plueme/wizJson huggingface dataset:
The major aims of the universal health care coverage (UC) policy initiated in Thailand in 2001 are not
only to increase the access of people to essential health services, but also to reduce the financial risk they
face due to out-of-pocket payments for health care. This study employed secondary data analysis of the
Socio-Economic Survey (SES) conducted by the National Statistical Office to estimate the number of households
becoming impoverished because of the payments for health care they had to make before implementation
of the UC policy (1996, 1998, 2000, and 2002) and thereafter (2004, 2006, 2007, and 2008), and to
compare the findings with a counter-factual UC-absent scenario, using segmented linear regression analysis.
At the national, regional, and provincial levels, the proportions of households falling below the poverty
line declined gradually during the study periods. Without the 2002-UC, a total of 100,604 households
nationwide would be impoverished by out-of-pocket payments for health care in 2008. The UC policy in
the same year could reduce the number of health-impoverished households by 37,628 (37.4%), which is
equivalent to 0.2 percent of 19 million households nationwide. The health insurance system design that takes into account both “breadth” (that is, the number of the population covered) and the benefit package’
s “depth” dimensions, provides better financial risk protection and prevents households from falling into
the poverty trap due to the necessity of making costly health expenditures
The organizations concerned with primary care have tried to develop the effectiveness of their service
for all people equally. This research has as its main objectives studying the readiness of networks for
network operations and studying supporting factors and obstacles found in three health centers, namely
Phra Pathom Chedi Community Medical Center, Sanam Chan Sanitarium and Nakhon Pathom Municipality
Health Center. The methodology utilized included semi-structured interview and participatory
observation.
The results of the study revealed that all three centers had different levels of readiness for network
operations. Phra Pathom Chedi Community Medical Center had comparatively the highest degree of
readiness. The second was Sanam Chan Sanitarium whereas Nakhon Pathom Municipality Health Center
did not show readiness. The factors affecting the readiness in network operations were community characteristics,
size, budget administration system, staff working style, executive working style, organization
regulations, knowledge and capability in responsible jobs, executives’ roles in network operations, manpower
allocation, quality assurance and control of network operations, cooperation with other organizations,
and monitoring and evaluation systems. It was also found that the obstacles to networking include
lack of policy for stakeholders’ participation, no information technology for coordination, no performancebased
direction planning, complex organizational structure and line of command, inadequate morale of
staff, insufficient stakeholders in the network, no knowledge management or learning organization practice,
and no effective unit cost management system.
Iodine supplementation is an additional intervention of the Ministry of Public Health that is used to
alleviate iodine deficiency disorder among the Thai population. This survey was aimed at examining the
opinion of obstetricians nationwide regarding vitamin and mineral supplements for pregnant women. It
can be used as input data for formulating national policy on iodine supplementation.
Over 90 percent of obstetricians prescribed folate and iron compared with 25 per cent of those prescribing
iodine. The number of participants who considered that iron deficiency, thalassemia and folate
deficiency comprised a severe or the most severe health problem in their areas of responsibility was 2-4
times greater than those who concerned iodine deficiency to be such a problem. This finding contrasts
with epidemiological data showing that iodine deficiency could be found in most of the places. Potassium
iodide plus folate and iron tablets were the preference of 90 per cent of obstetricians. Thus, we suggest
that the combination of the three minerals should be provided for pregnancies. Iodine only tablet should
be prescribed for thalassemic pregnant women. To effectively implement the administration of iodine
supplement tablets, guidelides are essential for vitamin and mineral supplementation for pregnancies
and good monitoring and evaluation systems are essential.
This study was aimed at comparing the cost-effectiveness of tuberculosis treatment strategies between
community-based DOTS (Directly Observed Therapy, Short Course) and hospital care at Maesai
Hospital, Chiang Rai Province. Data on costs were collected in terms of provider and patient perspectives.
