Conference of the IUATLD (1998)
and Prof Harald Zur Hausen Award from AOGIN – 2012 Conference of Asia Oceania Research Organisation on Genital Infectious and Neoplasia for the Best Research Paper, awarded of outstanding
performance and academic integrity in 2014.
Sukhontha is currently the President of the AIDS Society of Asia and the Pacific Foundation (ASAPF) and was a member of the AIDS Strategic and Action Plan (ASAP) Training Consortium for Asia andthe Pacific Region. She served as an abstract mentor for the IAS and as a member of the Technical Review Committee of the Red Ribbon Award in 2008 and 2010 for the 17th and 18th International
AIDS Conferences. She has served as abstract reviewer for the International AIDS Conferences and the IAS conference on HIV Pathogenesis, Treatment and Prevention for many years.

Tin Tin Su is a public health specialist and health economist. She is an Associate Professor for the Health Policy andManagement discipline at the Department of Social and Preventive Medicine. Tin Tin Su graduated from the Institute ofMedicine (I), Yangon in 1991. She has a Master of Community Health and Health Management degree (2001) and a
Doctor of Medicine (2006) from the School of Medicine, Heidelberg University, Germany. She has working and researchexperiences in Myanmar, Germany, Nepal, Burkina Faso and Malaysia.
Her research interest includes health economics, health system and policy, social determinants of health, cancer
awareness and health literacy, and community health development. She is a founding member of the Centre forPopulation Health (CePH) and appointed as Head of the research centre since March 2011. She is an execeutive board
member for Asia Helath Literacy Association and elected as a vice president since 2014.

ABSTRACTABSTRACT
Background: Increasing incidence of colorectal cancer (CRC) and its economic burden
are becoming a significant public health problem among low- and middle-income
countries. In Malaysia, the healthcare system consists of a government-run universal
healthcare system and a co-existing private healthcare system. However, with high andever rising healthcare spending on cancer management, cancer patients and their families
are likely to become vulnerable to a healthcare-related financial burden. Moreover, they
may have to reduce their working hours and lose income. To better understand this issue,
this study aims to assess the financial difficulty and catastrophic health expenditure amongcolorectal cancer patients and their families in the first year following diagnosis.
Methods: Data were collected prospectively from 138 colorectal cancer patients at
University of Malaya Medical Centre, Kuala Lumpur, Malaysia in 2013. Newly diagnosed
adults with colorectal cancer (ICD: 18-20), throughout the year 2013 were included in the
study. Patients were interviewed face to face by using a structured questionnaire at thetime of the diagnosis. And telephone interviews were carried out at six months and twelve
months following diagnosis. The socio-demographic information of colorectal cancer
patient, household data, health care expenditure, and illness and treatment data werecollected. The patient cost data consisted of direct out-of-pocket payments for
medical-related expenses such as hospital stays, tests, and treatment and for non-medical

18

2016 Kyoto Global Conference for Rising Public Health Researchers

Associate Professor
Health Economics, Department of Public Health Administration
Mahidol University / Thailand

items such as travel and food associated with hospital visits. In addition, indirect cost data
related to the loss of productivity of the patient and caregiver(s) was assessed. The
patient’ s perceived level of financial difficulty and types of coping strategy were also
explored.
Results: Throughout one year of treatment for colorectal cancer, the mean CRC
management cost was RM 8,306.9 (USD 2,595.9), and 47.8% of patients’ families
experienced catastrophic health expenditure. The main predictors of catastrophic healthexpenditure were “economic status of the families, female household head and thelikelihood of patient undergoing surgery” . Similarly 42% of patients perceived paying fortheir healthcare as difficult. The most frequently used financial coping strategy was a
combination of current income and savings.
Conclusion: Despite the high subsidisation in public hospitals, the management ofcolorectal cancer imposes a substantial financial burden on patients and their families. The
result of this study presents a significant message to stakeholders and policy makers toprovide financial protection against the consequences of cancer, a costly illness that often
require prolonged treatment.
Keywords: Colorectal cancer, catastrophic health expenditure, perceived financial
difficulty, cost of illness, financial risk protection, Malaysia

