plueme/wizJson huggingface dataset:
Direct non-medical cost (DNMc), the cost incurred to patients and caretakers while receiving medical
treatment, is deemed essential in cost estimation from the societal perspective. However, information on DNMc is largely lacking in the Thai context. This study aims to assess DNMc of in-patients at Suratthani
hospital.
A cross-sectional survey was conducted to collect information from 241 patients at Suratthani hospital,
a provincial hospital in Southern Thailand, during 8 May - 7 July 2012. The cost data, including travel
cost, productivity cost, and costs of food and accommodation, were gathered by interviewing patients
and caregivers, with base year 2012. The costs of food, productivity, and accommodation during the 24
hours prior to the interview were counted.
Results showed that the average DNMc incurred by each in-patient was 1,457.10 Baht per day (24
hours). The average DNMc incurred to each caretaker was 1,160.60 Baht per day. With respect to the
household area, the daily average DNMc of in-patients who lived in the municipal area of Suratthani,
outside the municipal area of Suratthani, and outside Suratthani were 1,036.20 Baht, 1,468.70 Baht, and
2,283.40 Baht, respectively.
This study sheds light on the DNMc of in-patients and caretakers, which not only helps medical
professionals plan more efficient medical treatments, but is also an important piece of information used in
conducting economic evaluation research. Future studies, assessing DNMc in other provincial and community
hospitals, are recommended.
This study aimed to analyze pharmaceutical purchasing capability of public hospitals using the
Pharmaceutical Acquisition Capability (PAC) Approach. The 2010 purchasing data of public hospitals
was provided by the Drug and Medical Supply Information Center (DMSIC), Ministry of Public Health. the data analysis was done by selecting the drug items that were submitted to DMSIC by more than 3
public hospitals. Total 31 items were included in this study that were categorized into 5 pharmacological
groups i.e. 1) HMG-CoA-reductase inhibitors or Statin, 2) Proton pump inhibitors (PPI), 3) Blood-glucoselowering
drugs, 4) COX-2 selective inhibitor, and 5) Combination of Statin. It was found that a number of
markets held Gini coefficient higher than 0.500. This could be interpreted that purchasers in this market
could buy the product at lower price suggested by PAC-DSS. In addition, high average PAC was also
found in the market with multiple sellers, leading to the recommendation that purchasers could easily
negotiate their price in this market. The study estimated that if hospitals had purchased 31 drug items at
PAC-DSS suggested prices, these public hospitals as a whole would have gained 77 million baht saving.
The standardization and development of data entry system is strongly recommended for better outputs.
The future study on additional invention of feedback information is also suggested to benefit users.
This case study was aimed to explore the processes of developing result-based strategic plan for
health promotion, prevention and disease control. Participants were 13 staff members who highly involved
with the processes of strategic development and plan of Bureerum Provincial Public Health Office.
They were purposive selected. Data were collected using focused group interview. Findings from the
study revealed three major processes of strategic planning including preparation, reviewing strategic agenda and binding up the master plan. The process of preparation involved seeking a better understanding,
early planning and data preparation. The steps in reviewing strategic agenda consisted of linking policy
from central level to the provincial needs, brain storming and revising the strategic agenda. Binding up
the strategic plan consisted of developing master plan, integrating projects and outcome indicators and
making plan more flexible. Suggestions to the findings of this study are to promote the strong intention of
the provincial admistrators in using result-based strategic planning for their administration and to promote
development of essencial competencies and skills related to the planning for their human resources.
The survey of core and functional competencies in relation to result-based management may guide the
plan for human resource development in diferrent levels of their team as well as promoting continuing
development of working processes covering overall areas in relation to the plan.
The objective of this paper was to study the epidemiology of blindness, low vision and eye diseases
in Thai children population by analysis the secondary data of surveyed sample aged 1-14 years totally
2,743 cases in the First Thai Visual Impairment Project 2006-2007. The surveyed data weighted on the
basis of stratified cluster random sampling represent the whole country was collected in 22 provinces.
