As known, Thai folklore wisdom of medicinal plants in pharmaceutical , cosmetics
and food supplements has been used for a long time. Up till now , there is no single Thai
medicinal plant product in worldwide competition market. Infact, Thailand has advantages of
high biodiversity. There are several Thai medicinal plants which can be developed to
medicinal plant cosmetic products. Our preliminary study has indicated that the worldwide
market is very interested in Thai medicinal plants. However, because of the restriction of the
trade regulations in many countries, the development of Thai medicinal plants in the form of
cosmetics is more possible than the form of medicines and food supplements. In 2005,
Thailand has higher import value of medicinal plants and their extracts than the export value
of about 4 times. Therefore, the objective of this research project is to propose the process
for the development of Thai medicinal plant cosmetic products for worldwide market
competition , by evaluating from the searching and collecting of the information from various
sources. The result from this study will decrease the import values of the extract and
cosmetic products containing Thai medicinal plants from abroad and increase the national
incomes. The popular trends of cosmetic activities in worldwide market at present and in the
future are antiaging , whitening, hair growth promotion and body slimming, by emphasizing
on high performance and safety which are cosmeceutical products. We have proposed ten
Thai medicinal plants which have high potential to develop as raw materials in the form of
extract or as the cosmetic products containing the extract for worldwide competition which
are , Aloe barbadensis, Mill, Curcuma longa L. , Pueraria mirifica, Morus alba, Linn, Senecio alata (L.)
Roxb. , Phyllanthus emblica L. , Centella asiatica (L.) , Piper nigrum, Linn, Zingiber montanum (Koenig)
Link ex Dietr. and Andrographis paniculata (Burm.f.) Wall. Ex Nees. The technologies in trends,
which are the plantation and organic approach for the cultivation of the plants,
nanotechnology and biotechnology for the cosmetic products, are proposed to develop the
Thai medicinal plant cosmetic products. The proposed complete process for the
development of Thai medicinal plant cosmetic products for worldwide competition, includes
the strategies , goals , problems, concerned topics and the related factors. The proposed
road map for the development of the Thai medicinal plant cosmetic products for the 5 - year
project (2007-2011) is the two dimensional model, the vertical and the horizontal dimension.
The vertical dimension is composed of the important drives or input of the collaboration and
funding which will be directed to the output of the product, patents and national incomes.
The horizontal dimension is composed of factors which are linked closely including
collaboration between private and government sectors working as clusters, quality
assurance system, revision of the regulations, selection of Thai medicinal plants, production
process, marketing / advertisement and the efficient follow up system. For the proposed
further study continuing from this project, there are more research on the ten selected Thai
medicinal plants , information of the consumers in the worldwide market for importing and the
business plan for the Thai medicinal plant cosmetic products for worldwide competition.


The objective of this study was to examine the feasibility of an outpatient casemix classification system based on the health insurance database in Thailand. The Ambulatory Patient Groups (APG) developed by 3M and Adjusted Clinical Group (ACG) by John Hopkins University were used as the reference model. Model for predicting outpatient expenditure in selected chronic disease groups i.e. diabetes mellitus, hypertension and high cost of care i.e. renal failure and thallasaemia. From 39.1 outpatient visits was grouped into 82 medical APGs which is 21.2 million visits. Most common medical APG groups were 3.3 million visits in influenza, upper respiratory infection and ear, nose throat infections (APG 542), 1.5 million visits in dental diseases (APG 541) and 1.4 million visits in hypertension (APG 572). While can be grouped into 80 groups in ACG which is 7.7 million persons. Most common ACG groups were 1.9 million persons in acute minor, age > 5 (ACG 300), 8.7 million persons in chronic medical: stable (ACG 900) and 0.7 million persons in likely to recur without allergy (ACG 500). From APG concept, significant variable (p-value < 0.05) which increasing medical charges per visit in diabetes model were age, male, provincial and general hospital, refer-out, complication and comorbidities as hypertension, cardiovascular diseases (CVD), cerebrovascular diseases and renal diseases. Significant variable which increasing medical charges in hypertension model were age, male, provincial and general hospital and co-morbidities as diabetes, hyperlipidaemia, cerebrovascular diseases, ischaemic heart disease and renal diseases. Significant variable which increasing medical charges renal failure model were provincial and general hospital, APG and cardiovascular diseases as comorbidity. Age was significant variable which increasing medical charges in thallasaemia model. From ACG concept, significant variable (p-value < 0.05) which increasing medical charges in chronic diseases with hypertension were age, male, provincial and general hospital, number of visits, length of duration between visit and MAC 5 AND 15. Significant variable which increasing medical charges in diabetes model were age, provincial and general hospital, number of visits, length of duration between visit. The results indicated that outpatient classification system requiring more information such as significant procedure and ancillary service for the other two main APG groups. These will be further developed for outpatient classification system in Thailand.


The pesticide sale promotion in local area According to the National Health Assembly held in 2003, pesticide advertising and sale promotion control were raised, among participants, as significant policy implications to relief pesticide problem in Thailand. These concerns emerged when it was found that pesticide advertising and sale promotion with various techniques have influenced the attitude, belief and practice on the pesticide use among farmers. In addition, the monitoring and control mechanism related to these two issues by public agencies at local scale was weak in terms of vague regulation and shortage of capital, qualified staff and essential information. Under this situation, the study on the pesticide sale promotion in the local area became an urgent task. This study would provide evidence based information which strengthened the movement of National Health Assembly in monitoring and urging local government to take better action in controlling the pesticide advertising and sale promotion control in their responsible areas. This study was conducted, during June until September 2004, in four provinces Nan, Kampaengphet, Suphanburi and Khonkaen, with aims to investigate the pattern and techniques of pesticide advertising and sale promotion in the sample sites as well as mechanisms in controlling and monitoring these two issues. The policy implications were the expected outcomes. Various techniques in the quality research were applied during the step of data collection such as documentary and field survey, observation, focus group, group interview and in-depth interview of key informants (pesticide vendors, farmers, communal leader and relevant public officials). Based on both primary and secondary data, the knowledge found in 4 provinces was synthesized and then presented through the seminar held for receiving the feedback and comments from experts and relevant organizations. With regard to the results, it was found that the farmers in all four provinces intensively used the pesticide for their agricultural practices. The agro-chemical shops were prevailing at all local administrative units (province, district, sub-district and village). The key actors in distributing the pesticide to the local farmers comprised of sale men, pesticide vendors, agro-chemical shop, agricultural cooperative, traders and retail shop. The popular techniques to increase the sale volume among pesticide producers, trading agencies, salesmen and vendors were price cut, road show, demonstration, premium, sweepstake, contest, commission, price rewards, tour reward in Thailand and international countries, bonus, party and seminar, score collection reward, credit, sale in packages and training. The model of sale promotion at local areas was a mix model. Although, the techniques to promote the pesticide use were variety, they were differentiated by the positions of pesticide supplier and the purchasing patterns. For example, salesmen and retail shop mainly focused on the direct sale while, contract farming could be observed as one of techniques by agricultural cooperative. In addition, the sale representatives and key vendors were recognized as the target groups of pesticide production companies. These companies would support their sale representatives by running sale promotion campaigns with specific farmers. However, the sale representatives in the local areas had to conduct sale promotion campaigns in parallel but they mostly dealt with small vendors and local farmers. Another interesting finding was that advertising through mass media was a key channel to serve the sale promotion campaigns. In conclusion, the model to promote the pesticide use in local areas were 1) Sale representative based promotion 2) Customer based promotion 3) Sale force based promotion The factors leading to the uncontrolled pesticide advertising and sale promotion in local areas consisted of 1) lack of stringent implementation and enforcement by relevant public agencies in controlling the pesticide advertising and sale promotion 2) high preference, among most of farmers, to get free rewards, cheap pesticide and quick returns from agricultural practices but low education about the danger of the pesticides 3) many trading names (grouping in the same general name) leading to the confusion among the farmers 4) high concern on economic profit rather than others observed among pesticide trading agencies 5) pro-pesticide policy or regulation of agricultural cooperative in forms of loan for pesticide 6) high competition for the market share among the production companies


