Query: 2020 medicine policy thailand

title: A Study on the Elederly's Behavior on Self Health Care with Thai Traditional Medicine in Four Regions of Thailand kaarsueksaaphRtikrrmkaarduuaelsukhphaaphphuusuung`aayudwykaaraephthyaephnaithy 4 phaakh
abstract: The study of health care behavior for elderly people is important for profound understanding in elderly people behavior. These information will be beneficial for national policy to promote health care of themselves without reliance to the others. The objective of this study was to assess health behavior of elderly people in four regions of Thailand. This one year study was approved by the ethics committee of Thammasat University No. 2 (Faculty of Medicine) It was conducted by using mixed method approach; combined quantity and quality results via survey, in depth interview, and focus group discussion with structure interview. The study samples were enrolled through purposive sampling method. The study sites included Loie province, Suphan Buri province, Chiang raai province and Nakhon Si Thammarat with 50 participants of each area. Data analysis was performed by using percentage and content analysis. Results showed that the main gender of four regions elderly people was female; and the widest age span was observed in Loei province. The general self care behaviors included the consumption of seasonal vegetables, fruits and fish. The results from in depth interview and focus group discussion showed that participants used herbs for relieving illness such as cultivated banana, bitter gourd and others because they could be both food and medicine. Tradition, culture and belief context were different depended on the region. Concept of self care followed the Thai traditional medicine and alternative medicine with regard to health care promotion (8 principles for living) which were quite similar except the veiration of food items. The results of this study demonstrated that the health care behaviors for elderly people by Thai traditional medicine were integrated with community lifestyle. Elderly people with good physical health, and good quality of life in physical, mental and environmental aspects would become more self reliance under the conceptual, belief, tradition and culture of each community.

title: Is Dual Policy an Overarching Strategy for Medicine Price Controls in Malaysia?
abstract: Several health related policies have been interrupted when the coalition government, Pakatan Harapan, fell after winning the 2018 election. Regulating medicine prices via referencing pricing was among Pakatan Harapan's most contentious proposals. Imposing reference pricing entails benchmarking medicine prices in Malaysia against other countries or within the domestic market. Referencing pricing is a prevalent form of price control to contain health care  A study compared the cost of 13 medicines for conditions such as heart disease and diabetes across 50 countries.2 Medicine cost profiles showed that Malaysia has the third cheapest medicines in the world. The United States has the most expensive medicines in the world, and Thailand has the cheapest. Even for costly therapeutic areas like oncology, medicine prices were not significantly higher than in other countries.3 Medicines, particularly innovative ones, are often targeted in cost containment.4 In Malaysia's heavily subsidized public sector, cost containment should be directed to the public sector spending.5 There is no reason to interfere with the private sector's spending. Measures like dispensing separation, deregulation of physicians' fees, and displaying charges in private health facilities that allow consumers to compare are more effective. The private market is best to be regulated by competition because it ensures that the best services are provided to consumers at competitive prices.6 Thus, consumer education is important to enable them to make informed decisions. India's medicine price control policy's failure is well known. Having one of the lowest medicine prices in the world, out of pocket expenditure is 61% of total health care expenditures and citizens are deprived of access to lifesaving medicines. New medicine launches declined by 75% since 2011, and access to new medicines was delayed by more than5 years despite being available in other parts of the  There is no incentive for pharmaceutical companies to bring new medicines into countries with such policy, and at its worst, withdrawing existing medicines from the market. Innovative medicines are inevitably costly due to the high risk and capital intensive nature of R&D. While costly, R&D is necessary because these drugs often fulfil unmet needs where there is no current therapy such as in rare and life saving conditions. Rewarding innovations is essential in thrusting R&D toward the discovery of high value treatments. "Value based" approach is more practical to maximize health outcomes with limited health care resources. Health technology assessment and economic evaluations have been developed to facilitate efficient resource allocation. These methods take a spectrum of values such as severity, rarity, and involvement of children into consideration, which are often lacking in price controls.1,4 A supportive role for price controls is possible for therapeutically equivalent medicines and situations where economic evaluations are inappropriate. A dual policy can be adopted to derive value for money from innovations using health technology assessment and supported by price controls in others. Netherlands' policy is an example of how the 2 approaches can be  A dual policy can be a sensible and acceptable compromise in pursuit of making efficient use of limited health care resources while maximizing health outcomes of patients in Malaysia.

