plueme/wizJson huggingface dataset:
Health sector reform: experiences in ten countries	This report aims to synthesize lessons derived from health sector reform experiences in ten countries, namely, Germany, United Kingdom, Australia, New Zealand, Japan, Republic of Korea, Republic of China (Taiwan), Singapore, Malaysia, and the United States. The main source of data for the synthesis comes from reports on health sector reform of these ten countries commissioned by the Health Systems Research Institute. Other sources include journal articles and discussion with academicians from some countries. 	Analysis of the structural aspect of reform addresses 1) overall structure of the health system, 2) benefits and choices available to, and burden borne by the consumers/ patients, 3) provider characteristics and payment mechanisms, 4) insurer/ fund characteristics, sources of fund, number and roles of insurer, and 5) intermediate system outcomes. Policy process model is used as the framework for comparative analysis of reform process. Lessons on the policy processes in each of the following policy stages are compared and contrasted: 1) agenda building, 2) policy formulation, 3) policy adoption, and 4) policy implementation. 	Experiences from these ten countries indicate that countries succeeded in instituting universal coverage of health care all employ compulsory insurance. While systems managed by a single insurer or insurance fund are often found to be less responsive to client needs, those managed by multiple insurers suffer from problems such as cream skimming, distribution of risk among insurers, and system inefficiency. Appropriate rules are needed to ensure overall equity, quality, and efficiency of insurance system(s) in a country. Insurer should be a prudent purchaser, playing active roles in selecting, negotiating with providers, and monitoring quality of care. Payment mechanisms can be designed in such a way that overall costs are controlled, while health promotion and preventive services are promoted. 	Health sector reforms taken place in these countries in the past century had two main objectives: expansion of insurance coverage and cost containment. Reform processes in most countries culminated in the enactment of laws. Experiences in some countries show that simply passing insurance laws does not always lead to the desired outcome. Implementation of policy is no less important than policy formulation and adoption for the accomplishment of reform objectives. Factors affecting the success of reform process include the degree the reform initiatives are in accordant with societal values, whether a comprehensive or a piecemeal approach to reform is employed, economic condition at the time reform movement took place, relative political power among the various stakeholders, political mobilization of the movement, development of technical capability for implementing reform, and the effectiveness of policy communication.
The purpose of this qualitative study was to explore the situation of alternative health systems for promoting the health of middle-aged women in 3 regions of Thailand. The study was undertaken at health services institutions and public places both in urban and rural areas of Chiang Mai (North), Khon Kaen (Northeast), and Songkhla (South), Three hundred and fifty seven women age 40-59 and eighty-two health discussions were used for data collection during March 1999-Februry 2000. Triangulation and content analysis were used for validation and analysis. Seven main themes emerged in describing an existing situation of alternative health promotion in the way of living and holism 2) Factors and conditions within women’s life and social context that lead to health promotion practice 3) Abundant and confusing information on the health promotion for middle-aged women 4) A modern health system which is based on health profession 5) An alternative health system which is independent and community based 6) Alternative health practices which emphasize mostly on nutrition, mind control, exercise, and using chemical agent and 7) Middle-aged women used alternative health systems more than modern medicine but health insurance undermined the health promotion activities. It is suggested that empowering women group in using alternative health systems and expanding their social arena are ways of developing alternative health systems to promote the health of middle-aged women.
Evolution of Thailand's HIV/AIDS  Preventive and Alleviative National ProgrammedObjectives : To study evolution of Thailand's HIV/AIDS  Preventive and Alleviative National Programmed from the advent of HIV/AIDS epidemic until the end of 1997. Subjects and methods : Researchers revised and analyzed the HIV/AIDS related  studies to illustrate Thailand 's missions and activities to prevent and control HIV/AIDS epidemic. To conceptualize AIDS paradigm shift the studies were subcategorized into 6 parts : AIDS  paradigm  development,  evolving  HIV/AIDS  information  system  for  good governance, HIV/AIDS catalytic role for civil society,  AIDS public policy development, as well as evolution of the HIV/AIDS social and health services.  Then the conceptual frame work for Health Promotion from the Ottawa Charter was employed to analyze the emerging Thailand's societal AIDS response.Results : HIV/AIDS public policy have been developed to create up the strategic infrastructure for HIV/AIDS prevention and alleviation. The crucial strategic areas which was the main finding are social environment, personal and community empowerment as well as social and health measure reorientation.   To achieve these societal evolution, the well developed information system to intercommunicate all the strategic alliances have been undertaken and an effective advocacy had been continually worked out so that the government can play their central role to collaborate the participatory function all the sectors. The individual and community empowerment have been turned to be the major tooldeveloped  to  change  the  people's  life  style  so  that   the epidemic of HIV/AIDS is under control and the HIV incidence have declined to a lower rate than last 5 years ago.Conclusions : AIDS crisis is so serious and complex that it can alert Thai society to learn and understand the intertwined health causal determinants which have its roots from social, economic, cultural and political infrastructure. The way its government develop a sounded health promotion strategy is the valuable lesson learnt then apply to other kind of health  problems.