Cost-effectiveness was calculated as the cost per patient successfully treated. The nine-month historical
cohort study from November 1, 2009 to July 31, 2010 was designed to measure outcomes of tuberculosis treatment. By matching new pulmonary tuberculosis patients aged 15 to 60 years, the study included
54 patients from community-based DOTS programs and 52 patients receiving hospital care. The
hospital cases were divided into three groups, i.e. days since admission: 1 to 7; 8 to 14; and more than 14,
totalling 38, 8 and 6 patients, respectively. The provider cost data were collected from medical records
while the patient cost data were collected in face-to-face interviews.
Results showed that the average tuberculosis treatment costs under community-based DOTS Programs
and hospital care were 9,436.84 baht and 13,540.32 baht per patient, respectively. Communitybased
DOTS reduced costs by 30.31 per cent in comparison with hospital care. Sub-group cost analysis of
hospital care of 1 to 7, 8 to 14 and more than 14 days since admission showed costs of 10,051.97, 19,168.63
and 27,969.72 baht per patient, respectively. The clinical success rates of community-based DOTS and
hospital care were 90.74 per cent and 94.23 per cent respectively. The incremental costs of a case successfully
treated in hospital were 1,175.78 baht higher than that of a community-based DOTS program.
The study suggested that community-based DOTS is a more economically attractive option than
hospital care. This is particularly important in settings where a TB clinic is implemented under the
limited resources available to Maesai Hospital.
This research was a survey of the characteristics of ideal women before and during married life from
the perspective of a group of married men. Two hundred twenty-six legally first-time married Bangkokian
men, aged 25-40 years, were surveyed using a 25-item questionnaire on the characteristics of ideal wives
in order to obtain opinions on their spouses before they got married and during their married lives. The
samples were grouped into three categories by the number of years of marriage, i.e., married for <3 years
(n=50), married 3-<5 years (n=90), and married for 5-10 years (n=86). The results were as follows:
1. The characteristics that the men considered ideal and desired their wives to have comprised the
following: honesty and loyalty; showing care for family members; loving mindfulness, with understanding
of her husband; and morality.
2. The characteristics of the ideal wife changed significantly during married life ( p<0.001, p<0.01,
p<0.05):
- Those married for <3 years were concerned less with facial appearance, general appearance,
aging, education status, and unmarried status;
- Those married for 3-5 years were concerned less with appearance, personality, intelligence, and
virginity;
- Those married for more than 5 years showed less concern about facial appearance, personality,
attractiveness, honesty and loyalty, financial prospects, social status, occupation, unmarried status, sexuality,
and virginity.
3. The characteristics considered ideal, which increased after marriage, appeared significantly
(p<0.01, p<0.05) only among those men who had been married for more than 3 years but not more than 5
years. Those characteristics were financial prospects, education, social status, and occupation, all of which related to findings of the SES.
4. The ideal characteristics that the men wanted in their wives, which had not changed from the
time before marriage to that throughout married life and were answered by all groups of married men,
were listed in descending order as follows: (1) care of family members; (2) loving mindfulness and understanding
of the husband; (3) morality; (4) emotional stability; (5) relationship with husband’s family; (6)
self-responsibility; (7) relationship with wife’s family; (8) social manners; and (9) similar hobby or activity
in leisure time. It should be noted that loving mindfulness and understanding of the husband, morality,
emotional stability, relationship with the wife’s family and care of family members were the five most
important ideal characteristics that all men desired in their wives.
In fiscal year 2009, Mae Hong Son Province suffered a severe and large outbreak of dengue hemorrhagic
fever; it has the second high incidence rate in the country for that disease. This study was aimed at
describing epidemiological data of patients at Srisangwan Hospital in Maung district, Mae Hong Son
Province, from January 1 to October 30, 2009. The study also reviewed criteria of diagnosis by physicians, and lag time of patient-access to the hospital and of disease-control in the community by a disease-control
team. Results may reveal the outcomes of diagnoses and lead to improvement of disease-control management.
It was found that complete patient files were available for 502 cases. The incidence rate in the age
groups 11-20 years, 21-30 years and 31-40 years were 1.94, 1.52 and 0.77 per cent, respectively. A high
number of cases occured in June and July. The most affected sub-districts were Jong-kum, Pang-mu, and
Pa-bong. According to the criteria of diagnosis, the study found that 37.65 per cent had no record of
abdominal examination and 32.47 per cent had no record of abnormal bleeding sign or tourniquet examination.