title: Political Economy of Thailand Drug System: What Lessons Learned? btheriiyndaanesrsthsaastrkaaremuue`ngkabrabbyaakh`ngpraethsaithy
abstract: The political economy, which explains the relationships between individuals and society and between markets and the state, have direct and indirect influences over the health and drug system. This article analyzed the influence of political economy on the drug system in Thailand, by reviews of relevant literature and drew a few lessons. As medicine is one of the four essential needs for human lives; in the era of absolute monarchy, medicines were used as a governing tool to gain loyalty and goodwill among the populace subjects. In the 1932 Siamese Revolution from absolute monarchy to a constitutional monarchy, medicine and public health were not one of the six policy pillars proposed by the Revolutionaries; however every government had given importance to the advancement of the public health system by expansion of public health facilities in every province, district and sub district nation wide. In parallel, extension of financial risk protection to the vulnerable population (such as the low income households, the disable, elderly and children under 12 years) and the formal sector public and private employees provided financial access by citizens. Until 2002 Universal Health Coverage was achieved for the whole population. In the Thai drug system; Thailand has followed western allopathic medicine since the time of major reform in the era of King Rama V (1853 1910) Thailand has been under the influence of western countries in terms of academia, business and politics. However various Thailand public health champions had boldly challenged these western influences using wisdom and courage. National List of Essential Medicines was adopted and effectively implemented following the principles recommended by the World Health Organization. Further national drug policies enforced the use of reference drug price for public procurement which contains drug expenditure and improves efficiency. The 1998 drug procurement scandal masterminded by politician was publicized by civil society organizations which led to prosecution and imprisonment. Additionally the pharmaco vigilance was fully established to monitor adverse drug event and result in immediate withdrawal of certain medicines. Despite pharmaceutical industry filed a law suit to the Administrative Court to retract the withdrawal of Phenylpropanolamine; the court dismissed the case. Furthermore for public health emergency which requires the use of certain expensive patent drugs, with bold leadership, Thailand implemented the compulsory license through legal provisions by the Thai law in the height of political pressure from the US government and pharmaceutical giants. In contrast, the prohibition of excessive and irrational use of Glucosamine was brought to the Administrative Court by Civil Servant Association which, controversially, the Court had ruled its continued use. Drug policies emerged under different political systems. For example, the National List of Essential Medicine and the reference drug price were established in the partial democracy, the Universal Coverage Scheme was launched in the full democracy, and the use of compulsory licensing was initiated by a coup d'etat government. The key deficiency is the lack of progress in pharmaceutical sciences and related disciplines which support research and development of new medicines or formularies; as more than half were imported finished products and all active pharmaceutical ingredients are imported. The Thai traditional medicine and herbal remedies are confined by a conservative mindset and at early stage of development.

title: International Trade Agreements and Impact on the Medicine System: Causal Relations? khwaamtklngkaarkhaarahwaangpraeths aelaphlkrathbt`rabbyaa: ehtuaelapacchcchay?
abstract: This article comprehensively reviews and analyses knowledge and information relating to international trade agreements and their implications during the past 17 years, both within and external to Thailand. To reveal the implications and impact systematically, the conceptual framework for analysis was drafted and the implications were mapped along the medicine value chain. The mapping shows cross link of the implications and took concerns of health sectors. Focusing on medicines, despite of positive impact, international trade agreements have had significant negative impacts on the Thai medicine system. There is worldwide recognition that expensive prices and higher expenditure of medicines result from the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) this research identified further implications including: the opening up of market access to government procurement and limitations on policy space for medicine management systems as well as public health. This paper also demonstrates the experiences of Thailand, India and Malaysia regarding TRIPS flexibilities. It was shown that all three countries exercised "other use without authorization of the right holder" which is a TRIPS flexibility, to strike the balance between individual right and obligation in access to affordable essential medicines, although difficulties and consequences were found in the process of exercising this right. Evidence shows that Thailand, as a developing country, may support the voluntary license but must keep all TRIPS flexibilities, including the compulsory license, as tool to overcome barriers to access and ensure the human right to health. Further system research as well as investigation of cross country impact of FTAs in and among ASEAN members are recommended.

title: Design Road Traffic Injury Data Model and Visualization
abstract: Due to serious situations of road traffic injuries in Thailand, the public health system has been affected and has to be reevaluated, as well as the injured people that need to be prevented both in planning and policy. Currently, there are many sources of information regarding road traffic injury from departments within the Ministry of Public Health in Thailand and there are many data standards used for these data. Although some standards and definitions are similar, the formats of the storage are different. Therefore, the data cannot be combined and exchanged for decision makers on prevention and policy. The objective of this paper was to develop and design a data model to standardize the three data sources under Misnitry of Public health including standard data structure on medicine, health, and referral, injury surveillance system, and information technology for emergency medical system of Ministry of Public Health. The data model was designed as a dimensional data model using the star schema of the data warehouse. The design using the dimensional data model allows the data to be analyzed in many dimensions. After that, the results of data analysis were presented as visualization for easier implementation in monitoring and policy making decisions.