The study found that the prevalence of blindness and low vision were 0.11% and 0.21% respectively.
The estimated number of blindness and low vision in Thai children population were 13,101 cases and
26,670 cases respectively. The causes of blindness were retinopathy of prematurity (ROP) 66.67% and amblyopia from uncorrected high myopia (-9.00 diopter both eye) 33.33%. The causes of low vision were
amblyopia from uncorrected high myopia (-6.00 and -11.00 diopter both eye) 28.55%, cortical blindness,
congenital cataract, optic atrophy, corneal disorders and congenital nystagmus 14.29% each. Top five of
eye diseases with visual impairment were refractive error 19.36%, strabismus 1.24%, amblyopia 0.36%,
cataract 0.25% and eyelid disorders 0.22%. Top five of eye diseases without visual impairment were glaucoma
suspect 0.73%, allergic conjunctivitis 0.22% and nasolacrimal duct obstruction, epiretinal membrane,
pterygium, retinitis pigmentosa 0.12% each.
Thus the Ministry of Public Health and the Department of Medical Services who have the responsibility
to take care the health of the population, should have the effective policy and strategy to reduce the
prevalence of childhood blindness and low vision. The comprehensive projects cover early detection,
proper intervention and referral system for complicated cases with participation of the community were
the key of success factors.
The purposes of this cross-sectional study were to study the disease and injury preventative behaviors
and to exam factors related to disease and injury preventative behaviors of garbage collectors during flood crisis. Data collection took place during February to March 2012 by using self-reported questionnaires
from non-randomization of 186 garbage collectors who worked in one district office of Bangkok
Metropolitan. Employing descriptive statistics, chi-square and multiple logistic regression, the overall
results found that the garbage collectors had the disease and injury preventative behaviors at a low level
(60.5 %). The relation between factors and the disease and injury preventative behaviors after adjusted for
the other variables in the model showed: 1) using self-preventative equipment behaviors statistically correlated
with the provision of these procured by the office for individual prevention tools at a high level
[ORadj (95% CI)=15.37 (4.24, 55.69)] and at a middle level [ORadj (95% CI)=4.63 (1.64, 13.09)] and appropriated
income with responsibility during flood crisis at a high level [ORadj (95% CI)=10.21 (2.56, 40.74)] and
at a middle level [ORadj (95% CI)=3.94 (1.46, 10.66)] respectively. 2) injury preventative behaviors statistically
correlated with the appropriated income at a high level [ORadj (95% CI)=6.76 (2.31, 19.79)] and thoughtfulness
and admonition of colleagues for during work accidents at a high level [ORadj (95% CI)=5.25 (1.50,
18.31)] respectively. And 3) risking injury occupational behavior statistically correlated with worked training
at a low level [ORadj (95% CI)=9.28 (2.71, 31.81)] and at a middle level [ORadj (95% CI)=4.05 (1.11, 14.73)]
respectively. In conclusion: Collecting garbage during flood crisis, the responsible office should plan and
modify predisposing factors, enabling factors and reinforcing factors for management in order to prevent
the diseases and occupational injuries.
This study analyzed the cost effectiveness of Alendronate (generic product) and Risedronate (original product) for the primary prevention of fractures in postmenopausal women with clinical risk factors, including rheumatoid arthritis, long-term use of oral glucocorticoids, a parental history of hip fracture,
high alcohol consumption and current cigarette smoking. A Markov model with nine health states was
applied to estimate total costs and effectiveness for eight age-groups (45, 50, 55, 60, 65, 70, 75 and 80 years
and above) under the healthcare provider perspective. The model used a 10-year time horizon and assumed
the 5-year duration of medication with a linear efficacy reduction after stopping the medication,
and 50% medication adherence. Epidemiological data on natural history of disease, clinical efficacy, cost
and utility data were obtained from literature review. An increased risk of fractures in patients with the
risk factors was adjusted according to the relative risks, which were estimated using the FRAX® model
under the conditions of the bone mass density (BMD) t-score of -2.5SD and body mass index of 24 kg/m2.