Background: Commercial sex and its related epidemics of sexually transmitted diseases (STDs) are becoming
an increasing problem. Effectiveness and sustainability of STD prevention intervention targeting sex workers andtheir clients are important. Comprehensive interventions comprise improved STD care services, promoting healthcare seeking behaviours and condom use. Outreach has been taken for the targeted establishments by STDs
Cluster. The study objectives were to assess cost of genital warts on provider and patient perspectives and to
estimate the government expenditure on prevention, control and treatment of the National STDs Prevention andControl Plan.
Methods: Cost data that include direct and indirect costs of providing clients with warts at a special STD
hospital, Bangkok, Thailand were collected using activity-based costing (ABC). There are 4 clinics: clinicalresearch women, clinical research men, women health clinic and male health clinic. Secondary data werecollected from government agencies on resource and budget in the situation under the universal coverage (UC)and other related to STDs programs. Sources of the entire allocated budget to each province were mainlycompiled and analysed to estimates of total resource needs.
Results: There were 72 patients in this study. The total direct cost was 111,167.08 Baht. Thirty one percent of thetotal cost was from the woman research clinic (34,427.40 Baht) followed by men health clinic, men researchclinic and woman health clinic. Specimen collection (4 specimens per patient were collected for diagnosis ofwarts) was the main activity account for the highest total cost of 20,033.63 Baht (275.25 Baht/person). The
second main activity was assessing patients, the total cost was 19,335.09 Baht (269.36 Baht/person).

Surprisingly, activity on medical service accounted for the lowest total cost of 1,626.09 Baht (22.92 Baht/person).
The highest cost per activity unit (292.04 Baht/visit) was from cervical cancer/rectum check-up which included
preparing material, registration, specimen collection, record the results and transfer to cancer institute so it madethis activity high labour and material cost and the second highest was counselling (120.59 Baht/visit). Indirect
costs of patients and their caregivers/follower include opportunity cost, patient food cost and patienttransportation cost. Average patient’ s transportation cost was 73.89 Baht/visit (the highest was 430). Averagepatient’ s food cost was 44 Baht/visit (the highest was 250). Average patient’ s opportunity cost (patients wereabsent from work or stop working to receive treatment) was 760.92 Baht/visit (the highest was 1,800). Average
caregiver transportation cost was 34.25 Baht/visit (the highest was 58). Average caregiver food cost was 53
Baht/visit (the highest was 75).
Regarding the actual of government program expenditure for STDs was USD 24,893,460 compared with the total
resource need estimation was USD 81,956,897. This was 30.37% of this actual spending on STDs fromgovernment agencies.
Conclusions: Evaluation of the treatment cost due to genital warts could be used to the develop direction oftargeted services at the most appropriate. National resource needs estimates are important for the country toprovide comprehensive interventions for the prevention, control and treatment by government agencies andother key stakeholders.
Key Words: Warts, Activity-Based Costing (ABC), direct cost, indirect cost, government expenditure, STD clinic

2016 Kyoto Global Conference for Rising Public Health Researchers

19

Beyond Accuracy: Assessing and Projecting the Public
Health Impacts of New Diagnostics for Tuberculosis
Hsien-Ho Lin

Using Cost-effectiveness Evidence to Inform
Health Care Decision Making

Associate Professor
Institute of Epidemiology and Preventive Medicine
National Taiwan University / Taiwan

John Cairns

Dr. Hsien-Ho Lin received his M.D. from National Taiwan University (2001) and completed the training in Family
Medicine from Hualien Mennonite Christian Hospital (2001-2005). He completed his Sc.D. in Epidemiology from
Harvard School of Public Health (2009). His research interest involves using epidemiological studies to assist thecontrol and prevention of tuberculosis. He has used dynamic transmission models to assess the potential impact oftuberculosis interventions that are being considered by policy makers, including new diagnostics in Tanzania andtuberculosis control programs in China and Taiwan. He has been studying risk factors and determinants oftuberculosis, including active smoking and passive smoking, diabetes, and indoor and ambient air pollution, using
population-based cohort studies and meta-analysis. He is also actively involved in the National Buren of Diseaseresearch project in Taiwan.

202016 Kyoto Global Conference for Rising Public Health Researchers

John Cairns graduated MA(Hons) in Economic Science from the University of Aberdeen. After a year of graduate study
at the University of York he spent two years as a research fellow in the Institute for Social and Economic Research. Thiswas followed by a return to the University of Aberdeen where he spent eleven years as a lecturer in the Department of
Economics. In 1989 he took up a post as senior research fellow in the Health Economics Research Unit and was
appointed director in 1993. He was awarded a personal chair in 2002. He took up his current post in May 2004. He has
been a member of the NICE technology appraisal committee since 2003 and a member of the advisory committee on
the Safety of Blood, Tissues and Organs since 2008.