Promoting the Civil Society and Mass Media for Health System ReformThis study is a participatory action research project launched in 4 provinces of 4 pouts of Thailand, including: Nakornratchasima, Trung , Phitsanuloke and Samutprakarn for 18 months  during May 2000 to October 2001.The objectives are to study existing relationships among three local networks:   public health network, mass media network and civil society network ; and to promote learning processes and cooperation model development for creating  health system reform movements at local level.The project  was  delivered by a central team and 4 area teams of researchers. The operation has 4 steps: (1) study the area contexts and mapping local potentialities (2) workshop of the researchers and some key persons from the target networks to identify a definite issue for social movement, target  groups and to design a process of movements (3) take action (4) workshop for lessons learning and synthesizing a body of knowledge about the possible roles of civil society and mass media for promoting the health system reform.The project findings are:	1. In the process of social movements promoting the health system reform to be a consensus local agenda, the issue of “social health” is sound possible and appropriate because local communities have holistic viewpoints for their health.	2. The powerful communications to promote local agenda of health need an integrative model of mass media, traditional media and personal media which request an appropriate designing for a specific area. 	3. A civil society of mass media for local health could be easily organized by setting a angular platform for health issue dialogue. The stakeholders, local intellectuals, academics, professionals, mass media and traditional media are the target groups to participate the forum, which should be started from their common heath problems or same local public issues.	4. The local civil society has potential roles of  “the learning process” and “the movements for social change” which takes part in social a wareness, promoting of  people   participation and local interactive learning through actions as well.
Conceptual framework for reforming the system of diseases prevention and control in Thailand was developed in this study. Issues which were involved, were 1) situation and trend of epidemiology, society changes which had influence to the system 2) strength and weakness of the existing system 3) recommendation for reforming the system. The study results were summarised as following;situations and impact of diseases were considerably changing, globalisation was promoting severity of both communicable and non-communicable diseases,decentralisation was making necessity to reform the system,the existing system had two major problems; lack of coordination in responsible organisations resulting ineffectiveness of handling problems and much emphasis on project based administration in addition to academic development which was useful for coping new and complicated problems,all disease control organisations should be united into single organisation for developing,Health Research Institute should be established to develop body of knowledge similarly to the US National Health,the establishment of the institute and merging all responsible organisations into single organisation should be stated in the National Health System Reform Act,the disease prevention and control system in many countries were studied to be taken as inputs for reforming.
The purpose of research is to study the communication process on health campaign among government, non-government, private and community organizations, by the leader or those who send messages in the organizations, and target groups for the campaign. Sample groups were purposefully selected, with 106 campaigns for quantitative study and 20 campaigns for qualitative study. All of these were campaigns for health promotion projects related to nutrition, exercise emotions. Disease-fee condition, and general good health. Data collection was done by using questionnaire and interview for quantitative data. In-depth interview, group discussion and observation are employed for qualitative data. Results of this study can be summarized as follow.Majority of health campign process were two-way communication, using individual messenger, event specific message, and mass media. Majority of the target group had the awareness but lacking consciousness and sustainability in health practices.In order to have effective health campaign, messenger had to have high level of trustworthiness and public concerns, while the message should be on holistic health. Message was communicated by individual messenger and mixed  media. Receivers should be involved individuals in health campaign.Influential factors in health campaign were leaders, social support, budget, involvement, participatory communication, networking and network communication, holistic health promotion, and community-center campaign.	Recommendations for health campaign are as follow.Empower, promote and support potentials of leadership, and core group to have capabilities in knowledge management, learning process, and skills in having good health and communication.Support networking in health campaign, by organizing activities and having regular network communication.Support for budget and other resources should be collective effort by every members in the alliance, groups, or network. This support should be consistent and completely covered all the necessities.Policy on strategic campaign should emphasize on participation of everyone involved, in every steps of campaign, by government, non-government, private and community organizations.Health campaign should be community-centered campaign, in order for the public to be aware of, interested in, and consciously driven, to have appropriate and sustainable health behaviour changes.