Networking and Processes for Road Accident Policy	Road accident cases in Thailand were on the rise since 1983 to 1991. Road users were increasingly injured by 60% and 38% more death rates found during this period. Despite the availability of road accident prevention policy e.g. compulsory use of motorcycle helmet and safety belt, injured cases were not reduced to satisfactory level. This study was to analyze Thailand’s road accident policy by using secondary data and interviewing those who were involved in the policy-making process. Limitations of policy-making process were explored and recommendations were synthesized to improving the process of policy-making. 	Lack of networking various agencies and stakeholders to processing the policy was the prime disadvantage while resources were also restricted to effectively facilitate the networking establishment.   The road accident problems should be made realized into wider groups of people including all road users, policy makers and politicians. The most active role player should be the government to set up the institution responsible for networking a number of agencies and people to get involved in the policy-making process and for evaluating policy implementation.


Results and guidelines of how to build up a desired family 	The objectives of this study from many research results and guidelines of how to build up a desired family are as follows: to have an analytical study in order to obtain some indicators in search of Thailand’s desired family structure and to inquire methods of how to strengthen a desired family particularly from the previous studies. All of these results would be useful for the research study programme will be conducted by Bureau of Health Promotion, concerning the conditions of the desired Thai family in 1998 and by the end of The Eighth National Economic and Social Development Plan in 2001.	From the study result, it was found that the government’s policies and plans  to develop the family institution had started since The Seventh National Economic and Social Development Plan. The plan elaborates roles and developmental directions on how to strengthen the stability of family institution, how to cultivate good morals and cultural values for thai people. Moreover, the government had edicted a policy and a long-term plan (1995-2005), Other than the above mentioned, it was also found in the study results that there were varieties of the meanings, duties, significance and family qualities, family structure. The analysed studies was categorized structurally by the Bureau of Health Promotion are: mother and child, schooling children and adolescence, working age group and the elderly, all of which are involved economically and socially with health factors regarding family relationship, education, earning, accommodation and surroundings.	With regard to studies on qualities of the desired family made by many governmental units responsible for developmental task concerning family institution and quality of life such as the Prime Minister’s Office, Department of Public Welfare, Community Development Department and Office of Primary Care, the emphasis was put on the strength of the each family unit: each family should have love and fonding care for each other, the family member should know one’s duties and responsibilities, A family should be self-reliant and be of help to others. One should be healthy physically and mentally. One should have conscience and useful behavior for his own community etc.	This study rendered many various indicators which are very useful, but in need of obtain in appropriate and coherent indicators, those varieties of indicators had to be examined in cooperation with the experts from many governmental units and they were digested into 5 characteristics as follows: health family, good family relationship, family economics status, social conscience and public spirited behavior.


This study was aimed to estimate cost profile, unit cost and performance of public and private hemodialysis (HD) centers throughout the country for the year 2001(2544BE). A self administered questionnaire survey was distributed to the whole 170 HD centers. This is to solicit information on labor cost (including salary, wages, fringe benefit and overtime payment) and time allocation for HD center only, direct material cost for providing HD services (excluding public utilities and related drugs for the treatment of complications). We use straight line depreciation cost for capital investment in HD machines (5 years useful life) and buildings (20 years useful life).A multiple regression was used to estimate cost function of HD centersWe got 117 questionnaire returned, 69% response rate, with 108 complete forms for analysis (64%). By 2001, there were 730 machines operating, 56% owned by publicand 44% by private. Private HD centers had higher productivity (number of sessionper HD per day) than public. On cost profile, the ratio of labor cost to material cost to capital cost was 40:43:17. Total costs of public and private HD center were 273.9 and 259.7 million Baht respectively. Capital cost of public HD center was 10% higher than the private HD centers. Unit cost per HD session was 1,927 Baht in public and 1,525 Baht in private HD centers. Multiple regression demonstrated that total sessions and session per HD per day determined total cost of public and private HD centers, with R2 of 0.865.We performed breakeven analysis, the current charge per session was high enough in both public and private to perform their productivity higher than the breakeven point.Reimbursement of 1,500 Baht for social security workers was too low and that hospital set charge higher than 1,500 Baht for them. Scatter-gram where X axis represented session per HD per day and Y axis represented unit cost, demonstrated that private HD centers were more efficient than public centers.This study should provide a strong ground for further policy analysis on expansion of renal replacement therapy for the Universal Coverage scheme. In the meantime, HD centers could improve its performance through reduction of unit cost and increase productivity. To improve the performance, there was a need to solve administrative problems at micro-level, such as staff incentives.