However, a dengue rapid test-kit was used in 59.36 per cent of the cases. In the first visit, cases
were diagnosed as dengue hemorrhagic fever or suspected cases (40.85%), acute febrile illness (36.85%),
and respiratory syndrome (17.13%). The lag time of first visit to the hospital was on average 1.91 days; the
lag time for being diagnosed as a case of dengue hemorrhagic fever or a suspected cose was on average
3.51 days, and disease control in the community was performed within 1.19 days after case notification.
Results showed the age group affected was mostly adult. Criteria for diagnosis by physicians were not
fulfilled to a certain extent; on the other hand, more rapid test-kits were used instead in a large proportion
of the cases. Therefore, indications to use the kits should be scrutinized and training courses should be set
up regularly. Though disease control was implemented shortly after notification, the number of cases still
increased continuously. Therefore, the efficiency and management of the disease control team should be
reviewed.
Thailand achieved universal health insurance coverage for the entire Thai population in 2002. However,
the health insurance system does not cover all people who live in the country because the National
Health Security Act 2002 indicates only “Thai citizenship” for eligibility under the scheme. This has made
it impossible for people with citizenship problems to get basic health care. It also caused financial problems
for health care providers that have to provide essential care for the people and disease control in
many areas.
For five years (four health ministers), there were many attempts to push forward the provision of
basic health care for people with citizenship problems. This policy was complicated, and concerned with national security. The lack of understanding of the institution concerned and the society at large are the
main obstructions. In 2010, the National Health Security Office (NHSO) employed the Moving Mountains
Triangle Theory which comprises three strategies: (1) knowledge generation; (2) social movement;
and (3) political engagement to push forward the policy. On March 23, 2010, the Cabinet approved this
policy and assigned the Ministry of Public Health (MoPH) to operate the scheme instead of NHSO.
Although the policy has been approved, some important issues need to be considered. For instance,
how well can MoPH manage when supporting systems are lacking? The budgets may not be enough
because the capitation budget was calculated by sharing risks with a population of 47 million under the
universal coverage (UC) scheme. The benefit packages also may not equal those under the UC scheme.
Thus, these aspects are challenging issues for everyone who works on this project.
Objective: The purpose of this study was to review the efficacy and cost-effectiveness of Glucosamine.
Method: A review of meta-analysis, randomized controlled trial with at least 12-month follow-up
in patients and cost-effectiveness analysis of Glucosamine between 2005-2010 was undertaken. The review
did not consider old studies because there was evidence suggesting publication bias.
Results: Compared with placebo Glucosamine was no more effective than placebo (statistical nondifference)
in people with osteoarthritis on WOMAC pain and WOMAC function, RMDQ and EQ-5D
scores also showed no or small effect on narrowing the joint space width. Both generic and innovative
Glucosamine had ICER greater than one time Thai GDP per capita.
Conclusion: Available evidence suggests that Glucosamine has low effect, therefore low cost-effectiveness.
Up until now it is still a controversial issue among prescribers and health insurers, especially the
in the Civil Servant Medical Benefit Scheme that whether it should be included the cost of treatment in
public health insurance system.
Dramatically increasing in the cost of OPD drug reimbursement under the CSMBS resulting in policies
to control and reduce the cost. The cabinet mandated Comptroller General’s Department (CGP) to
manage such policies into practice. A technical taskforce was appointed and assigned to study and propose
policy recommendations. Based on a key study by the technical taskforce, medical benefit and
pharmacoeconomic aspects of Glucosamine HCL (GS) are not well established. Thus, it was recommended
to remove GS from the list of reimbursement. This resulted in the CGP regulation announced on January 1, 2011. Affected patients and other stakeholders fight against the regulation. Conflicts and arguments
were presented in newspapers continuously for 6 months. The analysis of news coverage using 62 news
clippings compared the achievement of policy advocate and the opposition in using media to affect policy.
It clarified that the advocate seemed to be more successful in output from media both in size and PR value
of news but the outcome return to be different. Resulted from sender, message and channel strategies and
variety of alliance, the opposition successfully blocked the regulation. This article suggests on future advocacy
and media strategies for CSMBS reform processes.
