While direct non-medical costs (DNMc) are inevitable for healthcare seekers, little is known about the magnitude of the economic burden on the household. The study aims to estimate the DNMc of outpatients
at Suratthani hospital and four primary care units (PCUs) in Suratthani’s municipal area. In addition,
the DNMc of patients were compared across different health centers as well as the patients’ household
areas.
We interviewed 200 patients/caretakers at the out-patient department at Suratthani hospital and
147 patients/caretakers at 4 PCUs in the municipal area from 24 October to 21 December 2012. All cost
data were collected and calculated using 2012 as the base year. Statistical analysis, including t-test and
ANOVA, was performed to compare the DNMc between subgroups, with a statistical significance level of
0.05.
The average DNMc of patients at PCUs, 76.7 baht, were significantly lower than those incurred by
patients at the hospital, 585.6 baht. Within this latter group, the DNMc of those who lived in the municipal
area, outside the municipal area, in Suratthani, and outside Suratthani were 248.3, 774.8 and 1,719.4 baht,
respectively, with statistically significant differences.
The study quantifies the household cost for out-patients, demonstrating potential economic barriers
faced by health care seekers. Information from this study can be used when designing a treatment and
referral system that seeks to minimize the financial burden on the patient.


This study aimed to assess the management and the operation of health facilities under ”Health
Insurance Policy for People with Citizenship Problems, the Cabinet Resoluion on 23rd March 2013“, which
enabled the target population to have better access to essential health services, through a case study in
Ranong province. Qualitative methods: in-depth interviews, group interviews, observations and document
reviews, were applied. Thematic analysis was employed for data analysis. The results revealed that, before 23rd March 2013, healthcare services were provided for people with
citizenship problems through “Health Card for Displaced Persons”. After the policy was implemeted, the
province set up its own managerial systems by allocating a due proportion of the budget for disease
prevention and health promotion activities, specifying the amount remibursed to be varied by the quantity
of services at the facilities, and encouraging proactive works through “Alien Health Officers” and
“Alien Health Volunteers”. Yet, in practice, there remained problems, e.g., communication insufficiency,
limitation in budget use, failure in registering populations who ever held the health card, and lack of
technical supports in legal academia.
In conclusion, though local mechanism for operating the policy is devised, its effectiveness should
be leveraged through several measures: expanding population coverage in concordnace to their actual
residence, increasing legal knowledge support, elucidating the budget regulation, and endorsing regular
monitoring systems. However, this study still holds some limitations, e.g. a sole approach through providers’
perspectives. Further studies are recommnded to explore the possibilities in developing recommendations
to a real practice.


Drug expenditure in the Civil Servant Medical Benefit Scheme (CSMBS)’s Direct Billing System shows
an increasing trend. The study aims to identify the measures in 34 hospitals for promoting the rational use
of drugs in high-cost therapeutic classes and for controlling their expenditures. The study found that most
hospitals placed a priority measure for proton pump inhibitors (PPIs), non-steroidal anti-inflammatory
drugs (NSAIDs) and Coxibs, antihyperlipidemics, angiotensin-2 receptor blockers (ARBs), glucosamine
and anti-osteoporosis by requesting physicians to comply with rational indications. The priority measure
for anti-platelet aggregates, angiotensin converting enzyme inhibitors (ACEIs) and anti-cancers was requirement
of written statement for reasons in prescribing non-essential drugs. An increase in the number
of hospitals encouraging the prescribing of generic drugs in 2012 as compared to 2011 was found for antiplatelet
aggregates, NSAIDs, antihyperlipidemics, ACEIs and ARBs. However, the generic and therapeutic
substitution policy was not imposed in most hospitals. For non-essential-drug prescriptions, most hospitals
did not require prior authorization by hospital administrators nor did they require patient’s out-ofpocket
payment for later reimbursement. In conclusion, hospitals did not enforce a restrictive measure for
promoting the rational use of drugs featured on the priority list of the Comptroller General Department’s
CSMBS.


Logistics management is a useful tool with applicability to many businesses. However, drug distribution
from Klonglan District Hospital to its primary care networks was still in its infancy, resulting in an
excessive drug inventory. This is a quasi-experiment study that monitored 3 Key Performance Indicators
(KPIs) for comparison before and after using the modified vendor-managed inventory (VMI). The KPIs
were 1) inventory efficiency evaluated by ratio analysis, 2) cost-benefit analysis, and 3) stakeholder satisfaction
evaluated through content analysis from focus group discussions. The KPIs were monitored for
eight months at ten primary care units in Klonglan district. The period before using the modified VMI was
from December 2011 - March 2012; the period after using the modified VMI was from April 2012-July 2012
The results showed that KPIs were improved. The average inventory turnover ratio was reduced
from 6.67 months to 1.31 months. The inventory cost saving was 1,006,416.55 baht and the benefit-to-cost
ratio was 80.03. Stakeholders expressed satsifaction with the modified VMI because of the lower workload.
Regular meetings among stakeholders, however, are needed for improvement and maintenances of the
new inventory management system.


The objective of this study was to examine the pattern of drug companies in promoting disease
awareness activities in relation to HPV vaccines through various media channels in Thailand including
television, magazines and the internet. Using content analysis of media content from 1st January 2006 to
31th December 2008, 47 disease awareness activities were found, of which 23 (48.94%) were on the internet,
22 (46.80%) in magazines, and two (4.26%) in television programs. The primary source of information was
from government agencies (36.67%) and the most common presentation pattern was in the form of academic
paper (36.17%). A fear appeal was the most typical communication method (59.57%). Five activities
contained incorrect data about the vaccine (10.64%). On websites, the connection of the disease awareness
activities and the sponsoring drug companies could be identified by the brand logo, the theme color, and
the product packaging linking to specific HPV strands covered by the vaccine. Hotline numbers, sponsored
by the pharmaceutical companies, were also available on the websites and magazines for consumers.
We thus propose that responsible authorities, including the Thai Food and Drug Administration,
regulate the drug advertisement policy more proactively


Overuse of antibiotics for common, self-limited diseases such as upper respiratory infection (URI),
acute diarrhea and simple wound is rampant in Thai community pharmacies. A major reason is a lack of
confidence in the effects of non-antibiotic therapy on patient health and satisfaction. The study aims to compare health outcomes and patients satisfaction between the antibiotic-dispensed group and the non
antibiotic-dispensed group of patients afflicted with three targeted diseases: URI, acute diarrhea and simple
wound. Data collection was conducted in October 2012. Pharmacists from 97 community pharmacies
who attended the Antibiotics Smart Use training session were asked to make a follow-up telephone interview
with their patients 3-7 days after the pharmacy visit. Pharmacists from 54 pharmacies (55.7%)
completed the interviews of 1,021 patients. Responses from 998 patients (97.7%) were usable for data
analysis. The responses were from the patients with URI 71.5%, simple wound 21.2% and acute diarrhea
7.2%. The proportion between the antibiotic-dispensed group and the non antibiotic-dispensed group
were 26.8% and 73.2%, respectively. Interview results showed that 91.2% of patients were fully recovered
or better and 83.9% were satisfied and very satisfied with the treatment. There were no statistical differences
on patients’ health outcome and satisfaction between the antibiotic-dispensed group and the non
antibiotic-dispensed group (p-value > 0.05) and no statistical difference across the three targeted diseases
(p-value > 0.05). The study confirms previous studies that URI, diarrhea and simple wound can be cured without antibiotics.


