plueme/wizJson huggingface dataset:
Breast cancer is the most common cancer in Thai women with the age-standardized incidence rate of
25.6/100,000. Among mammography, clinical breast examination, and self breast examination, only mammographic
screening showed efficacy in decreasing mortality rate from breast cancer. But an organized
mammographic screening has not been established in Thailand due to lack of human resource and infrastructure.
The study aimed to evaluate the cost-utility of establishing a once-in-a-lifetime breast cancer
screening with mammography in Thai women aged 40-49 years and aged 50-59 years through decision
tress. Societal perspective was used to estimate both direct and indirect costs. Incremental cost-effectiveness
ratios (ICER) were calculated and sensitivity analysis was performed by applying probabilistic sensitivity
analysis. ICERs of establishing a once-in-a-lifetime breast cancer screening with mammography in
Thai women aged 40-49 years and 50-59 years were 1,847,481 Bath/QALY and 1,368,764 Bath/QALY,
respectively. The measure was not found to be cost-effective in Thailand.
Cholangiocarcinoma (CCA) is a malignant disease with a high incidence in Thailand, especially in
the North-eastern region. In 2002, the incidence of CCA in Thailand is the world’s highest. Without indicative
symptoms in its early stage, the cancer is often detected when the disease becomes severe. Early
detection of CCA is thus important. The study aims to assess the population-based screening methods for
CCA through a systematic review. Due to an absence of clinical-effectiveness evidence of the screening
methods, no screening method was recommended for CCA. Health promotion is still the only option for
disease reduction through behavioral modification.
As cervical cancer is the second most common cancer in Thai women, it is important for policy
makers to effectively implement the screening program. The aim of this study was to assess the incremental
cost-effectiveness of the current 5-yearly screening practice for all women aged 30-60 years, compared
with the alternative options that differ in the screening interval and target age groups. The study adopted
a Markov model conducted in 2007 under the Thai healthcare setting. All costs were estimated under
societal perspective and converted to the year 2012 values using the Thai consumer price index. Utility
score was calculated based on the Thai scoring algorithm. We found that screening cervical cancer in Thai women was cost-effective compared to no screening. The current practice showed a certain benefit of 40
percent reduction in incidence and mortality. The second most efficient strategy was a 3-yearly screening
for women aged 30-60 years, with the incremental cost-effectiveness ratio -73,300 baht per quality-adjusted
life year gained and the expected prevention of 900 cervical cancer cases and 450 deaths per year.
Treatment cost was reduced to 1.2 billion baht per year. But more than 180 cytologists and pathologists are
needed to cope with increasing demand. Strengthening the current program by increasing the number of
women for screening to reach the targeted coverage rate of 80 percent is the most cost-effective and pragmatic
option in Thailand.
Tuberculosis is a serious contagious disease in Thailand due to high prevalence and incidence. Population-
based screening guideline has not been well established although chest x-ray figures in an annual
checkup program for the Civil Servant Medical Benefit Scheme (CSMBS) without evidence for effectiveness
or cost-effectiveness. The purpose of this article is to review and provide recommendations for population-
based screening for tuberculosis in Thailand through a systematic review and stakeholder discussion.
Analysis of clinical practice guidelines and experts’ opinion found no value for screening in the
general population. Disease detection was 0.05-0.7 case per 1,000 films and the cost per case-detection was
$8,000. Moreover, 30% of extra-pulmonary tuberculosis had normal chest x-rays. The screening should be
conducted only in high risk groups or symptomatic patients, whereas the general population should be
educated on the disease in risk reduction.
Hepatitis B virus (HBV) infection is one of the most common health problems in Thailand population,
with its wide-ranging complications affecting the quality of life. The population-base screening of
HBV has not been implemented in Thailand, nor is its cost-effective clear. The study aims to assess the
economic value of alternative HBV screening programs in Thailand, based on societal perspectives and
economic costs. Compared with no screening, both HBsAg and anti-HBs testing combined with HBV
vaccination and HBsAg testing without HBV vaccination were cost-effective in all age groups and all
scenarios of vaccine coverage and could increase the life expectancy while decreasing future costs of
healthcare services. The selection of options should depend on the affordability of each healthcare scheme.