Health systems reform in TaiwanThis documentary study presented the developing process of health system in Taiwan. Strategies, tools, and other experiences those are applied to solve health problems in Taiwan will be learned Taiwan has succeedded in economics and industrial developments as well as impressive gains in the health of the general population. However new health problems accompany with the rapid rising cost of health expenditure and access to care problems are primary factors for formulating policy in health reform in Taiwan.These are:Setting of medical care Network: to balance their medical resources,Applying the National Health Insurance(NHI) Project in 1995Creating Computerized Patients and Health Information Network to improve health service facilities, andDeveloping Family Practice Tranning Programs for their personal. This universal coverage NHI program creates monopsony buying power and promotes administrative efficiency. Fee-for service and co-payment are used as financial strategies.Although the health system reform is able to distribute providers and facilities to remote areas and gives a chance for the poor to access health services, the cost of health expenditure in still rising. Many payment mechanisms such as capitation, case payment, or global budget and other administrative strategies are proposed by experts to solve this problem. Many differencess between Taiwan and Thailand should be concerned when some health reform strategies will be brought to apply in our country. Very contrast to Thailand, the strength of economic sector and government in Taiwan make at least 2 programs, NHI program and medical care network program, possible. Thus, these strategies should be careful if implement in Thai society. Many tools for health system reform from the Western countries, however, many have limitations for solving health problems in oriental developing countries as Thailand.
Currently, psychiatric patients classification for budgeting allocation’s purpose by employing diagnosis might be appropriate for acute disease but not implicitly to psychiatric cases. Psychiatric patients have their own special characteristics as follow: a requirement of joint symptoms’ diagnosis, less doctoral procedures, long average length of stay, various existing mental health assessments but not specifically designed for the purpose of budget allocation. The purposes of this research is to analyze various mental health assessments employed at Suan Prung Psychiartic Hospital and to study the correlation between mental health services cost and mental health assessment point given by hospital staff. The study is considered in the in-patient department by case mix method.Methods	The retrospective study collected and collated information from 1,207 out of  a total 3,715 cases from patients who came for services in in-patient department, Suan Prung Psychiartic Hospital during March to December 2002. Each selected individual patient for this study had to have 4 kinds of mental health assessments: Global Assessment of functioning Scale (GAF), Clinical Global Impressions (CGI), Brief Psychiatric Rating Scale (BPRS), and Assessment of Functioning form Mental Health Department. Individual’s information shall be periodically collected during each individual’ services stay. This study shall be employed a linear equation by categorizing costs into routine service costs, medical care costs, and individual drug costs. Results Our findings based upon 4 mental health assessments employed at Suan Prung Psychiartic Hospital show: significant correlation among individual assessment; Level of mental severity relate to level of services cost. The study shows that case mix of Schizophrenia, Paranoid and Acute psychotic disorders is the most costly, followed by Mood disorders; Mental retardation; Anxiety disorders, Eating disorders, Obsessive compulsive disorders, Personality disorders, Stress and Adjustment disorders; Alcohol Related; disorders and Drug Related, respectively. The following key factors directly affect mental health service costs in deceleration order: average length of stay, electro convulsive therapy, diagnosis, age, and gender.Conclusions After analyzing mental health assessments, our finding is health services costs are inconsistent between case mix and mental severity. Mental health assessments employed at Suan Prung Psychiartic Hospital that reflects budget allocation is GAF.