A mismatch between available antibiotics in the healthcare outlets and limited medical and microbiological
capacities of these outlets can lead to irrational use of antibiotics and subsequently worsens
bacterial resistance situations. The study aims to investigate (a) patterns of antibiotic distribution and
utilization among health promoting hospitals, private medical clinics, and pharmacies; (b) opinions on regulation regarding antibiotic distribution and use; and (c) terminology used by health professionals to
explain to patients about antibiotics. A cross-sectional survey using self-administered questionnaires was
conducted in 27 districts of 9 purposely sampled provinces during April-May 2012. The response rate was
53% (601 questionnaires); 276 of them were from health promoting hospitals, 107 from private medical
clinics and 218 from pharmacies. The results showed that,of the 47 antibiotics surveyed; 25, 35 and 37
items were available at health promoting hospitals, medical clinics and pharmacies, respectively. The
most commonly found antibiotics were amoxicillin (98-100%), norfloxacin (93-99%) and dicloxacillin (85-
99%). Private medical clinics and pharmacies had higher rates of antibiotic utilization for potentially selflimited
diseases than those in health promoting hospitals (40-60% vs. 20-30%, correspondingly). Most
physicians in private medical clinics (77%) agreed with the prescription-only measure for all antibiotics.
Fewer nurses and other health professionals in health promoting hospitals and pharmacists in pharmacies
(24% and 5%, respectively) agreed with such measure. The terms “antimicrobial agents” (36-55%) and
“anti-inflammatory agents” (19-25%) are used more often than the term “antibiotics” (11-28%). The observations
from this study indicate that the regulation of antibiotic distribution should be more restrictive
and such regulatory measures, together with measures to promote rational use of antibiotics, should be
implemented simultaneously.


An increase in antimicrobial drug resistance is a big concern for all hospitals. Thus, effective infection
control (IC) policy and antibiotic stewardship programs (ASP) are crucial to managing the problem.
However, data on such measures in Thai hospitals are limited. This cross-sectional study aims to explore
hospital IC measures, ASP, and barriers to implementation in public tertiary care hospitals (TH), district
hospitals (DH), and private hospitals (PH) in Thailand. The study was conducted during April and May
2012 in nine provinces, purposely selected to represent 5 regions. Among 102 hospitals included (13 TH,
69DH, 6 large PH, 14 small PH), the IC measures were implemented more than the ASP (96% vs. 88%)
with different focus in each hospital group. Non-cooperation from relevant health providers was the
most common barriers to IC and ASP implementation in all groups (38-70%). Inclusion of IC as the
criteria for hospital accreditation had the strongest effect that could introduce IC activities into more than
80% of hospitals. Strengths of the TH were microbiology laboratories and antibiotic susceptibility test.
Concerning ASPs, the TH was a good performer in using antibiograms for the selection of antimicrobials
in hospital formulary. They had IC committee as the core group and tended to implement antibiotic
restrictive strategies. TH’s limitations were staff shortage and disagreement from medical staff towards
some antibiotic guidelines. As for DH, strengths were persuasive measures developed from the
Antibiotics Smart Use program. Plus, DH had Pharmacy & Therapeutics Committee as the core driver.
Limitations were lack of budget, frequent staff rotation and discontinuation of the activities. For PH,
strengths were microbiology laboratories and persuasive measures. In conclusions, hospitals had
different strengths and limitations, thus careful selection of appropriate IC measures and ASP is needed
with participation of stakeholders to tailor the measures to hospital context. Policymakers might start
with activity that raise concern in relevant health providers, support their strengths, alert private
hospitals, and help reducing obstacles that limit further development and sustainability of the IC and
ASP.


Hospital-acquired pneumonia (HAP), one of the most common nosocomial infections, is associated
with a high mortality rate in hospitalized adults. The study aims to determine the prevalence of HAP
pathogens and antibiotic resistance rate at Suratthani Hospital.
We conducted a retrospective study of hospitalized patients aged 15 and over who were diagnosed
with HAP at Suratthani Hospital from January 2011 to December 2012. Data from medical records, including
patient characteristics and results from a sputum culture test, were used to demonstrate etiology and
antibiotic resistance rates.
A total number of 540 HAP cases were identified. The mean age of the sample population was 65
years old, with 54% being male. The median length of the hospital stay was 21 days. The four most common
pathogens were K.pneumoniae (31.2%), A.baumannii (21.9%), P.aeruginosa (14.8%) and S.aureus (4.3%).
Ceftriaxone resistance rates for A.baumannii, K.pneumoniae, K.pneumoniae ESBL and P.aeruginosa were 83.1%,
1.3%, 85.7% and 37.5%, respectively. Imipenem resistance rates for A.baumannii, K.pneumoniae, K.pneumoniae
ESBL and P.aeruginosa were 71.2%, 0%, 6.3% and 23.8%, respectively. All-cause hospital mortality rate was
29.4%.
High mortality and antibiotic resistance rates were observed among adult patients with HAP at
Suratthani Hospital. Information about the etiology and prevalence of antibiotic resistance of HAP in a
local setting may be helpful in the selection of appropriate antibiotics for initial treatment of HAP to
shorten the course of disease and length of hospital stay and reduce antibiotic resistance and mortality
rates.


The purpose of the study was to explore the problems in the caring system of the pediatric CNS
tumor in Thailand. CNS tumors in children need sophisticated diagnosis and treatment, which include
large multidisciplinary care teams. At present, there are many problems in the caring system in Thailand,
including the inadequate number of physicians involved in many aspects of the diseases, equipments for
diagnosis and treatment, and inappropriate referral and payment system, all of which can result in the
delayed diagnosis and treatment leading to an increased rate of morbidity and mortality. Suggestions
derived from the study were made to solve the problems systematically and serve as the basic data for the
improvement of the CNS tumor care in Thailand.


The study aims to identify factors that affect the door-to-needle time for fibrinolytic therapy in patients
with acute myocardial infarction in Buengkan hospital. A retrospective review of medical records
from October 2554 to October 2555 was conducted of all patients receiving thrombolytics for AMI. A total
of 37 patients with acute ST elevation myocardial infarction (STEMI) were identified. Median door-toneedle
time achieved was 30 minutes (range 10 - 180mins). A door-to-needle time of 30 minutes or less
was achieved in 22 (59%) patients. The predominant infarct location on EKG was anterior (35%). The three
factors that can affect door-to-needle time were evaluated: office hours, symptoms and use of care map.
Although the study found no statistical difference in the three factors, the percentage of patients whose
door-to-needle time within 30 minutes was achieved rose among those who came outside of office hours,
presented with typical symptoms, and after the implementation of the STEMI care map, (68, 60.6, and 63
percent, respectively). After implementation, the mean door-to-needle time did not decrease, but the
number of patients whose door-to needle-time within 30 minutes was achieved increased from 50% to
63%. Creating a STEMI network in Buengkan Province could decrease the onset-to-needle time.


Chronic kidney disease (CKD) is an important public health problem due to high volume of patients
and high cost of treatment. Sub-district health promotion hospitals are involved in screening the high risk
group. The aim of this study was to investigate the services provided to CKD patients by the sub-district
health promotion hospitals to understand the problems and limitation in providing health services.
This survey was conducted from March-April 2012. 135 directors of the hospital in Songkhla were
recruited. The questionnaire consisted of 2 parts: 1) general information of the participating directors and
hospitals, 2) services provided by hospitals. 92 (68.1%) of the directors were female. The median age was
45±11. 13/3% of the directors had never participated in the CKD-care workshop. The number of CKDpatients
was 1±2 per hospital. No CKD patients were found in 47.4% of the hospital. CKD services were
not provided in 57.8% of the hospitals. Searching and screening were not conducted in more than 80% of
the hospitals.