In spite of the policy of expanding HIV testing coverage to all adults up to 65 years of age being
recommended by international organizations, social and ethical concerns related to HIV testing exist,
including discrimination, stigma and human rights protection. The study reviewed service models of HIV
testing in the general population to identify the appropriate and effective approaches towards achieving
high uptake of testing among general population in Thailand. There are two voluntary counseling and
testing (VCT) service models: facility- and community -based services. The acceptance rate ranged from
11% - 95% for facility-based VCT and from 51% - 83% for community-based VCT. Provider-initiated VCT
was not only effective in offering VCT to general population, but also cost-effective for people aged 13-50
years. PIVCT should thus be performed in all healthcare facilities in Thailand, while further research on
other approaches are recommended.
Although asthma is a disease of high prevalence, incidence and burden of disease in Thailand, no
population-based screening guideline exists for the country. The purpose of this article was to review the
recommendations of population-based screening guideline for asthma in three phases: discussing guidelines
from Thailand and international literature with clinical experts for scoping of the research; conducting
a systematic literature review; and presenting preliminary recommendations to stakeholders. We found
no recommendation for asthma screening via laboratory testing in the general population. Asthma screening
through history-taking and spirometry was cost-effective only in children with uncontrolled asthma, but
not cost-effective in unaffected children, while screening with questionnaire could detect more patients.
In conclusion, screenings were recommended only in children with uncontrolled asthma. Moreover, appropriate
questionnaire for the Thai society should be developed to increase detection.
This article is part of a project entitled “Development of population-based screening package in
Thailand” and aims to conduct a literature review on policies and tools related to malnutrition screening
in the general population for the development of population-based screening in Thailand. For children
aged 0-18 years, screening should rely on Mother and Child Health Handbook, primary student medical
record form and secondary student medical record form. For those aged 15 and above, body mass index
(BMI) should be assessed at each hospital visit. For those aged 60 and above, BMI assessment at each
hospital visit, together with asking for a history of food consumption, unintentional weight loss or continued
weight loss, is recommended.
Although the burden on mortality, morbidity and economic cost of road traffic accidents are enormous,
there is no screening policy for motorists’ physical readiness. The study aims to identify the costeffectiveness
of individual screening interventions through literature review and policy synthesis. The
results supported the effectiveness of the visual acuity screening in drivers aged 60 and above, the revision
of the health-issue list for those applying for a driving license, a breath test, the sobriety checkpoint
and alcohol ignition interlock. More studies are needed for color blindness screening and traffic-accident
prevention for teenagers and motorcyclists.
Population-based screening is one of the public health services that attempt to identify people at risk
of, or are already affected by, a disease. A number of health screening tests have been publicly funded in Thailand without rigorous assessment of scientific evidence. This study aims to develop an appropriate
population-based screening package in Thailand through a transparent, systematic, and participatory
process. Health problems were prioritized through a consultation meeting among stakeholders and reviewed
for their screening tools. The results were appraised and deliberated for consensus. The final
recommendations for appropriate population-based screening package include screening hepatitis B surface
antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) for hepatitis B virus infection; complete
blood count (CBC) or hematocrit level (Hct) for anemia in infants; fasting plasma glucose for diabetes;
global risk scores for coronary heart diseases; pulse palpitation for atrial fibrillation; body mass index for
malnutrition; Pap smear or VIA for cervical cancer; ASSIST for alcohol dependence; provider-initiated
voluntary counseling and testing for HIV infection; and visual acuity for traffic accident. Two screening
tests were recommended for self-examination: measurement of weight and height for malnutrition; and
calculation of waist-to-height ratio for obesity.
Alcohol consumption is one of the major disease burdens in Thailand, particularly in Thai male. It is
believed that screening, with a brief intervention, can reduce the prevalence of alcohol abuse. The study
aims to evaluate the cost-effectiveness of the Alcohol Use Disorder Identification Test (AUDIT) or Alcohol,
Smorking and Substance Involvement Screening Test (ASSIST) in detecting alcohol abuse disorder in
the Thai population, followed by a brief intervention, via a decision tree model. The effectiveness of the
program was expressed in terms of the number of life-years gained from the reduction of alcohol consumption.
The results show that alcohol screening, followed by a brief intervention, saved cost while
contributing to the gain of population’s life years. Screening in a younger population was more costeffective
than in an older population.
This article aimed to gather the knowledge about Diagnosis Related Group (DRG). The DRG is an
acute-inpatient classification system. Developed by Robert Fetter and his colleagues at Yale University, it
was initially called Yale DRG. The system has been used for over four decades. Patients in the same DRG
group are provided similar services and the hospital’s resources. The DRG-base rate multiplied by the
relative weight and country-specific adjustment factors determines the reimbursement amount. The main
purpose of utilizing the DRG system in health financing is to increase the transparency and efficiency of
hospital services. The advantages and disadvantages of the payment method should be explored so as to
improve the system and minimize any negative impacts it may have on health financing.