The results showed that incremental cost-effectiveness ratio (ICER) of Alendronate and Risedronate for
the primary prevention of fractures in the postmenopausal women who had no clinical risk factors was
equal to 801,353-7,012,743 and 1,727,023-13,967,461 Baht/quality-adjusted life year (QALY), respectively.
The ICER was higher than three times of gross domestic product (GDP) per capita. When clinical risk
factors were considered, the use of Alendronate was cost-effective for women who were 75 years or above
and had the parental history of hip fracture (ICER, 202,089 Baht/QALY) or had the long-term glucocorticoid
use (ICER, 473,821 Baht/QALY). Risedronate was cost-effective for women who were 80 years or
above and had the parental history of hip fracture (ICER, 399,114 Baht/QALY).
Previous research has demonstrated the incurred direct non-medical costs (DNMc) of in-patients in
Thailand. However, the extent to which individual factors are associated with the DNMc is as of yet
unknown. The purpose of this study is to examine factors influencing the DNMc of in-patients at Suratthani
hospital.
We conducted a cross-sectional study to estimate DNMc from 301 in-patients who were admitted at
Suratthani hospital during 8 May - 5 September 2012. Travel costs of the patients and the daily DNMc of
the caretakers were estimated using 2012 as the base year. The associations between DNMc and relevant
attributes, including admission ward, gender, age, household area, and the chronic condition for which
the patients were admitted, were assessed using statistical methods at the significance level of 0.05.
The mean travel cost of the patients was 251.9 Baht, and the mean of the 24-hour DNMc of the
caretakers was 1,417.0 Baht. Evidence indicates that factors associated with patients’ travel costs include
ward (p-value<0.0005), gender (p-value=0.02) and household area (p-value<0.0005). For caretakers, factors
associated with the daily DNMc were ward (p-value<0.0005), gender (p-value=0.005), age (p-value =
0.02) and household area (p-value<0.0005).
The results of this study indicate that admission ward, gender, and patients’ household area play an
important role in determining patients’ travel costs and DNMc of the caregivers. Future research should
focus on identifying underlying factors influencing the DNMc across these relevant factors. In addition,
measures to reduce this hidden cost, such as improving the capacity of the community hospitals for managing
certain common diseases, are highly recommended, with the aim of alleviating economic barriers to
hospital access by patients.
Since May 2011, CSMBS patients have been allowed to get certain elective surgeries in accredited
private hospitals. The scheme pays private hospitals by case-based payment, Diagnosis Related Group
(DRG), and the hospitals can charge extra for bed and board and doctor fee. This study aims to assess
utilization trend of CSMBS patients for certain elective surgeries in both public and private hospitals prior
to and after policy implementation, and its impacts on service utilization of UCS members, efficiency of
service provision, and burden of expenditure on patients and the scheme. Claim administrative databases
of the CSMBS and UCS were employed in the analysis.
Results reveal that Intraocular Lens (IOL) Replacement for cataract was major procedure used in
private hospitals, 80%, followed by childbirth (5%) and knee replacement (3%). the number of patients
receiving IOL has been prominently increased following the policy. This was due to relatively high payment
rate for IOL, active screening for patients with cataract in communities together with no co-payment
policy and free transportation provided by one private hospital chain who was major provider under this
policy (74% of cases). Shifting of CSMBS patients to private hospitals let public hospitals having more
available beds and doctor’s time for UCS patients. The numbers of childbirth and knee replacement in
private hospitals under the policy were low due to lack of active marketing, relatively high copayment
especially for knee replacement. Negative impact on public hospitals located in provinces where many
patients got care from private hospitals was not found. Under prospective payment system, private hospitals
were more efficient in managing resources. Private hospitals selected better paid procedures in the
provision; moreover, there was huge variation in the level of copayments for same procedure of different
private hospitals. The policy increased expenditure on private inpatient care; however, it did not affect
overall expenditure of the scheme.