Vital statistics provide essential information for monitoring the progress towards achieving the United Nations
Millennium Development Goals (MDGs). Well-functioning and reliable civil registration and vital statistics systems (CRVS
systems) are not only needed for national development, monitoring and evaluation systems, but also for organizations
to plan and manage their operation and programs. Well-functioning civil registration systems are the best data source
for reliable vital statistics. However, more than half of the countries around the world do not have CRVS systems or, if
they do, they do not function well. The United Nations (UN) and the World Health Organization (WHO) recognize and
are aware of this issue and are facilitating member countries to evaluate and improve their CRVS systems.
In 2011, WHO and the University of Queensland, Australia, developed a standard tool called, “Strengthening practice
and systems in civil registration and vital statistics: A Resource Kit ”, in order to strengthen CRVS systems. WHO and
many UN organizations, such as the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP),
encourage and assist member countries to use this tool.
CRVS systems have existed in Thailand for many decades, but have not been systematically evaluated. Therefore,
an assessment was a key step to understanding the status of the current system and identifying areas that need
improvement. The Thai Health Information Standards Development Center (THIS) and other key stakeholders, such as
the Ministry of Public Health, National Statistics Office, and Ministry of Interior, came together to evaluate the CRVS
system using the WHO Rapid Assessment of National Civil Registration and Vital Statistics Systems tool.
This report outlines the methodology and findings from this rapid assessment. It contains three main sections: chapter
one describes the background and history of Thailand’s CRVS system; chapter two describes the assessment objectives,
the tool and evaluation process; and the final chapter provides an analysis of results and recommendations.
It is hoped that the assessment will be informed Thai policy makers, administrators and others involved in CRVS of the
system’s strengths and weaknesses and hope to gain their support for further improvment system.


Vital statistics provide essential information for monitoring the progress towards achieving the United
Nations Millennium Development Goals (MDGs). Well-functioning and reliable civil registration and
vital statistics systems (CRVS systems) are not only needed for national development, monitoring and
evaluation systems, but also for organizations to plan and manage their operation and programs. Wellfunctioning
civil registration systems are the best data source for reliable vital statistics. However, more
than half of the countries around the world do not have CRVS systems or, if they do, they do not function
well. The United Nations (UN) and the World Health Organization (WHO) recognize and are aware of this
issue and are facilitating member countries to evaluate and improve their CRVS systems.
In 2011, WHO and the University of Queensland, Australia, developed a standard tool called,
“Strengthening practice and systems in civil registration and vital statistics: A Resource Kit ”, in order
to strengthen CRVS systems. WHO and many UN organizations, such as the United Nations Economic
and Social Commission for Asia and the Pacific (ESCAP), encourage and assist member countries to use
this tool.
CRVS systems have existed in Thailand for many decades, but have not been systematically evaluated.
Therefore, an assessment was a key step to understanding the status of the current system and
identifying areas that need improvement. The Thai Health Information Standards Development Center
(THIS) and other key stakeholders, such as the Ministry of Public Health, National Statistics Office, and
Ministry of Interior, came together to evaluate the CRVS system using the WHO Rapid Assessment of
National Civil Registration and Vital Statistics Systems tool.
This report outlines the methodology and findings from this rapid assessment. It contains three main
sections: chapter one describes the background and history of Thailand’s CRVS system; chapter two
describes the assessment objectives, the tool and evaluation process; and the final chapter provides an
analysis of results and recommendations.
It is hoped that the assessment will be informed Thai policy makers, administrators and others
involved in CRVS of the system’s strengths and weaknesses and hope to gain their support for further system improvement.


Population-based screening is a large-scale process of identifying apparently healthy people for disease
risks. Some health screening programs in Thailand have been introduced without scientific evidence.
This paper details the experience gained from a systematic and participatory prioritization of health problems
to be screened in Thailand. A consultation meeting with three rounds of anonymous votes was conducted.
Participants included technical officers in the Ministry of Public Health, medical practitioners,
representatives of non-governmental organizations and lay people. We identified the primary list of 31
health problems for their contributions to disability-adjusted life years (DALYs) in Thailand. A set of
information depicting the burden of diseases and availability of screening techniques were provided to
participants prior to the meeting. The prioritization process was conducted with a modified Delphi technique.
The final list of high-priority health problems was determined by researchers using inputs from
round three and overall aspects: ischemic heart disease and stroke, diabetes, alcohol dependence, cirrhosis
and liver cancer, anemia, cervical cancer, HIV/AIDS, asthma, tuberculosis, nephritis and nephrosis,
breast cancer and traffic accidents. They will be investigated further on the appropriate screening program.


Ischemic heart disease and stroke are two major health problems in Thailand. This study aims to
review existing evidence of the screening for cardiovascular diseases at the population level from the
clinical practice guidelines used in selected countries, including Thailand. It is recommended that a global
risk score, known as the Rama-EGAT heart score, should be used for the general Thai population aged 35
years and above to screen for the development of coronary heart disease at 5 year intervals, with a plan to
monitor and evaluate the method at the population level. Further research is also needed for the development
of a global risk score for strokes in Thailand.


Atrial fibrillation is the most common type of cardiac arrhythmia that can cause serious complications.
Guidelines for population-based screening of atrial fibrillation in Thailand have not been reviewed,
nor have the benefits and cost-effectiveness been analyzed. This article aims to conduct a systematic review
and panel discussion on the population-based screening for atrial fibrillation in Thailand. Clinical
practice guidelines recommended checking pulses for 65 years or older. The sensitivity of pulse checking
for at least 20 seconds was 95 (95% CI, 84-97), and the specificity was 72 (95% CI, 69-75). There is no
sufficient data for other methods on a population level. Opportunistic screening is recommended since
the detection rates were similar to that of systematic screening (1.62% and 1.64% for opportunistic and
systematic screening, respectively.) Pulse checking was also found to be cost-effective.


Iron deficiency anemia is associated with long-lasting diminished mental, motor, and behavioral
functioning, especially in infants and toddlers for whom iron is necessary for development. Treatment
with iron can reverse the anemia and restore iron sufficiency, but poor developmental functioning can
persist. Intervention should focus on the prevention of iron deficiency anemia. Since population-based
screening guideline for iron deficiency anemia has not been well established, this study aims to conduct a
literature review on population-based screening for anemia, followed by a panel discussion among experts.
The results support iron deficiency anemia screening with complete blood count (CBC) for all infants
at 9 to 12 months of age who come for their first MMR vaccination. Hematocrit (Hct) can be substituted
where CBC cannot be performed. Further studies on anemia screening for the other groups of population
are warranted


Nephrosis, nephritis and renal stone, commonly found diseases in Thailand, can cause severe chronic
complications. This article thus aims to study the value of a population-based screening for nephrosis,
nephritis and renal stone in Thailand through a systematic literature review and stakeholder discussion.
Urinalysis and blood for renal function tests are widely used in health check-up programs without evidence
of effectiveness and cost-effectiveness. Analysis of the clinical practice guidelines and experts’ opinions
found support for screening in high-risk groups, but not in the general population. Cost-effectiveness
ratio was $282,818 per quality-adjusted life year (QALY), but $53,372 and $18,621 per QALY, in the elderly
and hypertensive patients, respectively. One case would be diagnosed per 800 screened. Incremental costeffectiveness
ratio was $2779. Therefore, renal function tests or urinalysis are recommended for high-risk
groups, whereas the general population should be educated on the disease and risk reduction. Further
studies of the effective and appropriate screening tests for high-risk groups are also needed.