The spread of AIDS epidemic in Thai society through some forms of sexual contact led to the policy that has been focusing on changing sexual behavior of people. Certain forms of behavior, such as teen and commercial sex, have been classified as highly risky. The policy relies on the measures to convince or force people to contain their sexual conduct in monogamous marriage. Although such measures succeeded in raising public awareness about AIDS, sex outside marriage has continued and new high-risk groups emerged. People in Thai society seem to resist the attempt of the state to discipline their sexual behavior. Based firmly on dominant system of belief about sexuality, policy on AIDS reflects and perpetuates sexual and gender inequality which has been accounting for social vulnerability to contact the HIV virus of various groups of people. The policy has been a mechanism to control sexual practices of the people. The policy process on AIDS issue has also been a site of contestation of many groups with different sexual beliefs.  Policy on AIDS has been affected, as well as a part of, sexual politics that people negotiate and resist the dominant version of sexuality in Thai society.
There has been significant improvement in distribution of human resources for health in Thailand. Historically, a shortage of health personnel in rural areas was severe. Nevertheless, the most needed group in rural areas was the physician. The doctors, dentists and pharmacists in rural areas were mostly under compulsory service program by which they were financially subsidised while studying. Nevertheless, there were high turnover rates of these groups in rural areas. The Bureau of Health Policy and Planning was responsible for determining needs for HRH (human resource for health) for utilisation while the Ministry of University Affairs (MUA) mainly produced HRH especially doctors, dentists and pharmacists. However, the Office of Civil Service Commission (CSC) controlled staffing patterns of all public health facilities. Most reasons of leaving district level given by HRH were job dissatisfaction and their need for further training especially for being specialists. However, health sciences students and their parents were not against the compulsory service program rather favouring government financing for education. The paper proposed number of doctors at the provincial level be less than that of district level which was opposite to the CSC’s requirement and the compulsory service program be remained for doctors, dentists and pharmacists. More equity of HRH distribution among provinces should be implemented and additional budget should be given to district health facilities to employ additional staff. Financial and educational incentives should also be delivered for those working in rural areas.
Lack of coordination for health policy implementation was concerned due to the fact that health policy had been largely determined and implemented by the Public Health Ministry. 	This study was aimed at synthesing alternatives to processing health policy, strategies and national health plan by reviewing health policy making process in other countries and development of other public policy in Thailand. Interviewing well-experienced people was also performed. Concepts for developing processes of national health policy determination were:firstly, the Thai Constitution in which civil involvement should be strengthened in policy making process, secondly, desirable mechanisms in which efficiency in administration, good governance, synergistic working, political accountability and evidence based implementation were created,thirdly, mission in which direction of national health policy (short to long term) was obvious,fourthly, three alternatives for processing health policy and determining health strategies were proposed. 	The first alternative was to promote coordination between public, private, community and people; nevertheless, bureaucratic implementation was likely to occur due to availability of many processes. The second alternative was to support civil society movement and to allow the cabinet to act as governing body. Even though flexibility to administration might be achieved, a number of societies were unlikely to be part in the policy making process. The third alternative was to let the mechanism under the Ministry of Public Health responsible for people health and determining national health policy. However, coordination with other organisations might be difficult to take place.
The objective of this study was to examine characteristics of non-profitable hospitals, as compared to profitable hospitals, in Thailand.  Administration national data for 640 public hospitals of fiscal year 2002 from Ministry of Public Health were analyzed.  A two-part model estimated by logistic regression and ordinary least-squares regression was used to examine the likelihood of hospital loss and the amount of loss, respectively.  The results showed that various managerial, service mix, and market variables were significantly associated with the likelihood of hospital loss.  An increase in average hospital Universal Coverage (UC) inpatient day per number of the UC and the concentration of hospital market could significantly increase the likelihood of hospital loss, while an increase in the average Civil Servant Medical Benefit Scheme (CSMBS) hospital inpatient day per number of the CSMBS inpatients and average Social Security Scheme (SSS) hospital inpatient day per number of the SSS inpatients decreased the likelihood of hospital loss.  The ratio between total patients and number of full-time employee was positively associated with the likelihood of hospital loss, but it required cautious interpretation since it was confounded by the employee salaries that was not included in this study.  Beside managerial, service mix, and market variables, the hospital characteristics also were associated with the amount of loss.  The larger hospitals and hospitals located in central area of Thailand tended to have higher amount of loss.  The results also suggested that managing the number of hospital employee, inventory, and patient hospitalization could control the amount of loss.  In conclusion, most of identified determinants of hospital loss were manageable.  The ramification of this study was to help policy makers understand the hospital loss situation in Thailand after implementing the UC scheme and design policy to resolve the hospital loss problems.