In conclusion, the policy increased access to IOL replacement for cataract patients among CSMBS
members; however, monitoring and evaluation system should be strengthened before scaling up the program.
The Civil Servant Medical Benefit Scheme has extended its’ benefit by allowing beneficiaries to get
elective surgery in accredited private hospitals with some cost sharing since May 2011. Three are 77 avail-able procedures in 32 private hospitals for this matter; however, three main procedures, intraocular lens
replacement for cataract, knee replacement surgery, and cesarean section, accounted for 88 percent of all
procedures. This study aimed to assess patients’ experiences in getting elective surgery from private hospitals
in terms of channels of receiving information and access to private hospital, burden of expenditure,
and their satisfaction. The study employed a telephone interview with patients or care givers, who received
any of the three main procedures, within a week after being discharged from private hospital.
Results reveal that majority of users were those with age60 and above and were parents of civil servants.
Main channels of information about this benefit gotten by the patients included physician who provided
care for them, message from friends or relatives, and public relation of private hospital. Apart from community
screening for cataract, physician who works in both public and private hospitals was key actor
bringing the patient to private hospital. Main reasons for getting care from private hospital include shorter
queue, convenience in transportation, and following their preferred physician. Majority of them were
informed about the payments prior to admission; however, most of them did not know that they could
compare the price with that of other hospitals prior to making decision. It was found that the level of cost
sharing for knee replacement surgery varied greatly, ten times, among private hospitals. This let some of
them reporting incurred financial burden even though it was unclear whether it was catastrophic for
them. However, this made some of them would not recommend the others to use private hospital. Despite
the cost sharing, majority of them had high level of satisfaction in using private hospital and would recommend
the others to use private hospital for elective surgery.
The Civil Servant Medical Benefit Scheme has expanded its benefit by poviding access to 77 elective
surgeries in contracted private hospitals since May 2011. This study aimed to assess institutional capacity
of the Civil Servant Medical Benefit Scheme (CSMBS) in regulating contracted private hospitals. Issues of
assessment included system design, factors influencing effectiveness of the regulation, and implementation
of the policy in regard to provider’s responses and medical record audit. We conducted in-depth
interviews with key stakeholders and analyzed medical record audit reports. Content analysis and descriptive
statistic were employed in the analysis.
Results show that the policy aims to increase choices of access and reduce waiting time for elective
surgeries among CSMBS beneficiaries. Moreover, the policy will increase level of patients’ satisfaction
while costs of the scheme remain contained. The policy was carefully designed in order to prevent fraud,
inappropriate care, and protect consumer’s right. Minimal standard regquirement of enrolled hospitals
was set including authorization process, and information needed for claim submission. However, limited
institutional capacity of the Comptroller General’s Department under the Ministry of Finance who manages
the scheme remained a major constraint in policy implementation; moreover, errors coding of diagnosis
and procedure was urgently needed for improvement before scaling up the program.
Use of expensive non-essential drugs is a major driver of rapid growth of health care expenditure,
especially for Civil Servant Medical Benefit Scheme (CSMBS). This study reviews past and ongoing national
policy interventions aiming to promote rational use of drugs (RUD) in public sectors, with respect
to National Lists of Essential Medicines (NLEM) and public insurance schemes. The study employs the
World Health Organization framework on recommended interventions, including (1) national drug policy
body, (2) NLEM, (3) monitoring and auditing system, (4) financial and payment incentives, (5) sufficient
government expenditure to ensure availability of medicines, (6) ethical criteria for drug sales promotion,
(7) clinical practice guidelines based on evidence-based medicines, and (8) the hospital pharmacy and
therapeutic committee. In summary, the NLEM is a basic measure for promoting RUD and assuring sustainable
insurance systems. The Sub-committee on essential drug list development under the national
committee on drug system development has played a unique role in selection of drugs suitable for use in
hospitals. The national agenda should advocate disincentive in the use of drugs outside the NLEM, using
appropriate provider payment mechanism. The CSMBS board should encourage a rapid introduction of
the prospective payment system. During a transition phase, hospitals should be closely monitored and
audited for prescribing patterns. The newly appointed Drug and Medical Management and Reimbursement
Committee should take a leading role in engaging co-operation from the hospitals and in harmonizing
across the three public insurance schemes. Development of the education system in all levels to ensure
rational drug use is urgently required as it has not been committed before.