title: Evaluation of Health Professional Training on a Large Scale Implementation of Chronic Care Model in Primary Care Settings of a Middle Income Country
abstract: The evidence on the effects of the Chronic Care Model (CCM) intervention in low to middle income countries is limited. A recent policy initiative in Thailand to improve care for patients with non communicable disease focuses on strengthening primary care through the allocation of family medicine physician and multidisciplinary primary care training and allocation failed to demonstrate any changes in knowledge and skills of the trainees.  Our study aims to examine the effects of provider training and local health systems settings on provider perception of implementing CCM for patients with diabetes or hypertension in Thailand.  We conducted a cross sectional survey of 1,064 multiprofessional providers in 128 primary care units in large and small municipalities from 11 provinces in Thailand using a self administered questionnaire modified from the assessment of chronic illness care (ACIC) form. Responses fall within four descriptive levels D, C, B, A of implementation ranging from D "little or none" to A "fully implemented" intervention. Generalized linear models were employed to compare provider perception of implementing CCM between trained pilot PCUs, pilot PCUs, ordinary PCUs, and NCD clinics.  Generalized linear models depicted an independent association between every CCM component and facility type with respondents of trained pilot PCU reporting the highest estimated marginal mean (EMM) scores (p<0.001) Statistically significant differences in the scores between health facilities in small and large municipalities were found in almost all components (p<0.01)  Policymakers might find the training approach promising in context with extensive universal healthcare coverage and relatively strong healthcare infrastructure like Thailand. In addition, modified ACIC in our study might be useful to assess and monitor the progress of the training in primary care settings. Further studies are needed to ascertain the effectiveness of the training using patient assessment and outcomes as indicators.

title: Capacity, committed funding and co production institutionalizing implementation research in low and middle income countries
abstract: co production institutionalizing implementation research in lowand middle income countries Jeanette Vega, Zubin Cyrus Shroff Kabir Sheikh, Irene Akua Agyepong, Binyam Tilahun, Viroj Tangcharoensathien, Assad Hafeez, Indu Bhushan, Abdul Ghaffar and David Peters 8 Red de Salud UC Christus, Chile Alliance for Health Policy and Systems Research,  Geneva, Switzerland Ghana Health Service Research and Development Division, Accra, Ghana University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia International Health Policy Programme, Thailand Health Services Academy, Islamabad, Pakistan National Health Authority, New Delhi, India Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

title: Corrigendum to "COVID 19 in forensic medicine unit personnel: Observation from Thailand" [J Forensic Legal Med 72 May 2020, 101964]

title: Clinical Medicine 2020 putting policy into practice.
abstract: The distinct place of a general medical journal such as Clinical Medicine is that we can include an article like the review by Hydes et al looking at the relationship between alcohol consumption and risk of cancer.[1][1] It is a continuing curiosity that there exist different attitudes towards the

title: Breast cancer in Thailand: policy and health system challenges to universal healthcare.
abstract: Thailand has successfully implemented Universal Health Coverage (UHC) and embedded the 2030 Agenda for Sustainable Development into its Thailand 4.0 policy. Breast cancer is a growing challenge in Thailand, as it is globally. It serves as a perfect medium through which to interrogate UHC and demonstrate areas of the health system which require further strengthening if UHC is to be sustainable in the longer term. We conducted a situation analysis and used a Systemic Rapid Assessment (SYSRA) framework to examine the challenges posed to UHC through the lens of breast cancer. We identified a number of challenges facing UHC including (1) continued political commitment; (2) the need for coordinated scale up of strategic investments involving increased financing and fine tuning of the allocation of resources according to health needs; (3) reducing inequities between health insurance schemes; (4) investing in innovation of technologies, and more critically, in technology transfer and capacity building; (5) increasing capacity, quality and confidence in the whole primary healthcare team but especially family medicine doctors. This would subsequently increase both efficiency and effectiveness of the patient pathway, as well as allow patients wherever possible to be treated close to their homes, work and family; (6) developing and connecting information systems to facilitate understanding of what is working, where needs are and track trends to monitor improvements in patient care. Our findings add to an existing body of evidence which suggest, in light of changing disease burden and increasing costs of care, a need for broader health system reforms to create a more enabling platform for integrated healthcare as opposed to addressing individual challenging elements one vertical system at a time. As low and middle income countries look to realize the 2015 Sustainable Development Goals and sustainable UHC this analysis may provide input for policy discussion at national, regional and community levels and have applicability beyond breast cancer services alone and beyond Thailand.