ABSTRACTABSTRACTIn the past few years, a number of new diagnostic tools fortuberculosis have been introduced. At the same time, national
tuberculosis programs face the challenge of choosing theappropriate diagnostic option that is most suitable for thecountry-specific epidemiologic situation and available
resources. We developed an integrated modeling approach( “Virtual Implementation” ) to assess and project the potential
impacts of a new diagnostic tool at the patient level, healthsystem level, and the population level. The integrated model
included a transmission modeling component (developed by
the National Taiwan University team) and the operationalmodeling component (developed by the Liverpool School of
Tropical Medicine team); the two components were linked
dynamically in order to account for the complex interactions
among the impacts at different levels. Using the integrated
model, we worked with the Tanzania National Tuberculosis
Program to evaluate the potential effects and cost-effectivenessof eight different diagnostic options that were considered by theProfessor
Department of Health Services Research and Policy
London School of Hygiene & Tropical Medicine

program, including the new diagnostic tool of Xpert MTB/RIF
and light-emitting diode (LED) fluorescence microscopy. We
found that, under the optimistic operational condition, the fullrollout of Xpert is a cost-effective option for tuberculosis
diagnosis and has the potential to substantially reduce thenational tuberculosis burden. It also estimates the substantial
level of funding that will need to be mobilised to translate this
into clinical practice. On the other hand, sensitivity analyses
from our models indicates that the impact of new diagnostics
depends on the context of the health care system where the tool
is implemented. For example, the impact of a new diagnostic
tool would critically depend on whether the diagnosis of a newtuberculosis patient could be linked to adequate treatment andcase management. This highlights the importance ofaddressing health system weaknesses when introducing a newtechnology into a resource-constrained setting.

Evidence regarding the cost-effectiveness of different interventions is
widely used in the UK to inform health care decision making. Examples
include the National Screening Committee, the Joint Committee on
Vaccination and Immunisation, the committee on the Safety of Blood,
Tissues and Organs, and the National Institute for Health and Care
Excellence (NICE). In the case of NICE economic evidence is importantwith respect to decisions regarding the health technologies (particularly
drugs) that the NHS should routinely use but also informs the developmentof public health guidance, and to a lesser extent the development of clinicalguidelines.
Notions of a cost-effectiveness threshold lie at the heart of any attempt touse cost-effectiveness evidence to inform decisions as to which healthservices to provide. Cost-effectiveness thresholds are important wheneveran organisation is concerned with obtaining value for money from its healthcare spending. They may be of particular relevance with respect to public
expenditure because they can increase the transparency andaccountability of decision making.
There are three main challenges when using cost-effectiveness thresholds

to inform decisions regarding which services to fund. First, how is theappropriate cost-effectiveness threshold or threshold range to be
determined, or indeed should there be a single threshold or multiple
thresholds? Second, how can the valuation of health benefits be refined so
as to better capture the value of treatments to patients and to the economy
as a whole? Third, how is the tension between cost-effectiveness, and theaffordability and sustainability of health services to be managed? These
questions are of course linked, for example, weighting QALYs and using athreshold cost per weighted QALY and having multiple thresholds fordifferent groups of QALYs (defined for instance by severity of theunderlying condition) are alternative means of recognising that not all
QALYs have the same value.
While high income countries must grapple with these challenges, they arealso relevant to low and middle income countries, for example, when
deciding what services to include in the benefits package. Albeit that thethresholds at which services are deemed cost-effective will be substantiallylower, and these countries face a more fundamental challenge in terms ofdeveloping and sustaining HTA decision making processes.

2016 Kyoto Global Conference for Rising Public Health Researchers

21

“Universal Health Coverage and Health Economics”
December 14 - 15, 20162016 Kyoto Global Conference for Rising Public Health Researchers

Poster Presentation
University

Kyoto
University

Chulalongkorn
University

22

No.

Presenter Name

Poster Title

01

Ayako Kohno

A Mixed-method Study Protocol on the Prevalence of Child Marriage in
Malaysia and their Health Status and Gender Norms

02

Chiawen Wang

A Qualitative Study on Cyberbullying and Traditional Bullying among Taiwanese HighSchool Students: Exploring Experiences, Perceptions, and Mental Health Aspects

03

Christina Abduljabar El- saaidi

A Cross-sectional study on Knowledge, Attitude and Practice of Infection
Control Among Students of Public Dental Schools in Egypt

04

Hironori Uematsu

Disease Burden of Antimicrobial-Resistant Infections in Japanese Inpatients

05

Koji Hara

Physician Geographic Distribution in Japan: Is it Improving or Worsening
when Healthcare Demand is Adjusted?