Prostate cancer is a common malignancy in elderly men in western countries. It is the leading cause
of mortality and morbidity worldwide. Two main tools for screening, digital rectal examination (DRA)
and prostate-specific antigen (PSA), are still controversial with regards to effectiveness and cost-effectiveness.
The study aimed to examine whether screening for prostate cancer reduces prostate cancer specific
mortality and all-cause mortality and whether population-based screening for prostate cancer is costeffective.
Literature search of randomized controlled trials (RCTs) and economic evaluation articles was
conducted through Medline and Cochrane library to assess the effectiveness and cost-effectiveness of the
prostate cancer screening. Five RCT with a total of 321,644 participants were included in this review. The
meta-analysis showed no statistically significant differences in prostate cancer-specific mortality and allcauses
mortality between screening and no-screening groups. Relative risks for mortality from prostate
cancer and all cause mortality were 0.99 (95%CI; 0.83-1.17) and 0.98 (95%CI; 0.97-1.00) respectively. Nor
was screening found to be cost-effective.


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.


Managing public health system in Thailand has been a challenging mission of many governments. The system comprises various health insurance programs such as the civil service welfare system for civil servants, the social security scheme, the universal healthcare coverage, the health insurance fund for foreign workers, as well as the independently managed health care funds for local governments and state-owned enterprises. Each program has separated management system. This leads to an overlap between the benefits of each fund, and the lack of standard of operation in many ways such as managing patients’ data system and claimant procedure, as well as evaluating disbursement and treatment quality. These problems incur inappropriately high cost.
Every previous government has attempted to integrate the national health care system which has traditionally been under the management of three state departments namely Ministry of Finance, Ministry of Labor, and Ministry of Public Health. However, these attempts resulted in the form of ad- hoc committees appointed by the cabinet resolutions. For example, the Abhisit government appointed the National Health Care Financing Development Committee (NHFDC) to design an integrated public health system. Later the Yingluck administration cancelled the NHFC and replaced it with the Committee on Drugs and Health Care Reimbursement System Management (CDHRM). The committee was assigned to control the expenses in the national healthcare system, especially the medicine price.
The change in structure and management in Thailand’s health care system as a result of the shift in political situation raised a question of whether the appointed committees are capable of fulfilling their objectives if being evaluated by empirical evidences, and what should be the appropriate structure of such agency.
This study analyses the structure, mission, operation procedure, and performance of the two committees. It finds that the two committees which were appointed at different times had each own origin and objective. The NHFDC was appointed according to the recommendation of the Health Assembly in order to improve the efficiency of national healthcare financing system, while the CDHRM originated from political pressure which sought to reduce the cost of national health system by focusing on the welfare for civil servants system.
For these reasons, the structure of each committee differs. The NHFDC comprised representatives from many sectors such as people’s representatives, consumers group, informal workforce group, as well as distinguished health scholars. On another hand, most of the members of CDHRM are from government departments and professional organizations relating to the national health management.
In term of performance, the NHFDC had some policy achievements such as designing the desirable health and financing system, issuing the directive for the Jor(2) medicine list,  and integrating the emergency system which led to the current practical operation. The CDHRM also demonstrated some distinct performances during its first phrase; for example, it initiated a project to evaluate the quality of integrated healthcare funds, produced the medicine database and codes for standard medicines, developed a program that links the codes for standard medicines with the codes in hospitals, as well as an agency overseeing the information system about medical services.
Nevertheless, the CDHRM’s achievements such as negotiating the medicine price, evaluating the quality of medical services, and developing the information system are essentially the tasks that had previously been handled by other agencies. The committee simply took over these continuous works as its missions. Therefore, it could be said that there is continuity in the practical level, despite the shift in main policy.
However, the committee’s structure which features the Health Minister as the President and the Comptroller-General as the Secretariat-General – which helps smoothen communication between the two departments – became problematic. As the Minister and Comptroller-General can directly give order to the responsible agents, who can also directly report the work progress to the two commanders, the practical roles of the committee are reduced.
This research team argues that the principle and direction of the national health system management need clarity and continuity and hence must be permanently managed by an agency, by enacting a law governing the national health system in order to lay out the form and structure of the desirable health system. The law shall also identify the authority that will direct the three health care funds integrally – instead of “asking for collaboration” as traditionally done – which resulted in some policies or measures that might have conflict of interest with one of the funds being ignored, even though they might be beneficial to the society.
The proposed agency should report directly to the Prime Minister and work under the Office of the Prime Minister. This is to prevent any state department from dictating the direction of health system management which involves many national departments. The structure of this agency should comprise two sets of committee namely the health system policy committee, and the health system management committee in order to separate the policy work from practical function, each of which requires a different set of committee members and form of authority.


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.


Healthcare financing is one of the building blocks of health systems.
Understanding how hospitals deal with various payment schemes and finance their
health care services would be crucial in improving health financing policies at the
macro level, particularly in the health systems with multiple heath-financing
schemes. In Thailand, there are currently three public healthcare financing schemes:
the Universal Coverage Scheme (UC) which covers approximately 75 percent of the
population, the Social Security Scheme (SSS) which covers approximately 13 percent
of the population, and the Civil Servants Medical Benefits Scheme (CSMBS) which
covers approximately 10 percent of the population (HSRI & WHO, 2006). It is crucial
to note that, there still remains a group of patients who choose to give up their
health benefits from the above three schemes and decide to pay out-of-pocket to
receive health care services from both public and private health care providers.
In the past, health systems researchers have focused only on the financing
mechanisms within particular health schemes, without addressing possible side
effects on other schemes. Given that the reimbursement policies for the three
schemes are quite different both in terms of reimbursement rates and payment
methods, hospitals are likely to have different financial incentives in treating patients
from different health schemes. Thus, this research attempts to address hospitals’
financial incentives in responding to the difference in reimbursement policies. In
particular, it seeks to identify and analyze possible cross-subsidization across health
schemes within the public hospitals in Thailand. Based on the qualitative content analysis, 13 sub-themes related to the
concept of cross-subsidization emerged. They can be categorized into four major
themes. First, the concept of cross-subsidization is perceived and understood very
differently among hospital administrators. Second, payment policies of health
schemes create obstacles to hospitals’ financial management. Third, organizational
factors of hospitals also create obstacles to hospitals’ financial management. Lastly,
hospitals respond to payment policies of health schemes by various measures.
The quantitative data analysis revealed that unit-costs are different across
schemes even if other characteristics are controlled for, and the differences between
reimbursement and cost vary across different schemes in a systematic pattern. In
particular, there is a gain from providing healthcare to CSMBS patients, while there is
a loss from providing care to other groups of patients, such as UC and foreign
patients. Nonetheless, these quantitative results do not indicate that the hospitals
intentionally make a profit from providing care to CSMBS patients in order to
subsidize its loss. In fact, this could be an evidence of “passive cross-subsidization,”
where the cross-subsidy results from insufficient reimbursement from particular
groups of patients. Lastly, there is no evidence that the hospital “cost-shifts” by
increasing the price charged to OPP patients to compensate for the UC loss.