This study aimed to evaluate outcomes from Diabetes Medication Therapy Management (DMTM)
project in patients with type 2 diabetes who used insulin in Tha Uthen Hospital. The outcomes were
measured in economic and clinical aspects comparing before and after DMTM project. The follow-up
treatment continued for at least 2 times every 1-3 months during the study in July 2010 - December 2010.
Humanistic outcome evaluation was done after the DMTM project during May 2011 - February 2012 to
assess the patient’s quality of life using the World Health Organization’s quality of life questionnaire in
Thai version.
This study enrolled 115 cases but only 103 cases who completely followed up. They were female
(74.76 %) and the mean age was 60.74 years. The economic outcomes revealed that the direct costs after the
DMTM project was increased significantly (P≤0.05) from 493,105.18 to 580,791.30 Baht while the indirect
costs was reduced from 51,496 baht. Therefore, the total cost was increased from 544,601.18 to 628,351.30
Baht. Regarding the clinical outcomes, it showed that average HbA1c level was significantly decreased
after DMTM project (P≤0.05), from 9.01 to 8.18. However, the HbA1c level was still higher than the standard
level. In term of the humanistic outcomes, the overall patient’s quality of life situated in the moderate
level.
This study evaluates informal care for disabled stroke survivors in Thailand. It applies the proxy
good method to determine monetary value of the care. Market prices of labor similar to informal care
activities were used in the cost calculation. Data were collected by means of interviews conducted during
2006. The sample consisted of 101 disabled persons who had suffered a stroke at least six months prior to
the interview, and had a functional status score of less than 95 as measured by the Barthel Index. Average
monthly time spent on informal care was 94.6 hours. Time spent for household activities of daily living
(HDL), health care activities (HCA), activities of daily living (ADL) and instrumental activities of daily
living (IADL) was 29, 24, 38 and 3 hours/month, respectively. The average monthly monetary value of
informal care was US$136 (at 2010 prices). Variations of the market price of labor caused changes in the
cost of approximately 50% (both increase and decrease). Severity of disability and urban area had significant
effects on the cost. The informal care value was less than that found using the opportunity cost
method of calculation. It was much more than the current welfare payment for disabled people (500 Thai
baht, or approximately US$16 per month). The findings should be considered as inputs for revision of
welfare payment for people with disabilities, particularly those who are also elderly.
Approximately 1.3 million people have been registered as persons with disabilities (PWDs) according
to the Persons with Disabilities’ Quality of Life Promotion Act (2007) of Thailand. There have been a
number of regulations across multiple governmental organizations launched as following actions recommended
by the United Nation Convention on Rights of Persons with Disabilities. There were, however,
quite a few rehabilitation projects implemented by local level policies. One possible reason could be the
lack of comprehensive database which can be shared among different organizations providing rehabilitation
services for people in need. The International Classification of Functioning, Disability and Health
(ICF) was introduced by the World Health Organization to be used to record functions and levels of disabilities
in a person. The author applied a questionnaire based on the concept and ICF classification system
in face-to-face interviews with 328 PWDs in the Mahasarakham Municipality. Database comprised of
types of impairment, ability to perform activities of daily living, needs for education, vocation, social
participation and benefits entitled. The database can be used to develop individual multidisciplinary
rehabilitation plans which could be regularly monitored and evaluated whether rehabilitation goals are
achieved. The database should be user-friendly, easily accessible and timely updated. Another factor that
should be created is an organization perform as a coordinator across multiple organization to emphasize
the success of the improvement of PWDs’ quality of life.