06

Naoki Takashi

A Qualitative Study on the Support to Community Dwelling for Male Elderlywith Stroke in Shizuoka City

07

Nurul Syafika AH

Psychological Stress among Southeast Asian International Students in Japan:
A Qualitative Study

08

Omid Dadras

09

No. Presenter Name

Poster Title

19

Daiane B Machado

Providing Universal Health Coverage in Mental Health Settings: Impact of the Brazilian Mental HealthServices on Suicide, Hospitalisations by Attempted Suicide, by Psychiatric and by Alcohol Problems.

20

Katherine Theiss - Nyland

Investigating the Gap between Policy and Practice in Continuous Distributionof LLINs through ANC and EPI

21

Kerry Wong

The Spatial Dimension of Health Service Access and Coverage: Systematic Review of Distance andTravel Time as Barriers of Attaining Universal Skilled Care at Childbirth in Sub-Saharan Africa

22

Noemia Siqueira - Filha

Costs of Treatment of HIV/AIDS and HIV/Tuberculosis Co-infection in a
Referral Hospital in the City of Recife, Brazil

23

Rachel Braithwaite

Ethnic Differences in Smoking in the Netherlands and the Contribution ofSocio-economic Factors: the HELIUS Study

24

Orapan Sa - ringkan

Higher Adherence of Antiretroviral Therapy (ART)in Community Hospitals thanin Regional Hospitals: A Cohort Study Under The Universal Coverage in Thailand

25

Ratchaya Jirapong

Job Stress among Thai Police Officers in Prachinburi Province

What Happened in Tanzania During Last Decade?: A Response to HIV
Epidemic Between 2003-2011

26

Chia - Lin Tseng

Social Solidarity in East Asian Health Care Systems: Exploring Universal
Health Insurance Schemes in Japan, Korea, and Taiwan from 1990 to 2014

Phayong Thepaksorn

Occupational Noise Exposure and Hearing Defects among Sawmill Workers in
the South of Thailand

27

Chih - Hsiang ShunStudy on Serum Metal Levels of Residents Living Near a Petrochemical
Complex in Taiwan

10

Pilar S. Suguimoto

Qualitative Study of the Access to Health Care of Children Under-five in an
Andean Region of Peru and Health Beliefs of their Caregivers

28

Jessica Tsay

Using Genetic and Spatial Data to Investigate Clusters of Multidrug-resistant
Tuberculosis in Taiwan

11

Shinomi Takahashi

Perception towards Diabetes among Community-dwelling
Diabetes/Non-diabetes Japanese Elderly: A Qualitative Study

29

Jung - Chi Chang

Spatial Variation of Selected PM2.5 Elements in an Urban Area

12

Takayo Nakabe

Informal Care Costs and Out-of-Pocket Payments of Dementia Care in Japan30

Po- Wei Chu

Tuberculosis Disease Risk Assessment in DM Patients

13

Wilunda Calistus

Caesarean Delivery and Anaemia Risk in Children in Low- and Middle- Income Countries:
Propensity-score Weighting and Meta-analysis of Demographic and Health Survey Data

31

Shun - Hua Ho

Exposure of PM2.5 at the Roadside Bike Express Lanes in Taipei

14

Yoshitaka Nishikawa

Transition of Emergency Medical Services in a Resettled Homeland After the
Fukushima Nuclear Disaster: A Retrospective Observational Study

32

Tzong - gang Wu

Concentrations of Airborne Fine Particles and Benzene at Bus Stops in Taipei,
Taiwan15

Yukiko Tateyama

Socio-epidemiological Study on Risk Factors of Non-communicable Diseases among
Adult Population in Rural Zambia: A Mixed Method Study (PhaseⅡquantitative study )33

Tzu Ting Tsai

Impact of Meteorology on Particle-bound Polycyclic Aromatic Hydrocarbons
in Taipei Area

16

Noor Alis Setiyadi

How Indonesian Stakeholders Perceive their 2014: National Health Insurance
Implementation

34

Yi - Lun Tsai

Sources and Consequences of the Fear of Malpractice among Physicians in
Taiwan17

Prichavijy Promjak“Modified-Continuous Ambulatory Peritoneal Dialysis (CAPD) Patient’ s
Handling Process” among Healthcare Providers at Primary Care Level

35

Roshidi Ismail

Awareness of Cancer Warning Signs and Anticipated Delay in Help Seeking:Results from a Cross-sectional Study in Multi-ethnic Malaysia

18

Wachiraporn Wilaiwan

Status and Trend of Mobile Communication Devices and Applications Usages
in Senior Citizens, Thailand: Case Study on Health Effects

36

Raymond Seow

Gender Disparities in Prevalence of Overweight and Obesity among University
Students

2016 Kyoto Global Conference for Rising Public Health Researchers

University

LondonSchool ofHygiene &TropicalMedicine

Mahidol
University

National
TaiwanUniversity

Universityof Malaya2016 Kyoto Global Conference for Rising Public Health Researchers

23

Kyoto Old
Imperial Palace

Kyoto University
Hospital
Jingu-marutamachi
Sta.
Heian Jingu
ShrineHearton Hotel Kyoto
Kyoto
Shiyakusho-mae
Sta.