The purpose of this action research was to develop a primary care model for a healthy community in the eastern region of Thailand. The research process consisted of 5 stages: 1) exploration of primary care delivery in selected settings, 2) improved understanding of the concept of primary care unit management, 3) build community health participation, 4) maintain development of primary, and 5) evaluate and recommend. Selected settings for the study were a community health center and municipal health center in urban area of Chonburi province. Informants included administrative committees, health care providers, village health volunteers, community leaders, and people in the community, Data were collected from documents and reports by in-depth interviews, focus group discussions, brain-storming, questionnaires, and observations. Content analysis was validated by informants and experts in the community.	The results were as follows:The Primary Care Model is designed by developing and modifying structures of the previous health centers as the primary care units (PCU). The PCU activities focused on four dimensions of health care including health promotion, prevention, primary medical care and rehabilitation. The main health care providers working at the PCU were professional nurses and technical nurses. The physician worded regularly at the PCU for a half day per week. There was a health referral network. The health care networking committee was set from four alliances in order to create changes, monitor, and evaluate the development of the PCU.The process to establish effective primary care units emphasized personnel development, health service system improvement, and community potential enhancement. The keys for success included shaping ideas and enhancing knowledge as well as building community participation in the health system development. The educational institutes in the community mentored and supervised the development.The outcomes of the development process included providing four dimensions of health care services that were congruent with the health care providers’ experiences and background. Applied the concepts from anthropology to understand the potential of the community. Health care providers and community members started working together by creating sa vision and mission; building community participation in health care; setting a strategic plan, and establishing a health care networking committee. Establishing a health partnership in the community was a key for success for the primary care model. The communities were satisfied with convenient services that easily accessed, and provided service with care. Educational institutes and community agencies took responsibility to develop services. The professional nurses are the main personnel and demonstrated competencies in working at PCU.The main element to improve the quality of services included having focused health policy and qualified personnel. The qualified nurses should be Masters prepared in the field of community or family nursing. An effective budget management, quality control health networking, community data base are needed. In addition, modification of the role of community agencies and people in the communities in the communities in order to take responsibility for their own communities by establishing community health partnership.Recommendations for primary care model development are to prepare and improve the structure, the main personnel should be a professional nurse and allocate personnel based on their potential and ratio between health personnel and clients. Development of the ability of personnel and the administrator. Improvement the home health care, the holistic care. Development the budget management, the quality control and the net working. Establishing the health learning center and community volunteers in the community, And modification of the role of community agencies in the communities in order to take responsibility.Suggestions for health policy should be built by agreement of government, professional agencies, and educational intakes. Future research should study the development of a primary care model focusing on service cost analysis, decentralization and role of satisfied primary care model, and a health learning center.


Review and Brainstorming for Establishing Research Questions on the Public Health Assistance SchemeThe purpose of this study was to set the priority of research questions for improving the Public Health Assistance Scheme. Literature review and brainstorming from key informants e.g. experienced people, academics and those either directly or indirectly involved in the scheme, were performed. The study found that the urgent research questions were : To what extent the scheme reached the poor and to what extent the registration compulsory for all members benefited the targeting mechanism, What was the main objective of the scheme (creating equity of care access or safety nets) which would be advantageous for developing targeting criteria and basic package, How to edit the laws relevant to the scheme in order to improve the scheme comprehensively, How to set the new poverty line and other suitable criteria to improve the targeting mechanism.


This study aims to enlargement of safety promotion system development in the school buses at rural areas of Chiang Rai province in the 4 districts. Study population are 408 school bus drivers. Implemented activities and data collection was concurrently done in two periods of time. Questionnaires, focus group discussion and behavioral surveillance are used at the first period. Activities including physical check-up, meeting, school bus check-up for developing the school bus safety system were conducted at the second period. Results Most of school bus drivers were male (86.4%). Mean age was 41.6 years.59.8% of them were primary school education level background and 27.9% were juniors high school. 9.9% of them were smokers, 1.6% were drinkers About half of them (56.8%) had annually physical check-up and 12.4% had health problem. Fifty-five percents of school buses were pickup truck and 34.8% were van. Most of drivers have their own school buses and had 4.9 years (median) driving experience. Thirty percents of school bus (roof, seats) were modified and each school bus was used for transferred students in one school. Most of passengers were junior high school students (85.75%). The capacity building that related to traffic law, ethical and primary health care was developed and found that the school bus accidents were decreased when compared to the previous period. Conclusion The promotion of school bus safety and the collaboration of governments organization, school bus driver association and school bus network led to declination of traffic accidents.


The study objectives were to know incidence and risk factors of getting lung infection in patients on respiratory machine and to assess effectiveness of surveillance patients in all wards. Retrospective technique was used to look into 246 OPD cards admitted in department of medicine paediatric and surgery from August 1 to September 30, 1995. Self reporting questionnaires were used on doctors and nurses to gather problems which could occur in such patients. Group discussion with doctors and nurses was also used to assess sterilisation technique. Consequently, surveillance technique for  lung infection in patients on the machine was developed to be able to report infection rates. This study recommended the study be reported to administrators to know the problems, special surveillance be paid on risk patients for example CVA, light weighted babies, patients with head injury and lung infection outside the hospital, the guideline be strictly followed and targeted-surveillance be practiced rather than hospital-wide surveillance.


Evaluation  of  the  Criminal  Justice Response  to  Family  ViolenceIn order to reflect the importance and necessity of welfare protection of persons from domestic violence, this research firstly studies on the issue of domestic violence based on reports of international organizations and related agencies to define the meaning of domestic violence, behavior pattern, abuser and cause-effect of this phenomenon. The outcome of this research identifies that domestic violence has to be ended because it violates fundamental human rights. Criminal justice system is recognized as an important tool to end the domestic violence and to protect victims of this incident continuously and seriously.  However, there is still a remaining problem that whether the current system can cope with this situation effectively or not.  Therefore, the current Thai criminal justice system has to be evaluated.Unfortunately, there are many restraints on this study such as lacking of accurate statistics on domestic violence cases. This research, therefore, focus on current statutes and normal practices of agencies in the criminal justice system especially on domestic violence cases including opinions and recommendations from focus group and case studies. After analyzing, this outcome indicates that Thai criminal justice system insufficiently response to domestic violence as following:The system strictly punishes the perpetrator of domestic violence with criminal penalty. After initiating cases at police station, there is no way to end this criminal process because it is a public offense.  The police officer always conciliate a couple in order to avoid criminal proceedings. However, there is no mechanism or monitoring system to protect victim from domestic violence. Personnel in criminal justice agencies have a negative attitude on domestic violence cases because victims and perpetrators used to have a relationship or live together. They perceive domestic violence cases as an ordinary misdemeanour case.  After surveying the criminal justice system responsive to domestic violence situation in the UK., US. (New York), Australia, Malaysia and Singapore comparing to Thai criminal justice system, we found a strong point of Thai criminal justice system laying down in the constitution in section 53 subsection 1. However, the formulation of Thai criminal justice should be amended and improved as following:	a. The court of justice should apply civil order (protective order) to protect victim or survivor from domestic violence. In addition, the perpetrator must be sent to rehabilitation programme.	b. In order to access civil order, it must be easy and economical to let victims participating in any decision making process.	c. Enforcement mechanisms following the protective order must be created. If there is a violation on protective order, criminal penalty must be applied immediately.	d. The framework and role of the criminal justice agencies must be clear and their personnel must be specially trained to have positive attitudes and effective performance on domestic violence cases.e. The process of protection and restitution for victims against domestic violence must be closely done with multidisciplinary teams such as polices, lawyers, doctors, psychologists, social workers, etc.