This study aimed to better understand the management and the operation of health
facilities under 'Health Insurance Policy for People with Citizenship Problems: the Cabinet
Resolution on 23rd March 2010', which enabled the target population to access to essential
health services, through a case study in Ranong and Tak province.
This study suggests that HIS-PCP successfully reduced the expenditure from receiving
healthcare services in the target population and also made health facilities gain more revenue. However, it did not signifcantly change the utilizations of the target population and the service
burdens at health facilities. Futhermore, there remain unsolved problems in managing the
system. A comprehensive review on advantages and disadvantages of the operation of HISPCP
as status quo comparing with other alternatives in managing the system is recommended.


One of the major public health policy debates in the recent years is the rising costs of
Civil Servants Medical Benefit Scheme (CSMBS), especially for outpatient care. Nationally, the
CSMBS outpatient costs had steadily increased since the 1990s but started skyrocketing in
2004. Several government agencies and scholars have tended to blame this rapid rise on the
new reimbursement policy (the Direct Payment (DP) program), which took place in the same
year. Before the DP program was introduced, CSMBS beneficiaries had to cover the full cost of
their outpatient services first, and process the reimbursement afterward. The DP program
replaced this old payment system by having the government pay to the hospitals directly.
Although the DP program seems to be the most probable source of the rising CSMBS
costs, there is no careful analysis to support the argument. Comparing aggregate costs beforeand-
after the policy change would overstate the DP effect due to other factors (e.g., a steady
increase in the number of aging population and a self-selection problem). Our study aims to
carefully examine the impact of the DP on utilization and cost per patient. We employ patientlevel
data from Saraburi Hospital, a large regional hospital, which CSMBS costs closely mimics
the nation’s trend. Its CSMBS outpatient costs rose approximately 10% per year prior to
2004and soared to 31-37% per year between 2004 and 2009.
Our analysis focuses on two issues. First, we examine the key determinants of the
change in outpatient costs during 2004-2009, by breaking down the total change in outpatient
costs into the change in the number of patients being treated and the change in cost per
treated patient. Second, we study the impact at the initial stage of the DP program where
eligibility was restricted to beneficiaries with four specific chronic diseases.
Our results indicate that during the first two years where only chronic disease patients
were eligible, the increase in the costs was driven by the higher cost per patient rather than the
larger number of patients being treated. This suggests that some enrolling patients might over
utilize healthcare services or ask for unnecessary prescriptions. In contrast, when the program
was fully expanded to cover all CSMBS beneficiaries, the number of new patients turned to be
the major factor accounting for the increase in the costs. This is not surprising given that
patients with chronic diseases were more likely to incur higher costs, and most of the patients
with chronic diseases had enrolled earlier. The effect of the initial stage of the DP program on visits and cost per patient were
assessed by the difference-in-difference approach. We find that, on average, patients enrolled
in the DP program increased their number of visits by 18.3%. In addition, the average
outpatient cost per participant increased by 35.4% comparing to their cost before enrollment.
Finally, we show that the estimates from simply comparing visits or costs before-andafter
policy change largely overstated the effect of the DP program. For visits, the estimate from
the simple comparison is +24.5%, while our estimate from the differences-in-differences
approach is +18.3%. The simple comparison also suggests a considerably larger effect of the
DP program on the outpatient costs (+108.8% vs. +35.4%).
These results underscore the need for careful evaluation of policy changes. Our study
only takes a modest step toward such direction. An important area for future research is to
identify sources of treatment intensity associated with certain prescriptions or diagnostics. We
are not able to trace such details since the outpatient financing records from Saraburi Hospital
do not contain charges by item. A clearer understanding of the factors accounting for the recent
rise in the healthcare costs will prove critical for crafting cost containment strategies.


This study was a qualitative research aiming to study the experience of long-term care,
its associated burden and impact as well as the role of organizations involved in long - term
care for the elderly in Thailand. Data were collected, from June of 2012 to May of 2013,
through indepth interview, focus group discussion, and direct observation of 179 elderly
persons and 187 caregivers, at 13 districts of nine provinces and five regions of Thailand. The
data were analyzed using content analysis, thematic analysis, and frequency and percentage.
The experiences of long-term dependency of the elderly with stroke, dementia, co -
morbidity, and aged 80 years and above, were documented. The care givers who provided
long-term care for the elderly in Thailand showed that the majority of them feel relative
powerless; most of them (85%) were female; one-third had a chronic health problem; and
one-third were elderly caregivers. Three-quarters of caregivers also work, about one in nine
people need to provide long-term care for more than one person, and the majority had
never experienced any long term care. In addition, it was found that the pattern of family
caregivers for long-term elderly care in Thai social that the caring was subject of gratitude.
Regarding the burden and effect of care, nearly four in five caregivers who care for the
elderly with stroke and co-morbidity experienced the economic burden, due to costs of care,
financial debt, and a lack of opportunities for career development. More than two in three of
caregivers experienced emotional burden including anxiety, depression, and severe stress, and
conflicts within relatives. More than two-thirds of caregivers experienced physical burden of
elderly care, including fatigue, body pain, increased health problems. And, the majority of
long-term care for the elderly was only activities daily living care. It found the elderly 45 %
who did not receive rehabilitation.
Also, the psychological burden and emotional problems were the most common,
about four in five, among those who provided care to elderly people with dementia. More
than three in four of these caregivers experienced physical, social and economic burdens.
Moreover, 11% of paid care workers quit their job. And,it found the restrictions of diagnosis
and knowledge of the elderly with dementia that the elderly lack of opportunity in the
treatment of 72%. In addition, there is a lack of continuity of care for the elderly in the longterm
health care system, a lack of assurance for the quality of home care, and the lack of
integration of missions of the organizations involved in the care of the elderly in a
community. In conclusion, the long-term care for the elderly in Thailand results in tremendous
burden on caregivers and families amidst the unavailability of family and community support
systems. Therefore, support system development and system design for long-term elderly
care options for caregivers and families in the community include; development of primary
care services, promote the role of local government in the long term care system for the
elderly, development potential family caregivers, and standardization and quality control
long-term elderly care nationality.Thus, leading to the development of a sustainable aged
care that is in accord with the culture of Thailand.


This study has three main objectives first, to study influence of social model of
disability and human rights of disabled people approach which reflect to project, plan
and social movement of disabled people in Thailand. Second, to study interaction
between ideology and discourse in Global level with social practice and implement of
organizations in local setting which exercise over disabled people’s social life. Third, to
develop the contemporary social science research on disabled people program
This study shows that transformation in policies of the Thai state, economic and
political contexts, the discourse power of international organisations and Humanitarian
reason of Theravada Buddhism contribute to the generation of an ethic regime of the
proper body of Thai citizens. As a result, the impaired body became a ‘political object’
and problematized as ‘moral-political object’. People with an impairment in Thailand
have lived in an ambiguous situation between citizen and non-citizen, or between able
bodied and disabled bodied. Their ambiguous situations are excluded by means of an
inclusion through the technology of power in the modern Thai state. This study argues a
weak point of the social model’s dualism: the model considers that impaired body is
neutral phenomena while disability is a social construction this study discusses the
emphasis within the model that there is no pure or natural body, impaired body is not a
naturalistic and it is, in essentialist term, as pre-social and ahistory which is free from
biopolitics, and existing outside of discourse. This study shows that disabled people are
products of technology of power and biological discourse in modern Thai state
Moreover, this research reveals the ideology of human rights as the political-moral
project in global that is translated in local by associations and social activists in Thailand.
As a result, human rights as moral language and moral progress are being transformed into
a political apparatus to respond to the discourse about morality in local by Karma
ideology and rhetoric of Vedana of Theravada Buddhist. This research also shows that the
human rights of people with disabilities to establish itself to become a dominant moral
discourse has created a singular moral category. The results is that it is discrimination
against people with disabilities of some kind especially blind singers whose image is close
to the image of beggars that social activists who are active in social politics on the
concept of human rights tried to eliminate.
The finding of this study lead to the suggestion that the framework of social
science research on disabled people program should understand disabled people’s life world as the produce of interaction between Global ideology with local moral world.
Moreover, this study suggests that in order to develop the research program has to
focuses on strategies which use research process as knowledge generating tool and tactics
which emphasize on management cooperation and research cooperation