Nijo St.
Karasuma Oike
Sta.

Oike St.

Shijo St.

Shijo
Sta.

Kawaramachi
Sta.
Kamogawa River

Karasuma
Sta.

Gojo
Sta.

Shichijo St.

24

Shichijo
Sta.

Keihan Line
Hankyu Line

JR Tokaido Line

NagoyaKawaramachi Kawabata Higashioji
St.
St.
St.

2016 Kyoto Global Conference for Rising Public Health Researchers

Demachiyanagi
Sta.
Kyoto seika Girl’sHigh School

-s
Kyu

hira

kaw

O

a

GroundSt.

w
neay Faculty of Medicine
Kyoto University

ShiranKaikanEV
EV

Kyoto University
Hospital

Konoe St.
Poster Session

Kasagakami St.

Yamauchi Hall

Kumano Shrine(kumano Jinja-mae)

Marutamachi St.

Yasaka Shrine

Kiyomizu-GojoSta.

JR Kyoto
StationKarasumaSt.

Inamori Hall

AccessOsaka

Horikawa
St.

Tozai Line

Subway Line

Karasuma Line

Gojo St.

Gion-Shijo
Sta.

Higashiyama
Sta.

Kyoto University

Konoe DoriSanjo Sta.

Sanjo St.

・Yamauchi Hall
・Inamori Hall

Higashi-Ichijo St.

Jingu marutamachi
Sta.

Marutamachi
Sta.

(Kyodai seimon-mae)

LaTourShiran Kaikan 2nd Floor

Lavatory

Konoe St.

Hyakumanben
Kyoto University
Main gate

Keihan Line

Kyoto University

Kamogawa River

Demachiyanagi
Sta.

N

Higashi Oji
St.

Lavatorye

Seifuso Villa

Shiran Kaikan

Marutamachi St.

Marikouji
St.

Kawabata
St.

N

n Lin
Eiza

ImadegawaSta.

Imadegawa St.

Floor Map

Local Map

Kyoto City Map

Main Railway station

Route

Terminal

Kyoto Station JR.
Kintetsu Railway

City Bus #206
bound for Kitaoji bus terminal via Higashiyama St.

Kyodaiseimon-mae

Hankyu Railway
Kawaramachi Station

City Bus #201 bound for Gion, Hyakumanben
City Bus #31 bound for Kumano, Iwakura

Kyodaiseimon-mae

Karasuma Subway line
Marutamachi Station

City Bus #202 bound for Kumano jinjya, Gion
City Bus #204 bound for Higashi Tenno-cho,
Kinrin Shako-mae

Keihan Railway
Jingu-marutamachi Station

10 minutes walk nor th-east from No.5 exit

Kumano jinjya-mae(and change to above bus lines)

2016 Kyoto Global Conference for Rising Public Health Researchers

25

Ce

nt

re
fo
rH

ea
lth
De
ve

e
of HyghNaul a id ol
lon Uni t iona l
v
Taiw
gko
e
a n Unrn U rsityi vers it ynivers it yi en e and T r op i c al M ed i ci n

y

oo l
Sch

n
ndo

Masahiro Kihara, MD, PhD, Professor
Takeo Nakayama, MD, PhD, Professor

Ma

Lo

Akio Koizumi, MD, PhD, Professor

Ch

Yuichi Imanaka MD, MPH, DrMedSc, PhD, Professor

eal

Satoe Okabayashi, MD, MPH, DrPH, Assistant Professor
Teeranee Techasrivichien, PhD, Assistant Professor

th forMoraima Flores, Chief Assistant, KUSPH International Office

Participating Institutions
Chulalongkorn University
London School of Hygiene and Tropical Medicine
Mahidol University
National Taiwan University
University of Malaya
WHO Centre for Health Development, Kobe

al

ay

rH

a

Yoshimitsu Takahashi, DrPH, Associate Professor
Tetsuya Otsubo, PhD, Assistant Professorer si tKyoto University School of Public Health

Fo

Kob

i ve

nt,

Un

me

oto

lop

Ky

Organizing Committee

A ll

U

e
niv

rsi

ty

M
of