Assessment of the pilot project on service quality improvement in public hospitals with TQMQuality improvement for hospital services currently received enormous interest. In 1993, the Health Systems Research Institute, Thailand initiated the pilot project on service quality improvement in public hospitals using the total quality management (TQM) approach. The duration of the project was 2 years. Eight public hospitals in Bangkok and nearby provinces participated. Our study aims to assess and outcomes of the TQM pilot project in public hospitals by applying criteria modified from the Malcolm Baldrige National Quality Award and to determine a set of selected knowledge, attitudes and practices perceived by the top and the middle management and operating personnel in service quality management using TQM concepts. A combination descriptive study designs were conducted by a retrospective ocumantal review with two site-visit key performances interviews and a post-intervention cross-sectional survey during July 1996 and March 1997. The results revealed that the project was systematically organized in providing 2-day TQM training for senior management and middle management and in setting structures to support TQM activities in hospitals. However, participating hospitals had different levels of progress in TQM implementation; two of them were classified as having "breakthrough" progress while the other six hospitals were classified as having "incremental" progress. The following factors were identifies as contributing to the differences: the senior and middlemanagement leadership commitment and continuity, information system and analysis, strategic plans development, human       resources training in quality tools and analytic techniques and management, involvement in patient care services process which brought about visible organizational outcome and had impact on customers. In addition, hospital personnel from the two groups of hospitals had significantly different levels of opinions towards policy deployment, hospital status, knowledge on TQM, attitudes towards quality improvement, process management and hospital outcomes. The three most important factors that contributed to success or failure of TQM project in their opinions were attitude and involvement of all personnel, the senior management attitude and strong support, and training in TQM. Consequently, we suggest a new model for effective TQM implementation in public hospitals by emphasizing changing "process first", quality policy deployment, TQM training, enhancement of strategic and tactical action planning, key services process focus, and closer to both internal and external customers and also their expectations by pre-and post-intervention customer surveys.


This retrospective descriptive study was conducted to analyze the quality and the efficiency
of the Nursing Service System in the outpatient department in fiscal year 2007, using a
questionnaire comprising 10 key indicators for evaluation, as contained in the fifth section of the
standards for nursing services; the results were presented as percentages. The study showed that the
nursing practice fulfilled the criteria for eight of the indicators, failed one, and could not be
evaluated for the other.


This was a cross-sectional descriptive research study, the objectives of which were to assess
 the mental health of persons infected with HIV and those with AIDS at Nonsaat Hospital, Nonsaat
 District, Udon Thani Province. The data were collected from 66 persons by direct interviews
 conducted in an area in front of the counseling room in the period January-March 2008. Thereafter,  the data were analyzed using a computer program. The statistics analyzed included frequency,
 percentage, arithmetic mean, and standard deviation. The results showed that the persons infected
 with HIV and the AIDS patients had a 62.1 percent lower level of mental health than the general
 population. When considered by dimension, the study showed that, at the first dimension, HIV/
 AIDS patients had a mental capacity 74.2 percent lower than the average person; the second
 dimension, 66.7 percent lower; at the third dimension, for the persons infected with HIV and the
 AIDS patients, the percentages were 34.8 and 36.4 respectively; and at the fourth dimension, the
 percentage was 47. The study suggested that, besides promoting preventive measures and fostering
 good mental health among this group, physicians need to provide serious and continuous help for
 such patients.


The propose of this study was to evaluate technical efficiency of twenty community
 hospitals in Khon Kaen Province, Thailand. The number of patients and the resources provided by
 Khon Kaen Provincial Public Health Office since 2005 were analyzed using the data envelopment
 analysis (DEA) method. The study revealed that, four medium-sized community hospitals (30-60
 beds), located in areas populated with more than 60,000 inhabitants, were highly efficient, while
 those of the small-sized community hospitals exhibited very low efficiency indices. It noted
 that the patient/resource ratios among the efficient hospitals were significantly higher than those of
 the inefficient hospitals, suggesting that they ware efficient in using the resource provided.


This cross-sectional research consisted of a quantitative and a qualitative study. The study
was aimed at determining the factors influencing teenage pregnancy/giving birth. In the quantitative
part, 31 samples, who had given birth in Wangpong Hospital between October 1, 2006 and September 30, 2007, were selected and interviewed by using a questionnaire. In the qualitative part,
the participants were purposively selected and interviewed by using an interview guide until data
saturation had been achieved; there were eight subjects in this study. Quantitative data were
analyzed by using descriptive statistics, namely percentage, mean and standard deviation, and
qualitative data were analyzed by the process of summative analysis.
The study results showed that the majority of pregnancies were females 18 years old,
whose husbands were 22 years old. Most of them studied to the junior high school level. They were
farmers with low income. The age of first pregnancy was between 12 and 17 years and included
both wanted and unwanted pregnancies. The complications of pregnancy included preterm labor,
eclampsia, low birth weight and dystocia. The causes of the child being unwanted by the parents
were lack of knowledge of sexuality, birth control and family planning. The pregnancies that were
wanted reflected different problems, such as economic problems, and those related to family support
and the environment. Suggestions given by the pregnant teenagers were (1) be strong minded and
donût take it easy, (2) obtain a higher education before becoming pregnant, and (3) practice birth
control if one is at risk of pregnancy. These findings suggested that hospital or health services
should be offering antepartum care for pregnant teenagers in order to provide knowledge about
family planning and effective care of a pregnancy. Moreover, hospitals should also coordinate with
high schools in giving classes on sex education and family planning.


The purpose of this retrospective descriptive study was to evaluate the effectiveness of the
Diabetes Clinic at Buengkan Hospital in reducing renal complications. The medical records of
patients from May 2006 to May 2008 were reviewed and the glomerular filtration rate (GFR) was
calculated by MDRD equation. The study materials included 916 patients (females 75%) out of a total of 1,970 diabetes
patients. The patients with increased GFR accounted for 63.3 percent of the total (average GFR
before the project was 55.5 ml/minute, and after project it was 60.9 ml/min); statistical significance
was determined by paired t-test (p=0.001). Staging of chronic kidney disease was reduced to the early
stage. It was concluded that the Diabetes Clinic at Buengkan Hospital had enhanced the condition of
diabetic patients by increasing their GFR and reducing chronic kidney disease to the early stage.


This retrospective descriptive study was conducted to determine the effectiveness and the
side effects of the three-drug antiretroviral tablet (GPOvir), containing nevirapine, stavudine and
lamivudine, in the treatment of naïve HIV-infected patients with varying CD4+cell levels. The
study subjects comprised HIV-naive patients 15 years old and older who received GPOvir for more
than one year at Thabo Crown Prince Hospital, Nongkhai Province, in the period from February
2004 to September 2007. CD4+cells were counted and the side effects observed after one year of
treatment. The results revealed severe drug side effects in 33.90 percent of the patients: hepatitis in
15.24 percent, and extensive rashes in 6.78 percent; the responses of CD4+ cells from the initial
counts of less than 50, 50-100 and 101-200 cells/mm3 were statistically significant after 6-24
months of treatment. The study concluded that GPOvir was effective in the treatment of
HIV-infected patients even though the level of side effects was high in one-third of the patients.