This report presents a draft proposal of the organization, scope,
missions, structures, mechanisms and linkages of a national data clearing
house (NDCH) for the Thai health security schemes. It is drawn from the work
of the assigned taskforce under the supervision of the steering committee
appointed by the Health Insurance Systems Research Office (HISRO), using
brainstorming sessions, extraction of key contents from technical papers written
by selected Thai experts in the field, and reviews by the committee.
In sum, the basic missions of NDCH should include data assessment
and information processing for reimbursement purposes for health services;
research, development and determination of data standards, databases and
information systems to be used in reimbursement processes in order to meet
requirements of health security organizations and related government agencies,
while feasible for providers to comply effectively and efficiently; building and
administering warehouse of reimbursement data, as well as performing data
analysis, review, and creating information applicable for policy management,
system management, utilization review of health resources, and for use in
research and development; information services for other governmental
agencies for academic research; and revenue generating to support its operations
and development. To accomplish the missions, NDCH needs to develop effective
work systems, organization structures and governance.


We aim to study the rates and correlating factors of stroke patients returning to work after treatment
byretrospective descriptive cohort at Prasat Neurological Institute. 198 stroke patients who received treatment
and were subsequently discharged from the Prasat Neurological Institute during January 2010 to
December 2011.Patient medical records were reviewed to select patients who satisfied the inclusion criteria
of the study. Follow-up questionnaires about patient’s return to work were sent to the patients via post.
71.72 % of the 198 stroke patients surveyed could return to work. Statistically significant differences
were found when accounting for occupation, job characteristics, muscle weakness, aphasia of speech,
altered level of consciousness (Glasgow coma score<15), pre-discharge Barthel Index (BI) score, and physical
therapy during hospital admission. Multivariate analysis indicated that only occupation and pre-discharge
BI score contributed to the prediction of returning to work. Patients from private companies vs. governmental
employees had BI scores of 80-100 vs. 0-39, with an odds ratio of 1.279 (0.255-6.41) and 7.333 (2.821-
19.062) respectively. Significant predictors for returning to work after stroke were occupation and predischarge
BI score.


The action research was conducted to study the potential of local organizations on elderly care
management, especially for the disabled elderly in the community, and to assess their needs. The results
showed the potentials of local organizations on disabled elderly care management in 1) manpower: multidisciplinary
teams give care in community 2 ) money: there are budgets to support health promotion
activities, 3 ) materials: materials and equipments were distributed to the elderly and 4 ) management:
local organization provides peer-education programs, training for community leader and health volunteers,
communication assistance and also 24-hour mobile car for referral. Lack of trained elderly caregivers
and the cooperation of family members were the barriers on elderly care management. The elderly needs
a day-care center, trained caregivers, a suitable environment, increased welfare allowance, and 24-hour
hot-line service. Both government, private organizations and family members should therefore collaborate
on establishing an elderly care training, budget or material support, and a day-care center.


This is a participatory action research on the Holistic Care Model Development for the Elderly of
mechanisms involving Local Administrative Organizations, sub-district health promoting hospital,
volunteer, elderly, community leader, monks, teachers, caregivers and community people to share their
knowledge with the Mahidol University research team and the local research team in eight sub-districts of
Nakhon Pathom and Kanchanaburi provinces. The process was divided into 6 steps: 1) community preparation
2) the elderly-need assessment 3) Assessment of potential mechanisms 4) Community feedback
5) Additional activity development 6) Public data dissemination.We found that the holistic care model for
the elderly should cover health surveillance and care for the depressed, continuous development of occupation
for the elderly, distinguishing selection in urban and rural areas, coverage of every elderly group,
and the networking mechanism in the community


Study on Alcohol’s Harm to Others (HTO) is an innovative paradigm for revisiting the whole range
of alcohol-related problems. It comprehensively focuses on the negative consequences of alcohol drinking
to non-drinkers. Patterns of relationship between drinker and non-drinkers play a major role for this
harm. Problems emerged from drinking by family member, relative, friend, colleague or stranger in
society can be vastly different in terms of magnitude and pattern. The range of HTO covers from the less
severe such as mere annoyance to the most severe such as assault and death. HTO-related national data
were only available from social cost study, population survey and data of service system such as the
hospital, the police and court cases. But due to methodological or conceptual constraints, the data might
not best reflect the real situation. While Thai society may recognize alcohol-related traffic accident and
domestic violence as HTO, other problems have been largely ignored. Other HTO issues have not been
covered such as quality of life, impact on physical, mental health and belonging of people surrounding
drinker, impact to children and youth from parents and caretakers as well as impact on co-workers in
workplace. Comprehensive HTO data could demonstrate panoramic magnitude and severity of negative
impacts to the public, support alcohol policy development, and raise public awareness.


This descriptive study aimed to explore oral care utilization among children aged 5-14 years under
the Civil Servant Medical Benefit Scheme (CSMBS) and the Universal Health Coverage System (UCS)
which have been implemented since 2001, using the data of 2003, 2007 and 2011 Health and Welfare Survey
conducted by the National Statistic Office. Members form households selected by stratified two-stage
sampling were interviewed. Total samples were 68,433; 69,679; and 71,847 persons, respectively, in which
there were 12,048; 11,395; and 10,489 persons respectively, in the 5-14 age group. The data were weighted
to represent total population.
Among three surveys, this age group had decreasing utilization rates and frequencies. The UC children
had lower utilization rate than those of CSMBS (14.89 vs. 22.35 persons/ 100 population, 11.99 vs.
20.26 persons/100 population, and 10.60 vs. 15.74 persons/100 population, respectively) as well as lower
frequency (0.23 vs. 0.40 visits/ per capita, 0.16 vs. 0.33 visits/ per capita and 0.15 vs. 0.27 visits per capita,
respectively). The greater differences were found in regional areas than in departmental areas.
The differences of utilization rates increased from 33.38 % to be 40.82 % in 2007 and decreased to be
32.66 % in 2011 while the frequency percent differences increased to be 51.52 and 44.44 % in 2007 and 2011,
respectively. These evidences indicated inequity of oral care accessibility between the two schemes.


We aim to examine the food advertising in children’s television programs based on Notification of
the Public Relations Department Announcement on “Criteria and duration of time for advertising on
radio and television that may have an impact on children”, dated 18 January 2008, and to propose policy recommendation in regulating food advertising in children’s television programs in Thailand. The study
on advertising during children’s programs in free TV on 18th September- 8th October 2010 was conducted
to identify the duration, frequency, technique and strategy used for advertising, and type of products
advertised based on the previously mentioned Notification.
25 (64%) of 39 of children’s programs advertised more than 10 minutes per hour. Of the 39 children’s
programs, 15 (38%) had half of their advertising time that could have an effect on children. Technique and
strategy used for advertising did not follow the criteria in the Notification. Eight products no warning to
consumers to children announced by the Food and Drug Administration regulation. 82 percent of children’s
television programs had indirect advertorial.
Advertising in children’s television still did not follow the Notification of the Public Relations
Department Announcement. The duration and frequency that were in violation of the Notification
decreased from the year before. The Office of the National Broadcasting and Telecommunications
Commission (NBCT) should establish new regulations to protect children and enforce compliance from
the media.