Over two decades, the expenditure for Civil Servant Medical Benefit Scheme (CSMBS) which employed
the open-ended provider payment methods has a continual double-digit annual growth. In recent
years, the outpatient expenditure outpaced the inpatient one. An analysis of prescriptions and expenditures
of the outpatient drugs of 26 out of 34 large public hospitals under the direct billing system in 2009
revealed that on average 41% of total prescriptions and 67% of expenditure belonged to those not covered
by the current National Lists of Essential Medicines. The highest proportion of the non-essential (NE)
drug prescriptions occurred in university hospitals (45%), whereas the NE proportion in the Ministry of
Public Health hospitals and other ministries was relatively lower (35% and 42%, respectively). However,
the NE share of drug expenditure was similar across the three hospital types (66-68%). The top six therapeutic
classes of drugs, sharing 41% of total drug expenditure, were antilipids, anticancers, antiosteoarthritis
(nonsteroidal anti-inflammatory drugs -NSAID, COX-2 inhibitors and symptomatic slow-acting drugs
for osteoarthritis -SYSADOA), antiosteoporosis, angiotensin converting enzyme inhibitors (ACEI) and
antigiotensin-2 receptor blockers (ARB), and antisecretory/antiulcers (histamine-2 receptor antagonists -
H2RA and proton pump inhibitors -PPI). The NE drugs accounted for 86.4% of the expenditure for antilipids,
87.8% for ACEI-ARB, 93.6% for antiulcers and 97.2% for antiosteoarthritis. With respect to market status,
the single-source products accounted for 92.3, 86.0, 65.0, and 44.0% of the expenditure for antiulcers,
antilipids, ACEI-ARB, and antiosteoarthritis, respectively. A case study of university hospital with relatively
low use of NE drugs revealed that leadership of the hospital administrator and the Pharmacy and
Therapeutic committee is a key to success of cost containment that can counteract threats from market
strategies of drug industry and misunderstanding of prescribers toward the use of the NE drugs. It was
recommended the central administration of CSMBS should give priority to cost-containment policies including
reference pricing systems for drug reimbursement, monitoring and evaluation using prescriberspecific
drug utilization data. In addition, appropriate financial incentive for well-performed hospitals,
capacity building for hospital personnel in data analysis and platforms for knowledge sharing should be
introduced.
The medical expenditure for outpatients under the Civil Servant Medical Benefit Scheme’s direct
billing system continued to be very high in 2009-2010 due to the use of drugs outside the National Lists of
Essential Medicines. This study estimated potential cost-savings using the aggregate drug utilization data
from 28 large public hospitals under two scenarios of reimbursement: 1) the lowest price of generic in each
drug group, and 2) median price of each drug. If the reimbursement rate was set most restrictively based
on the minimum price of the essential drug with an equivalent Anatomical, Therapeutic, and Chemical
(ATC) code 1-3 (eg. the lowest price of simvastatin for antilipids), the expenditure for antilipids,
antiosteoarthritis (non-steroidal anti-inflammatory drug (NSAID), cyclo-oxygenase (COX-2) inhibitor, and
symptomatic slow-acting drugs for osteoarthritis (SYSADOA)), and antisecretory/antiulcers (histamine-
2 receptor antagonist (H-2RA) and proton pump inhibitor (PPI)) in 2010 would be reduced by 72.8, 85.7,
and 86.5%, respectively. If each individual hospital was allowed the drug reimbursement as is but no
higher than a ceiling determined as the median of price per prescription for the drug with the equivalent
ATC 1-5, the expenditure for antilipids and antiosteoarthritis would be reduced by 13.4 and 13.3%, respectively.
For 20 drug groups with relatively high expenditure, the reimbursement ceiling could reduce the
expenditure by 14.0%. The least restrictive reimbursement condition using a fixed rate referent to the
median price of drugs with equivalent ATC 1-5 from all hospitals could reduce the expenditure for the 20
drug groups by 2.9%. Therefore, to contain expenditure using a fixed rate of reference price based on
drugs with an equivalent ATC 1-5 would be the least restrictive policy option.