This action research study was aimed at developing a model for the promotion of exercise
behavior in 196 type-2 diabetic patients who were residing in a community of Bang Kor Laem
District, Bangkok. The study population comprised 43 men and 153 women, whose average age was
58.4 ± 9.2 years. The researchers studied the exercise behavior and related data, and measured the
patientsû anthropometry, fasting blood sugar, hemoglobin A1c, and lipid profiles. In this action
research for exercise behavior modification, the Transtheoretical Model (TTM) was employed, and it
yielded successful results; however, when the çFour-step Model for Achievement of Exercise
Behavior Modificationé was applied, it was found that 168 of 189 diabetic patients (equal to 88.9%
of the total) had improved exercise behavior. When comparing the result of blood chemical
concentrations checked before and after the study, it was found that the level of hemoglobin A1c
decreased, with the statistical significance being p = 0.00; however, other factors showed no
statistically significant changes. Based on the results of the study, it was concluded that, after
developing the model for promotion of exercise behavior in type-2 diabetic patients through the
application of the TTM, as well as designing the proper exercise prescription for diabetic patients,
the exercise behavior of the majority of diabetic patients in this program had been successfully
modified.


This research was conducted from October 2005 to September 2007 with the aim of
developing a counseling system and determining the efficiency of HIV counseling in preventing the
maternal transmission of HIV at the antenatal care unit in Pong District, Phayao Province. The first
step was undertaken in 2004, namely a situation analysis and result evaluation for planning. The
second step in 2005 developed the couple HIV counseling system, promoted project and personnel
preparation, and tried a one-stop health center approach. The third step in 2006 implemented
the system, while the fourth step in 2007 adjusted and further developed it. The device for
collecting data was evaluated, i.e. an awareness form for HIV counseling and gathering general data
for that purpose in the antenatal care unit. Analysis was by mean, percentage and standard
deviation. The result of the study showed that after counseling the mean awareness of the couples
was higher than before counseling and that success had been achieved in developing the couple
HIV counseling system in the health center of Pong District. Coverage was more 100 percent of
health centers and more than 80 percent of all such couples in 2007 in the antenatal unit; now all
health centers have a couple HIV counseling system. There was no instance of one mate infecting
another and in more than 80 percent of the pregnancies of an HIV-infected mother there was no
transmission of the virus to the child.


This case-control study was conducted to identify the risk factors for obesity in preschool
  children in Jaehom District, Lampang Province. The subjects comprised 108 obese and 108 non-
  obese children, aged 0-6 years. Information on the childrenûs weight, height and activities,
  consumption style and family background was collected by the study team from the childrenûs
  parents. The findings on the following risk factors were all statistically significant (P< 0.05): a body
  mass index >23 kg/m
2
 of the childrenûs fathers, their own birth weight being >3.5 kg, their food
  intake exceeding  three meals a day, their habit of taking food before going to bed, consuming
  large amounts of food per day, being fond of fried and fatty food, and parents having an attitude
  favoring a chubby-looking child. These findings suggest the need to improve consumption behavior
  as part of the intervention program to prevent childhood obesity.


The objective of the study was to assess the mechanism of human subject protection, focusing on the
ethics committee in the central part of the Ministry of Public Health. The methodologies included a literature
review, questionaire, and in-depth interview. The study revealed that most departments in the Ministry
had established ethics committees, i.e., Ministry of Public Health, Department for the Development of Thai Traditional and Alternative Medicine, Department of Medical Services, Department of Disease
Control, Department of Medical Science, Department of Mental Health, and the Health System Research
Institute. There are institutional ethics committees in the Department of Medical Services, e.g., the National
Neurological Institute and the Queen Sirikit National Institute of Child Health. Most members of
the committees are acquainted with international ethical principles and guidelines for research involving
humans. The composition of the committees is in line with international guidelines. Each committee has
its own guidelines and standard operating procedures. Only one committee has been surveyed, evaluated,
and recognized by the SIDCER/FERCAP Recognition Program, i.e., the Ethics Committee for Thai
Traditional and Alternative Medicine. Since research is not the first priority of the Ministry of Public
Health, there are some shortcomings that need to be considered for correction and improvement. Most
medical and health journals have no policy requiring the ethical clearance of studies submitted for publication.
Most ethics committees focus only on a preview of the protocol, with no proactive activities on
continuous review or site visits. Most committees review both scientific and ethical aspects; meanwhile,
most members of ethics committees have limited knowledge and experience in research on advanced and
complicated sciences. The support of most committees is inadequate. Information techno-logy is not fully
used by most committees. Some committees have problems in conducting timely reviews and there may
be doubts about their independence in some cases.


Public Health Database Management System for Prik Municipality (PHDBMS_PM) was a research project supported by the Southern Health Systems Research Institute (HSRI) to study the healthy conditional prototype of a community at the level of sub-district municipality. Prik Municipality at Sadao district, Songkhla province was selected as a target area for this case study. The study composed of six stages. 1) Assessing community needs and collecting data, 2) Designing Knowledge  Base System, 3) Developing Knowledge base System, 4) Developing skills and training for Knowledge 5) Developing Public Health Database Management System, and 6) Developing skills and training for Public Health Database Management System.
In the study process, there were a number of field surveys for collection data. The study developed a tool for knowledge management in the format of web application at URL: http://www.tonprikinfo.org for staffs of Prik Municipality, educational offices, and community people. The study process also included learning exchange by classifying on community of practice, story telling, local wisdom, center of excellence, forums, and lesson learned.
	The result of assessing community needs indicated a total of indicators of five healthy conditions. 1) Physical condition with 28 indicators, 2) Emotional and spiritual condition with 9 indicators, 3) Social condition with 17 indicators, 4) Environmental condition with 11 indicators, and 5) Network condition with 2 indicators.  The data were collected from three sources that were Prik Municipality, Prik Sanitation Station, and Basic Information Needed for Families from the Community Development Department, Ministry of Interior. The study developed a database system to indicate the healthy condition of Prik Municipality community through web application at URL: http://www.tonprikinfo.otg/application. The system shows the output in the easy understandable format with convenience to improving and searching for the information. This system supports three groups of users that are administrators, municipality staffs and community people in Prik community.  The administrators can use information for decision-making such as planning the policy for the health of people in Prik community and etc.
	The PHDBMS_PM is flexible that can be adjusted to increase, reduce, of change the indicators when needed by users and can be further applied as the prototype of public health database management system in other community as well.