In 2006, ASEAN Member States signed the Mutual Recognition Arrangement (MRA) for Nursing
Services and in 2009 signed the MRAs for Medical Practitioners and Dental Services. In view of the
operationalization of the MRAs, review of the impacts in the European Union context was conducted to anticipate potential positive and negative impacts of the movement of health professionals within ASEAN
under these MRAs. We found that MRAs in the EU were complex and took 30 years (1975-2005) for the
detailed requirements in each directive to be completed. Unlike ASEAN, members of the EU have similar
levels of economic development, administrative system and culture. Movement of the health professionals
flowed from member countries with lower level of development to countries with higher level of
development. Each EU country has different responding measure to the health professional movements;
countries in need of health professionals accepted foreign professionals immediately, while those not in
need of health professionals delayed their acceptance. The movement created both positive and negative
impacts. Positive impacts are job opportunities and knowledge exchange. Negative impacts are quality of
services caused by language limitation, different levels of education and culture and insufficient number
of health professionals in countries of origin. As an ASEAN member state, Thailand may be affected by
the MRAs. Over the short term, health professionals should take a leading role in developing their country
positions with regard to the movement of health professionals. Longer-term preparation involves an
analysis of probable scenarios for further improvement of the said positions.
ในปี 2554 ระบบหลักประกันสุขภาพถ้วนหน้าเป็นการประกันสุขภาพของภาครัฐมีความครอบคลุมประชากรไทยประมาณ 48.3 ล้านคน (คิดเป็นร้อยละ 74.3 ของประชากรทั้งประเทศ) การศึกษานี้มีวัตถุประสงค์เพื่อหารูปแบบของการใช้บริการผู้ป่วยนอกในระบบหลักประกันสุขภาพแห่งชาติ ค่าใช้จ่ายของผู้ป่วยต่อคนต่อปีและความแตกต่างระหว่างค่าใช้จ่ายของผู้ป่วยกับรูปแบบการใช้บริการในแผนกผู้ป่วยนอกต่อปี วิธีการศึกษาใช้ข้อมูลผู้ป่วยนอกรายบุคคลที่ใช้บริการในปี 2554 จาก 4 จังหวัด คือ เชียงใหม่ ขอนแก่น ลำปาง สงขลา กำหนดรูปแบบการใช้บริการ 31  รูปแบบ จาก 5 ประเภทหน่วยบริการประกอบด้วย สถานีอนามัย โรงพยาบาลชุมชน โรงพยาบาลศูนย์/ทั่วไป  โรงพยาบาลมหาวิทยาลัย และโรงพยาบาลอื่นๆ การวิเคราะห์ข้อมูลใช้สถิติเชิงพรรณนาและการวิเคราะห์ความแปรปรวนระหว่างค่าใช้จ่ายของผู้ป่วยต่อคนต่อปีกับรูปแบบของการใช้บริการ ผลการศึกษาพบว่าการใช้บริการในหน่วยบริการประเภทเดียวมีการใช้บริการในสถานีอนามัยเฉลี่ยร้อยละ 29.1, ที่โรงพยาบาลชุมชนร้อยละ 19.8 ลำดับที่สามคือโรงพยาบาลศูนย์/ทั่วไป ร้อยละ 7.5 การใช้บริการหน่วยบริการ 2 ประเภท พบว่ามีการใช้บริการสูงสุดที่สถานีอนามัยและโรงพยาบาลชุมชนคิดเป็นร้อยละ 20.8,  เป็นที่สถานีอนามัยและโรงพยาบาลศูนย์/ทั่วไป ร้อยละ 4.5, โรงพยาบาลชุมชนและโรงพยาบาลศูนย์/ทั่วไปร้อยละ 2.1 สำหรับการใช้หน่วยบริการ 3 ประเภทพบว่าใช้บริการสูงสุดที่สถานีอนามัย,โรงพยาบาลชุมชนและโรงพยาบาลศูนย์/ทั่วไป ร้อยละ 2.8 สำหรับรูปแบบการใช้บริการอื่นๆ มีการใช้บริการน้อยกว่าร้อยละ  1.0  ด้านค่าใช้จ่ายของผู้ป่วยต่อคนต่อปี  