This study reviewed the prevalence of moderate and severe visual loss, as indicated by the World
Health Organization’s definition of low vision and blindness, in the Thai population. Three data sources
from national surveys of the Thai population during 2006-2009, namely 1) the forth National Survey of
Blindness and Low Vision in Thailand during 2006-2007; 2) the 2007 Disability Survey; and 3) the fourth
Health Examination Survey in Thai Population in 2008-2009, were reviewed. In addition, reviews of
visual loss in other countries were conducted using structured search terms in PUBMED. Due to differences
in the definition in each Thai survey, the prevalence of visual loss revealed varied results. The 2007 Disability Survey showed visual loss prevalence (moderate: 0.80%; severe: 0.063%) was lower than the
2006-2007 National Survey of Blindness and Low Vision (moderate: 3.69%; severe: 2.04%). The prevalence
of moderate and severe visual loss in the 2008-2009 National Health Examination Survey was 30.2% and
3.4 respectively. In conclusion, every study revealed that prevalence of visual loss in Thais increased with
age and was greater in female. It is also found that high-income countries have lower visual loss, as
indicated by prevalence of blindness and low vision, than medium- or low-income countries.


Although the provision of school lunch for primary school children was established since 1952 in
Thailand, evidence indicates the limitation of the school-food program in tackling over- and under- nutrition.
This cross-sectional mixed method study aimed to analyze school food management systems and
determinants which affected the nutritive value of school lunch, food safety and types of food and drink
available in school. The qualitative study was done by in-depth interview and focus group discussion
with key informants. Quantitative data was drawn from self-reported questionnaire from 226 primary schools. Descriptive statistics and correlation analysis were used in data analysis. The results showed that
the nutritional values from lunch menus achieved only 74.11% of the target. For energy and types of
nutrients, lunch menu achieved only 79.24% of the target energy; and 56.94%, 48.89% and 37.51% of the
target iron, vitamin A and dietary fiber, respectively. Size of school, type of school and use of the community
farm products were significantly associated with the nutritive value of the school lunch (p < 0.05).
Most of the school had the food safety program, whereas two-third of the schools had food and drinks
high in fat, sugar and sodium contents. The result indicated that the schools under the Bureau of Border
Patrol Police (BPP) can provide better nutritive lunch than others and can thus be a role model. Challenges
include the improvement of the food safety management and the control of high fat, sugar and sodium in
school food and drinks


Regional Medical Sciences Center 10th Ubon Ratchatani is the medical and public health laboratories
which play an important role in public health surveillance and improvement for the Regional of Service Provider 10th. Laboratory Quality System was used as a parameter for customers reassuring.
To evaluate the development of laboratory quality system, the CIPP model including context, input,
process, and product evaluation was used. In this process, the secondary data was collected as well as the
questionnaires for customers, satisfaction surveys of the target groups including customers, official
workers and executive/head of the agency in the Regional of Service Provider 10th during July to
September. The results concern the quality, efficiency of the service, and outcome of the development.
The service quality showed that 82.3% of the items passed the criteria for an inter-laboratories proficiency
testing while 90.4% of the proficiency testing showed the accurate results. The customer’s satisfaction also
showed 83.0-90.0 % and moreover, customer’s complaint showed 2-19 items in fiscal year 2009-2013. The
service efficiency showed that 89.2, 97.5, 98.8, 97.6 and 95.2% of the tests were completed by the cutoff
time in fiscal year 2009 - 2013, respectively. In addition, development outcomes are ISO/IEC 17025 for
testing laboratory; ISO 15189 for medical laboratories; and the silver award for excellence in medical and
public health laboratory of the year 2013 from the Ministry of Health. The present study showed that the
development of the Laboratory Quality System of the Regional Medical Sciences Center 10 Ubon
Ratchathani is consistent with an organizational policy for international standard. Laboratory Quality
System is a continual improvement process which requires continuous support so as to become the
reference laboratories in the Asian region.


This is a cross-sectional descriptive study which aimed to explore prevalence of stress and its associated
factors among medical interns. 283 medical interns in 2012 participated in this study. A self-administrative
questionnaire was used to collect the data during April to August 2013. The response rate was
71.11%. The study results revealed that the prevalence of stress among the medical interns was 29.40%.
Most of them illustrated normal and none of stress levels. The significant factors associated with stress
found in this study were income (p value=0.036), preparation before working as a medical intern
(p value=0.007), time constraint ( p value<0.001), risk of being sued due to duty ( p value=0.004) and lack of
leisure time (p value<0.001).


Dementia is a common condition in clinical practice. Its prevalence has been on
the rise, due to the rapid increase of elderly population. Alzheimer’s disease is the
most common cause of dementia syndrome. It often presents with progressive
cognitive decline and followed by behavioral and psychological symptoms. Patients
always had cognitive impairment in many aspects which impact their daily livings.
Therefore, proper evaluation and diagnosis are very important in the patient’s care.
Certain systemic and psychiatric diseases need to be excluded prior the diagnosis of
neurodegenerative disease. Further investigation is often needed for specific diagnosis
according to the standard criteria for each disease. During the past decade, the criteria
have been changed significantly due to better understandings in their pathophysiology.
Biological markers are incooperated to aid in earlier diagnosis. This will eventually
hasten the research and development for more effective treatment, or at least slowing
the disease progression.
New understanding in its pathophysiology has paved the way to potentially
more effective therapy. Pharmacological treatment for Alzheimer’s disease has been
progressing for the past decade. However, the currently approved therapy is still
limited to acetylcholinesterase inhibitors (AchEI) and memantine. AChEI (donepezil,
rivastigmine and galantamine) is mainly indicated for mild to moderate disease. Each
medication may have additional indication, according to its individual study.
Memantine is indicated for moderate to severe disease and may be used as
monotherapy or combination therapy with AChEI. They should be started and slowly
titrated up to the recommended dosage. Treating physician should periodically
monitor their side effect as well as efficacies. Even though their efficacy is modest,
they are helpful in maintaining the patient’s cognitive function and possibly delaying
the disease progression.
Other drugs such as antioxidants and anti-inflammatory agents were not proven
to be effective. Immunotherapy is the novel treatment strategy which may directly
affect Alzheimer’s pathology. It either inhibits the accumulation or eliminates Abeta or
amyloid protein in the brain.