The Report describes and analyses the Thai alcohol policy process in the period 1997- 2006, in order to investigate the characteristics and areas for potential improvement of the Thai alcohol policy process. The analysis used several extant public policy models. The models covered three aspects of the process at the macro level: stages of development, the characteristics and behaviors of major policy players, and the policy context. At the micro level, the analysis employs concepts of agenda setting, policy formulation, policy implementation, monitoring and evaluation, stakeholder relationships and policy context. Information on Thai alcohol policy was collected from two sources: secondary data included official documents, literature, technical publications and mass media; primary data was collected through stakeholder interviews.
Thai alcohol policy, during this period became more comprehensive and more oriented to public health. Problem-reduction values gained momentum while economic values remained significant. Thai policy stakeholders focused on the formulation process, while implementation, monitoring and evaluation were neglected. Limited resources, human capacity and ineffective management exacerbated this situation. Incrementalism characterized Thai alcohol policy formulation; existing policy or the policy precursor was very important to the decisions made. Limitations in the availability, accuracy and utilization of knowledge about alcohol consumption, related problems and alcohol policy also affected the process.
The Thai alcohol policy process became a more open public policy sphere for stakeholders. Many new players made major contributions to the process. The mechanisms stakeholders use to influence policy have become more complex and included:  technical knowledge, the use of mass media and civil movements, and coordination among stakeholders. A centralized bureaucratic administration and personal and institutional interests are critical features for official stakeholders, while connection to high-ranking officials and representation in the process are significant for interest groups. The Thai cultural context had a crucial impact on the alcohol policy process; cultural features that are not explicitly covered in the Western policy models utilized include cronyism, relationships, representation, commitment, negligence, and compromise. These characteristics make the Thai alcohol policy process difficult to fully explain in terms of the available public policy theories.


Background: Series of violence have ruined lives and properties of residents in Pattani, Yala, Narathiwas and some districts of Songkhla provinces since January, 2004. From the beginning, the violence inevitably has affected health care services, particularly primary health care in rural area. Outpatient in primary care units were decreasing while those in hospitals were increasing. Health personnel had been under enormous fear and stress of insecure living and working environment. Shortage of health personnel due to moving out of the crisis area was observed.
Objectives: To identify strategy and develop model for immediate intervention and long term health care system that appropriate to the southern violence crisis context.
Results:
•	Security of health care facility and personnel:
Health practitioner and academia had developed security management package using the concept of neutrality and strengthening protection to harden soft target and immunizing with good and impartial health services which increase community acceptance to soften threat.
•	Emergency medical care and referral system:
Regional and provincial referral center and expert consultation network were set up. However quality improvements in some area e.g. transfer from place of occurrence to health care facility are still needed.  In addition to health personnel were worry about security during refer.
•	Financing management:
Budget was increasing, mainly in operation, incentive and investment while expense was also increasing. Overall balance is slightly increasing.
•	Human resource management:
Although number of overall health personnel is above the country’s average, shortage of some particular fields e.g. surgery is still a big problem due to increased workload from crisis.


The Universal Health Care Coverage Program (known as the 30 Baht Program) has attracted tremendous attention from both public and private sectors since its initiation due to its widespread impacts on health care clients and providers. However, there have been only a few systematic studies on the impacts of the program. The purpose of this study is to apply econometric methods to study and evaluate the impacts of the Universal Health Care Coverage Program on both the demand for (i.e. patient visits) and the supply of health care (i.e. quality of health services). This study also provides some suggestions that may help reduce existing problems of the program so that it can be more successful and effective in order to offer true benefits to Thai people.
	It is interesting to see that the impacts of the Universal Health Care Coverage Program on outpatients were dramatic during the first year of the program, and them faded away quick in the subsequent years. A possible explanation is that, during the first year, participating hospitals faced a sharp increase in the demand for health care while they were not ready to provide services with decent quality. This caused problems such as long waiting time for hospital visits, uneven quality of health care services provided to patients with different types of health insurance, and a lack of confidence in the quality of the services provided, As a result, some of the patients who looked for high-quality services and were able to afford private hospitals or clinics, though they were eligible for the Universal Health Care Coverage Program, decided to switch to those alternative. Moreover, since this process of adaptation takes time, we do not observe the decline immediately during the  first year of the program, but in the later years.
  	At  the micro level, individual level, we find that three hospitals in our study share a common important finding. After the program was implemented.  Inpatients that had some types of coverage even before the program visit the hospitals more than those who never had any coverage until the program was introduced. Since impatient cares usually involve high treatment costs relatively to outpatient cares, Universal Health Care Coverage has relatively small budget compared to other coverage programs, it is possible that hospitals have incentives to allocate their resources unevenly across health care services provided as well as across patients under different coverage programs. The hospitals might have an incentive to  provide more services to patients with other types of coverage programs than patients with Universal Health Care Coverage. However, with existing data, our empirical results cannot lead to a precise conclusion and we leave this issue to future studies.
	It terms of the impacts of the Universal Health Care Coverage program on household’s expenditure on health and other categories, we find that household’s health expenditure decreased by 68% as compared to the period before the program (425 baht per month or 5,100 baht per year). In more details, we find that the impact from the program fades away over time.  In 2545, household’s health expenditure dropped by 93% (as compared to the period before the program was implemented) while heath expenditure in 2549 was only 47% lower (as compared to the period before the program was implemented). Although the program helps households save on their health spending, we do not find and empirical support that suggests an in expenditures on education, or harmful items such as tobacco and alcoholic beverages.
	Another interesting result from this study is that households that did not have any member eligible to health care before the Universal Health Care Coverage Program tend to have a smaller decrease in their health expenditure after the program, even though these households are the main target of the program. There are several possible explanations for this finding. These households voluntarily chose not to participate in the program, or there were some obstacles that prevent these households to exercise in the program, or there were households might not trust the quality of the health care or might not satisfy with the services provided, and therefore chose not to participate in the program. It could also be that some households were not able to afford the transportation costs to and from the participating hospitals.