Therapeutic drugs, a major component of outpatient care have made the utilization pattern in the
Civil Servant Medical Benefit Scheme (CSMBS) different from the Universal Health Coverage Scheme
(UCS). This study analyzed a time-series of 57 months during 2003-2007 for drug prescriptions in 6 Regional
Hospitals and General Hospitals and forecast the overall expenditure. Four therapeutic classes
with high expenditure or frequent use, including angiotensin-converting enzyme inhibitors (ACEI) and
angiotensin-2 receptor blockers (ARB); antilipids; proton pump inhibitors (PPI) and histamine-2 receptor
antagonists (H2RA); and non-steroidal anti-inflammatory drugs (NSAID) plus COX-2 inhibitor were analyzed
with respect to two expenditure components; (1) propensity to use the target drugs, which are not
covered by the National Lists of Essential Medicines or are the single-source products, and (2) the utilization
quantity. Results from the expenditure forecast before and after the CSMBS’ direct billing policy and
the UCS’ 30-Baht copay abolition policy using a segmented regression analysis revealed that the use of the
following target drugs, including ARB, non-essential antilipids, single-source PPI and COX-2 inhibitor
was associated with the total and expenditures growth of the four classes. The close-end method of provider
payment currently employed by the UCS, if applied to the CSMBS would be able to reduce 40
percent of the expenditures for PPI-H2RA and NSAID-COX-2 inhibitor to 100 percent of the expenditure
for antilipids. For the substitution measure, the degree of cost-saving would depend largely on the policy
compliance levels. With the 20 percent compliance, 8 percent of the expenditures for PPI-H2RA and NSAIDCOX-
2 inhibitor and 20 percent for antilipids could be saved. With the 80 percent compliance, the costsaving
would range from 30 percent to 80 percent.
Antibiotic prescribing for acute diarrhea was common among prescribers although most for acute
diarrhea conditions were not caused by bacterial infection. The purpose of this study was to investigate
antibiotics prescribing for acute diarrhea in the outpatient department in Pua Crown Prince Hospital,
Nan province. Medical record of the targeted patients during 1 January to 31 December 2009 were evaluated
regarding antibiotic prescribing. Criteria for antibiotic prescribing for acute diarrhea included having
fever (38o C or above) and mucous or bloody stool or stool exam with red blood cell and/or white
blood cell. Result showed that of a total of 613 patients with acute diarrhea, 406 patients (66.23%) were
prescribed antibiotics. For patient who received antibiotics, 90.40% were identified as irrational antibiotics
prescribing. This data showed that clinical practice guideline was important data to make good decision
to start antibiotics in patient with acute diarrhea.
The high-risk medications used in the elderly is a pressing problem that is a concern in many countries
around the world. However, in Thailand there is still lack of studies related to this issue. Therefore,this study was aimed at surveying the high-risk medications used in the elderly at Wang Taku Subdistrict,
Nakhon Pathom based on the criteria for high-risk medications used in the elderly of Winit-Watjana W. et
al. The data of this cross-sectional study were collected by surveying and interviewing the elderly. Of 118
elderly, 72.9 % were female. Average age was 72.63 ± 5.25 years. Most medical problems found were
hypertension, (76.3%). Of 421 drug items, 92 items were high risk medication use or 0.78 item per patient.
The findings revealed 79 drug items with potentials to cause adverse reactions; 11 drug items with drugdisease
interactions and 2 drug items with drug-drug interaction. After analyzing each subgroup, angiotensin
converting enzyme inhibitors (out of 34 drug items) was mostly found in causing adverse reaction
and non-steroidal anti-inflammatory drugs (16 drug items) were subsequently found. In drug-disease
interaction subgroup, hypertension/heart disease (9 items) were found to be the most, and the other 2
items were gout-hydrochlorothiazide (HCTZ) and asthma/ COPD-benzodiazepine. The last subgroup,
drug-drug interaction, aspirin with NSAIDs and digoxin with HCTZ were found. Results of this study
can be used to develop a guideline for advising and monitoring high-risk drug use.