The objectives of this study were to evaluate Management of Medical Emergency
Services under Integration Management Policy, survey the member of Social Security Scheme
in term of their attitude between emergency medical service under Social Security (72 hrs.)
and Management of Medical Emergency Services under Integration Management Policy, and
work out appropriate payment method and reimbursement for eligible private hospitals that
gave provision of care to medical emergency patients. Mix method, qualitative and quantitative
were using for approach. In-depth interview were using for qualitative approach and questionnaire
were using for quantitative approach.
Policy evaluation found that for this policy follows ideology and the social justice of
Thai society, which is clearly showed in Thai Constitution and other related Acts. System
design in theory is well link systematically from input to process, output, and outcome.
However, a lot of hurdles are found at the level policy deployment. Many factors are
identified include clear assignment, appropriate resource especially reimbursement price and
asymmetrical information among staffs of social health protection schemes in different level
and beneficiaries.
The result of interview showed that when the member of Social Security Scheme
were admitted for the emergency treatment under Management of Medical Emergency
Services under Integration Management Policy. They have to reserve budget to private
hospital which provide care to them. Rate of reserve money to pay are 48.2%, the same as
the rate of not reserve money to pay (51.3%). For reserve money, it contributes to the cost
burden to patients as high as 97.6% in particular in group of income below 10,000 to 29,999
baht. The complacency of patients under Social Security Scheme between emergency
medical service under Social Security (72 hrs.) and Management of Medical Emergency
Services under Integration Management Policy were found to be similar percentage of 4.62
and 3.9, respectively.The appropriate payment method and reimbursement, payment by the Diag
Related Groups (DRGs) payment method is also appropriate in the current situation. To
propose appropriate reimbursement for private hospitals, using the reimbursement rate of
the Civil Servant Medical Benefits Scheme (CSMBS) to university hospitals, for treatment of
medical emergency patients which 17,662 baht per AdjRW, including 13,483 baht per AdjRW,
2,379 baht of labour price, and 1,800 baht of room and food prices for three days. Through
participatory approach in undertaking this project, the researchers and representatives of
private hospitals have an agreement that the appropriate imbursement rate should be
adjusted periodically in the future.


ST Elevated Myocardial Infarction (STEMI) is a life-threatening condition that requires immediate
medical care; treatments include thrombolytic therapy e.g. Streptokinase. The objective of this study was to explore the characteristics of STEMI patients associated with medication failure in the use of Streptokinase.
Method: A retrospective study was conducted in STEMI patients who were admitted to Suratthani
Hospital from 1st January 2011 to 30th June 2013. Failed Streptokinase is defined as ST resolution (STR)
<50% and ongoing chest pain >90 minutes after receiving medication. Data, including age, sex, door-toneedle
time, wall of infarction, smoking status, Killip classification, and underlying diseases such as hypertension,
were collected. Multiple logistic regression models were used to explore the association between
these covariates and failed Streptokinase, as well as each of the criteria used to define failed Streptokinase,
with a significance level of 0.05. A total number of 93 STEMI patients were identified, with a
mean age of 58. Factors significantly associated with STR <50% after 90 minutes are hypertension (OR
2.913, 95%CI: 1.014, 8.369), Killip class >1 (OR 3.057, 95%CI: 1.053, 8.878), and having anterior wall infarction
(OR 7.018, 95%CI: 2.219, 22.199). There is an association between ongoing chest pain after 90 minutes
and having anterior wall infarction (OR 5.09, 95%CI: 1.297, 19.973). Failed Streptokinase is associated with
Killip class >1 (OR 3.652, 95%CI: 1.032, 12.921) and having anterior wall infarction (OR 6.602, 95%CI 1.498,
29.089). Despite its advantages, STEMI patients with hypertension, anterior wall infarction, and Killip
class>1 may be less likely to be beneficial from using Streptokinase.


The objective of this study was to assess the hospital response to policy implementation of the Glucosamine
(GS) negative list. This study comprised both quantitative and qualitative approaches. A survey
form of quantity and expenditure of GS 6 months before and after policy implementation was sent out to
provincial hospitals, general hospitals and teaching hospitals (107 hospitals). A qualitative approach included
focus group discussion with head pharmacists of 11 teaching hospitals, in-depth interview with
pharmacists who deal with this policy, and an evaluation of patient’s written complaints sent to Comptroller
General’s Department (CGP). Completed data from 58 hospitals (54%) were analyzed. The total
drug expenditure 6 months before policy implementation was 185 million Baht, and total drug expenditure 6 months after policy implementation was 27 million Baht. Total drug expenditure saving was 158
million Baht, or 85% of total drug expenditure before policy implementation. It appeared that this policy
reduced the expenditure of original drug than generic/local drug. Results from focus group discussion
and in-depth interviews showed that hospitals which succeeded in excluding GS from their list because of
the decision of the pharmacy and therapeutic committee and hospital boards or authorized physicians.
On the other hand, hospitals that still retained GS in their list because they did not understand the
evidence which indicated that this drug was not cost-effective. An evaluation of patients’ complaints
revealed their perceptions as follows: GS are not reimbursable even this drug was indicated for joint
disorders, the policy seems to force patients to responsible for their drug expenditure and policy seems to
be cut off the subsidy for CSMBS beneficiaries. The results of this study showed the impact of this policy
on both health care providers and patients, and unveiled the problems and burden associated with the
policy.


Subdistrict Health Promoting Hospital was promoted from health station in order to increase its
capacity of primary care services, in both proactive and passive strategies. After studying the work process
of Subdistrict Health Promoting Hospital, the significant problem of service provider’s perspective
was the issue of data collection and querying to summarize the operational report according to the Key
Performance Indicator (KPI) system. KPIs could be changed annually, depended on the public health’s
situation. Normally, it took up to 10.22 working days a year to summarize the report. This research emphasized
on developing the KPI reporting system that users were able to identify parameters of indicators.
Moreover, KPIs during the fiscal year 2007 - 2013 were collected in this reporting system to support
the case of evaluating by the previous indicators. In the system, Application Program Interface (API) was
used as a tool to connect and manage the Relational Database Management System of JHCIS application
together with PHP, HTML, and JavaScript programming. This research could reduce time spent in collecting
data, querying data, and generating summary report about 7.93 working days a year or 77.97 percent.


In Thailand, the “One Health” concept emerged with the goal of strengthening the multidisciplinary
collaborations among all sectors at all levels, subsequently leading to a holistic health by recognizing the
close relationships between human health, animal health and environment health. This study aimed to
compile and understand the evolution of “One Health” in Thailand. The methods included document
review, observation, and in-depth interviews of key informants. The study found that the public health and livestock health sectors have been cooperated for over 20 years in order to prevent and to control
zoonotic diseases. It was later expanded to be a multidisciplinary collaboration to contain the H5N1 Avian
Influenza outbreak in 2004-2006. The “One Health” concept has been adopted as a key component of
national health policy, in particular in the National Strategic Plan for Emerging Infectious Diseases (2013-
2016) in 2012. However, the current recognition of “One Health” is still mainly limited to health related
sectors, with variation in interpretations of the definitions and scope of “One Health” which is based on
organization and/or individual own interest, and lack of a variety of examples for implementation. This
study recommends that “One Health” concept should be promoted to other related non-health sectors
including the general public in order to gain mutual understanding of the concept. In addition, the One
Health concept should be implemented where different agencies work together to achieve its objectives in
a sustainable way.


The pharmaceutical manufacturing process must concern a quality requirement. There have been
chances of mixed-up of pharmaceutical products particularly when multiple drugs were produced by
using the same equipment. The mixed-up results in harmful effects on consumers and affects the image of
organizations. Therefore, the objective of this research was to improve risk management system, particularly
the problem associated with the mixed-up. The risk management system was conducted according
to the Notification of Ministry of Public Health. In this research, two unacceptable risks (risk score equal
25) caused by human errors was found from risk assessment. Those were the main causes of the mixedup.
A strict quality assurance guideline was applied in this study as a prevention measure of the mixed-up
in the process of product storage and line cleaning of filling. The result showed that the level of risk was
reduced to acceptable risks (risk score equal 5). Then, the prevention measure was established in all the
medicine production.