This research report is part of the research program entitled “financing study to support the public health security in Thailand” with the primary focus on public hospitals under supervision of the Ministry of Public Health. The objectives of this research are: a) to deepen understanding about cost efficiency of public hospitals in Thailand and to search for those hospitals that are operating at cost frontier, b) to lend support to the database development that would adequately cover the financial aspect of hospital management; c) to apply econometric tools to measure cost and technical efficiency of public hospitals and to perform comparative analyses of efficiency across public hospitals.
	This research compiled data and information from public hospitals that are broadly grouped into 3 types, namely, regional-, provincial- and community hospitals and adopts economic theories and models to estimate cost functions, unit cost, economies-of scale, and capacity utilization. With respect to relative efficiency of public hospitals, the present study employs Data Envelopment Analysis (DEA) as tool to measure technical efficiency scores of each hospitals; the model has some desirable features in that it is nonparametric approach and does not requires rather strict assumption regarding distributive functions of the parameter. Our DEA method follows the input-orientation (cost minimization) and two alternative assumptions are adopted for sake of comparison, VRS (Variable returns to scale and CRS (constant returns to scale)
The case studies under the coverage of this research include 710 hospital units under supervision of the Ministry of Public Health that are  classified under 3 groups, namely, regional hospitals (23 units), provincial hospitals (58 units), and community hospitals (62 units). Three sources of information are pooled into our database, namely, a) the financial data based of the yearly accrual accounting report of individual hospitals with details of spendings by categories such as personnel expenses, drug and medication cost, utilities and others—all figures refer to fiscal year of 2006;  b) the provision of health cares by individual hospitals that are broadly grouped into 2 categories, viz., in-patient day and out-patient cases and the relative weight of DRG (diseases related grouping   to reflect degree of severity of illness; c)the basic  information of public hospitals that are inclusive of the number of bed, numbers of medical staffs and support staffs, where the hospitals are located, and others.
Findings: The average efficiency scores in case of regional hospitals ranged from 94-97%, in comparison to the provincial hospitals whose averages ranged from 86-89% and the community hospitals whose average values ranged from 75-81%. These estimates imply that there are room for further improvement and , if so, -would reduce hospital costs by 3-7% in the case of regional hospitals, 11-14% in the provincial hospitals, and 19-25% for community hospitals.
	Another topic of study is to investigate whether the public hospitals are operating under constant-cost, or decreasing-cost, or increasing-cost situation. Based on economic theory, the decreasing cost situation implies there is a possibility to reduce the unit cost by expanding the scale of operation, and this suggests that the particular hospitals are that those hospitals may have operated beyond the full capacity. The research team performed regression analysis of cost function by different types of public hospitals-the results indicate that: a) the regional hospitals tended to operate at constant-cost that implies a full capacity utilization; b) in the cases of provincial- and community-hospitals, our regression estimates indicate that they were operating at decreasing cost and that implies a less-than full capacity situation.
	Discussion: The results from the DEA efficiency and the regression estimate of cost function reinforce each other and confirm to our prior expectation that the regional hospitals were almost always operated at full capacity and their efficiency score ranked highly. Remind that the efficiency score reflects the excessive input, for instance, the cost efficiency score of 90% implies there is a scope for cost reduction of approximately 10%.  The total cost of regional hospitals  were, on average, 1,330 million baht, in comparison to 499 million baht and 65 million baht for provincial- and community-hospitals respectively. Taken into account the magnitude of the cost of production, the scope for cost reduction in the case of regional hospitals is high and there might have motivated hospital managers to either reduce the excess inputs or to increase the scale of production whenever the utilization rate fell below the standard norms—in addition, there might be other qualitative factors such as location at the city-centered and the completeness of hospital care services provided by regional hospitals that raised confidence of patients, compared with the provincial-and community-hospitals. These do not mean to belittle the management of the provincial-and community hospitals, but they might have operated in different situations from the regional hospitals. To our understanding, some of community hospitals are located far from the town-centered, in island, in the rural and the remoted area with sparse density population-these situations made it difficult for those hospitals to operate at full capacity, And taken into consideration that demand for health cares are subjected to daily and seasonal fluctuations in illness—despite of these limitation and the nature of contingent demand, those community hospital are still necessary from the public management perspective, and accordingly, they tended to operate at below full capacity and, thus, higher unit cost and they fared lower in terms of efficiency scores.
Similarly to other researches, there are limitations to the present study which is considered to be at a “pilot” stage, we are of opinion that there are scope for much further improvement in our model and database. We would like to express our gratitude to the Research Steering Committee (chaired by Professor Ammar Siamwalla) and the financial support of the Health Insurance System Research Office for valuable comments and advices over the past year that have led to a marked improvement in our model.  Following their advices the research team had conducted the hospital visit and held 3 focus group meetings in the north, central and southern provinces from which the medical doctors, the financial analysts and support staffs of hospitals were invited to comment and to suggest ideas for improvement in the next stages.


This report presents a study of managing the mechanism of providing the information of health insurance system that is suitable for consumers. The purpose of the study is about the organization’s mechanism and process in providing information regarding the health insurance system by considering efficiency, effectiveness of its mechanisms and management guidelines in providing the suitable information of health insurance system. The methods of the study includes both the quantitative and qualitative researches. The quantitative researches are conducted for  3,015 cases; the area of research is Bangkok and 11 provinces in 4 peripheral regions. While the qualitative researches are conducted the exclusively interviewing  59 persons. It also includes the public hearing and doing research of  5 case studies. The results of study are as follows.
	Regarding the mechanism of providing information of health insurance system, it is found out that there obviously exists the agencies who are responsible for universal coverage health insurance and social insurance system. But the welfare system for civil servants, which is additionally attached to Comptroller General’s Department, Ministry of Finance who will be in charge, does not have a clear structural mechanism to handle the system. The process of  providing information before the medical treatment (upstream) about the rights that one can receive according to rights of all three health insurance system is evaluated as fair, especially  the rights of civil servants/state enterprise staff about their registration in order not to pay the medical bills in advance. For both in-patients and out patients, they are aware of more than two health insurance systems. From the opinions about the process of providing information of  health insurance system in each stage of undergoing medical treatment (midstream) of health insurance system,  It’s also found out that the simple groups agree at a high rate, especially the cases of receiving the medical treatment at medical centers, about the data of service users’ illness. And form information providing when finishing the medical treatment  (downstream), regarding giving the clear information the sample groups also agree at a high rare, especially the case of being transferred to receive treatment at other places. Regarding the efficiency of mechanism and process of management of providing information of health insurance system, it is found out that the first two health insurance systems are not more efficient than the civil servants’ welfare system, is less efficient and lacks mechanism for systematic management. In terms of the effectiveness, the service users are quite satisfied, However, from the qualitative study it is found out that the study groups are satisfied to some extent and think that it needs to improve three systems continuously for their sustainment.
	It is advised in the study that all three systems are to be improved to guarantee fairness and equality for the basic common rights of the three systems. In case of over the eligible rights, the service users should bear the expenses as well. It should be created the participation in sharing information earnestly and continuously. It should be developed the empowerment information process (EIP) to enable everyone to realize the importance of providing information and regard that it is the beginning of building the good relations between the parties concerned. It should be regulated the structure of management of providing information, that will comprise watching, following up, monitoring and learning from the best practice. There should be the organization, that will receive and deal with complaints, and be independent. It should be built the culture of reporting the mistakes occurring in the system. It should be fixed that providing information of health insurance system will be the index of evaluating the quality of organization (HA). It should be analysed about the nature / formats / channels / contents of information of health insurance system.