พบว่าค่าใช้จ่ายต่ำสุดอยู่ที่การใช้บริการที่สถานีอนามัย คิดเป็น 295.4 บาทต่อคนต่อปี และสูงสุดที่โรงพยาบาลศูนย์/ทั่วไปและโรงพยาบาลมหาวิทยาลัย คิดเป็น 13,236.2 บาทต่อคนต่อปี จากการหาความแตกต่างระหว่างค่าเฉลี่ยค่าใช้จ่ายกับรูปแบบการใช้บริการทั้ง 31 รูปแบบสรุปได้ว่าค่าใช้จ่ายสามารถจัดกลุ่มรูปแบบการใช้บริการได้ 7 กลุ่มที่มีค่าใช้จ่ายที่แตกต่างกันจากการศึกษารูปแบบการใช้บริการมีความสอดคล้องกับนโยบายระบบหลักประกันสุขภาพถ้วนหน้า ความแตกต่างของรูปแบบการใช้บริการมีผลต่อค่าใช้จ่ายของผู้ป่วยในการจัดสรรงบประมาณ และพัฒนาระบบการจ่ายเงินสำหรับผู้ป่วยนอก ผู้กำหนดนโยบายควรคำนึงถึงรูปแบบการใช้บริการผู้ป่วยนอกด้วย
การศึกษานี้เป็นการวิเคราะห์ค่าใช้จ่ายที่เกิดขึ้นจริงของผู้ป่วยจิตเภทตามรูปแบบสิทธิการเบิกจ่ายในประเทศไทย กลุ่มตัวอย่างได้แก่ผู้ป่วยจิตเภทที่เข้ารับการรักษาในโรงพยาบาลจิตเวชขอนแก่นราชนครินทร์ระหว่างเดือน มกราคม พ.ศ. ๒๔๔๓ ถึงเดือน ธันวาคม พ.ศ. ๒๕๕๕จำนวน ๓,๘๙๖ คน วิเคราะห์ข้อมูลโดยใช้การวิเคราะห์ความแปรปรวนร่วมและการวิเคราะห์การถดถอยพหุ ผลการวิเคราะห์พบว่าผู้ป่วยจิตเภทร้อยละ ๙๓ ใช้สิทธิหลักประกันสุขภาพถ้วนหน้า สำหรับค่าใช้จ่ายในการรักษาพยาบาลที่เกิดขึ้นจริงทั้งในส่วนที่เบิกได้และเบิกไม่ได้ในการรักษาแต่ละครั้ง เมื่อควบคุมตัวแปรจำนวนวันนอนโรงพยาบาล พบว่ากลุ่มเบิกต้นสังกัดของข้าราชการมีค่ารักษารวมสูงสุดเฉลี่ย ๒๗,๘๖๑.๔๗ บาท กลุ่มใช้สิทธิหลักประกันสุขภาพถ้วนหน้ามีค่ารักษารวมเฉลี่ย ๑๕,๑๙๙.๒๓ บาท และกลุ่มใช้สิทธิประกันสังคมมีค่าใช้จ่ายรวมน้อยที่สุดเฉลี่ย ๑๕,๐๖๓.๐๕ บาท ความแตกต่างอย่างมีนัยสำคัญทางสถิติของค่าใช้จ่ายแยกตามประเภทพบว่า ค่าใช้จ่ายที่แตกต่างสูงสุดเป็นค่าเตียงและอาหาร ค่ายา ค่ากายภาพบำบัด  ค่าผลการทดสอบทางห้องปฏิบัติการและค่ารักษารวม ขณะที่จำนวนวันนอนโรงพยาบาล ระดับการศึกษา จำนวนครั้งของการเข้ารับการรักษา อายุและอาชีพมีความสัมพันธ์เชิงบวกกับค่าใช้จ่ายรวมอย่างมีนัยสำคัญทางสถิติ
This study aims to assess patients’ perception and experiences in emergency medical service under
the harmonization policy for three health insurance schemes. A telephone interview using a semi-structured
questionnaire was employed. The study population used medical care in private non-contracted
hospitals, appeared in the Emergency Medical Claim Online database (EMCO) during August-October
2012, and was selected by simple random sampling through personal identity number. Of the 292 patients
interviewed, 105 cases were from the Universal Coverage scheme; 95 cases from the Social Security Scheme;
and 92 cases from the Civil Servant Medical Benefit Scheme. Most patients were aware of the policy, but
not the definition and boundary of the valid conditions under the policy. Most came with medical conditions
and used in-patient care service (91%). The majority chose (92%) and came (91%) the hospital by
themselves; only 2 percent called 1669 EMS. 85 percent of the patients based their selection of the health
services on the distance and quality of the hospitals. Less than 17 percent were aware of their benefits and
the referring process. Most of them were asked to pay, despite the policy stating the contrary, thus imposing a burden on them and their families. Most knew neither the hotline number nor a place to lodge their complaints.
This is a participatory action research using a community-based rehabilitation model as a conceptual
framework. The research aims to develop caretaking programs for persons with disabilities (PWDs)
in the community through the use of the International Classification of Functioning, Disability and Health
(ICF) data and explore the participants’ basic knowledge and attitudes towards PWDs. The study comprised
of three phases: 1) situation and health needs analysis and planning; 2) development of participatory program for PWDs; and 3) evaluation. Fifty-two participants working with PWDs from four provinces
(Roiet, Khonkaen, Mahasarakham and Kalasin) were involved. Quantitative and qualitative data
were collected through questionnaire, seminar workshops, observations, field notes and informal interviews.
All participants were involved in all three phases. The participatory rehabilitation program comprised
of five steps: 1) initial screening; 2) target group selection; 3) function and need assessment;
4) provision of care; and 5) engagement across different organizations. Knowledge, attitude and satisfaction
toward participatory rehabilitation programs for PWDs were improved after the workshops. Comprehension
of the PWD functioning data should be encouraged among participants. An appropriate program
should be developed from the multidisciplinary teamwork across different organizations following
the five steps as mentioned. Care network should also be expanded to improve the quality of life of the
PWDs and families.
Avoidable mortality, defined as deaths which should not have occurred when effective public health
and medical interventions were available, is a widely-used indicator for quality and effectiveness of the
healthcare system in developed countries. This study aimed to estimate the avoidable mortality from the
death registry in Thailand in 2009 and its trend from 2004 to 2009. We applied a list of avoidable causes of
mortality and age limits based on the Australian and New Zealand study. Vital registration data were
used to calculate age- and sex- specific death rates and standardized with the reference from the World
Health Organization World Population. The findings showed that avoidable mortality amounted to 36.7%
of total deaths in 2009. The rate for men was approximately double that for women throughout the period.
Age-standardized mortality rates for men and women decreased from 332.6, and 178.8 per 100,000 to
288.1, and 149.7 per 100,000 in 2004 and 2009, respectively. The top three causes in 2009 were invasive
bacterial and protozoan infectious diseases, followed by suicide, self-inflicted injuries and liver cancer.
There was a notable reduction in avoidable mortality in Thailand from 2004-2009. But since the estimation
relies on the cause-of-death information, effort to improve data quality is required.
The study aims to investigate factors related to performance effectiveness among directors of Tambon
health promotion hospital in the Public Health Region 3. One hundred and sixteen directors participated
in this study through proportional random sampling. Descriptive statistics and ANOVA were used in
analysis. The results revealed that the directors of Tambon health promotion hospital in Public Health
Region 3 had a high level of performance effectiveness. According to path-goal theory leadership, over 45
percents of the directors adopted the participative leadership style. The study also revealed statistically
significant difference between types of leadership and performance effectiveness (F=2.992,p-value≤0.05)
and a statistically significant relationship between role ambiguity and performance effectiveness (F=6.722,pvalue
=0.01). To achieve effective leadership directors of Tambon health promotion hospital should undergo
a preparation course that aims to raise their correct awareness of the role and responsibilities.
The study aims to evaluate and identify factors affecting the quality of services in the primary care
units in Prachuap Khiri Khan. Subjects were specifically selected from 162 health personnel (a head of
each primary care unit and staff) and 405 patients (five per unit) and asked to fill in the questionnaires.
Descriptive statistics was employed to determine service quality; K-mean method of cluster analysis was
used to classify the primary care units; and multinomial logistic regression was used to determine the
relationship between the unit’s characteristics and service quality. The results show that 75.80% of respondents
found the quality of service higher than expected. 27.16%, 45.68% and 27.16% of the primary care
units offered good, medium and poor quality of service, respectively. The factor affecting service quality
was the availability of electricity.
This descriptive study aims to analyze the efficiency of the Thawung Hospital’s extra-working time
dental clinic. Efficiency indices used in this study were the operating unit costs and the charge cost ratios.
Three database sets for service and charge, material and medical supplies, and dental health information
from 1st October 2010 - 30th September 2013 were used. The results showed that at the 2011-price base,
unit costs of dental service in budget year 2011, 2012 and 2013 were 656, 552 and 498 Baht per visit, respectively,
while the charge-cost ratios were 1.61, 1.40, and 1.52, respectively. The most efficient year of dental
services with regard to resources used was 2013 due to its lowest unit cost. The most efficient year with
regard to the earning capacity was 2011due to the highest charge-cost ratio.