This study is aimed at reviewing people’s accessibility to dental health care service. Primary data was derived from two major household surveys conducted by National Statistic Bureau; health and welfare survey, and economic and social status survey both in 2003 (N = 26,520 households and 68,433 individuals) and 2006 (N = 25,98 5 households and 74,057 individuals). Extrapolation to total population by weigh was then calculated.
	Marginal increase in overall health insurance coverage in general population was found from 95% in  2003 to 93 % in 2006, of which national health insurance scheme contributed 68-88%. Considered by age groups, 81-83% in school age and 87-88% in school age get highest coverage of the national scheme. Focusing to dental health care service, the overall utilization has declined from 10.19% to 7.44%, compared to those covered by the national scheme from 9% to 6%. The highest utilization was among school age children (17% to 10%) compared to the lowest, pre-school age (3% to 2%). The result revealed that despite of high coverage of national health insurance scheme, the low accessibility to dental health care is still unsatisfied. Among them, preschool age children to whom dental health promotion should be concentrated getting worse.


This is a qualitative research using quantitative data collected by a survey research and having the objective to study the meaning and value of life of People with Disabilities in Buddhism so as to comprehend Buddhist monks’ understanding about the meaning and value of life of People with Disabilities in Khonkaen province and to know about the problems, obstacles and suggestions of practice following the teachings of Buddhism regarding meaning and value of life of People with Disabilities.
	The results of the study indicate that according to Buddhist principles of People with Disabilities are able to train themselves by special method from other normal people depending on the level of their physical disability. Self-training not only means to train in right livelihood which is value of life at the mundane level but also means dhamma practice in order to develop the mind that leads to value in super mundane level.
	Life of People with Disabilities has the following values-(1) They are born with moral rights that have intrinsic values, (2) Their life is the moral matrix or they are creator of virtues that appear clearly in this world same as normal people, (3) They have the potentiality of self-training following the Buddhist teaching.
Whether it’s congenital disability or disability that arises later on , Buddhist perspective holds that-(1) disability can tell us about the past so as to understand the reality of life and action and its effect, thereby making one acknowledge the value of life that is lived in a heedless way- (2) Physical disability can also indicate the future that is based on physical difference from normal people. (3) Physical disability is also social narrative tool indicating that society should learn from the life of People with Disabilities in the same way as one’s own life so that the “otherness” of People with Disabilities will disappear from society. When society understands People with Disabilities in a real sense it would be possible to create the necessary and appropriate things for them which lay the foundation of a friendly society. There are Buddhist teachings that are supportive of a society that is kind to People with Disabilities and there are Buddhist principles that can be used in practice to support and assert value of life for them. These principles are-frendliness (Kalyanamitta), Divine Abidign (Brahma Vihara), Principles of service (Sangahavatthu), states of conciliation or virtues for fraternal living (Saraniyadhamma), and enlightenment factors (Bojjhanga).
	Regarding the Buddhist monks’ understanding of the meaning and value of life of People with Disabilities in Khonkaen, the study found that they have good understanding of intrinsic value at a moderately level. Regarding the problem of meeting the religious needs of People with Disabilities it has been found that at times Buddhist monks lack the religious information about them and most temples/monasteries do not have the aids and place that can be used for the practice of religious activities of People with Disabilities
	The present research has the following policy-related suggestions- (1) increase the imparting of knowledge about the meaning and value of life of People with Disabilities in Buddhism to both monks and laypeople; (2) give opportunity and support to People with Disabilities to receive education, knowledge, participation in religious activities that are appropriate to them at the individual level.
	For future research it can be suggested that more research is needed to be undertaken regarding the religious practice of People with Disabilities of different types including both ordained and laypeople and also about the bioethics of these people.


The goal of the Thai health system development is to achieve a balanced and sustainable society in which all Thai citizens have security to live a happy life in a healthy and better condition. The objective of this research were literature review formed a foundation and knowledge of Thai good governance in health system, analyze and plan for research mapping.
In this study, the good governance in health system was divided into 10 sectors; rule of laws, ethics, transparency, participation, accountability, value for money, human resources development, knowledge organization, and information technology. These were simultaneously analyzed in macro and micro analysis system that influenced by the economic, social, political conditions as well as agency’s role.
The literature review found that there were problems in every components of health governance, if these problems were solved more effectively, it would generate a better and improved service in health care system. Consequently, it would create a sustainable society in which all Thai citizens would live a happy life in a healthy condition.
	The study found that  governance is a function of the health system, each governance principle should be developed and adapted, and governance issues should identified at all levels. The problems of study in  health governance were that it need more research,especially in qualitative approach and comparison of the  international governance function


The rising health care cost has reached the point where cost sharing from patients might be essential to sustain the health system. This report is aimed to synthesize lessons on cost sharing policies in 10 countries; namely, Australia, Canada, Finland, Germany, Japan, Singapore, south Korea, Taiwan, R.O.C. United Kingdom, and United States of America.
	The study comprises two components. The first is literature review general information of each country on its current health insurance systems, basic principles for cost sharing, approaches and rates used for cost sharing, mechanisms to protect the disadvantaged population, as well key concerns about implementing cost sharing policy.


Since its establishment, the National Health security Office (NHSO) has been developing a variety of systems and mechanisms for purchasing health care. The purchasing operations vary by types of  health services with differing advantages and limitations. They affect access to care, quality of care and resource efficiency.
	This study, therefore, aimed to examine current concepts, models, along with problems and obstacles off vertical purchasing arrangements of NHSO. In addition, it intended to explore reasons behind health care purchasing initiatives and criteria for selecting conditions suitable for vertical purchasing arrangement from foreign experiences published in academic journals or other sources. The study purposes also included developing recommended purchasing models comprising appropriate selection criteria, disease or service groups, requirements for health services and organizations, systems and mechanisms framework, and systems and mechanisms for monitoring and evaluation for vertical health care purchasing arrangement. And, Finally, it planned to assess feasibility of the recommended model. The 11-month study period was from June 2007 until April 2008, and could be divided into two phases:
	Phase 1 Collection of preliminary data and details of operating vertical health care purchasing arrangement of NHSO by document review, stakeholder interviews and system analysis.
	Phase 2 Assessment of systems and mechanisms of NHSO, as well as contracted providers, according to a proposed “Disease management” purchasing model in order to explore results and adjust the models and requirements proposed using results from the phase 1 of the project.
	The study findings suggest that NHSO has many health care purchasing approaches. They can be organized into two major systems:
1.	Basic care purchasing
2.	Vertical purchasing arrangement (VPA), comprising purchasing contracts  that are separately done from basic care purchasing by well-defined customer groups, service provider requirements, payment mechanisms, billing and system administration operated by the central office of NHSO.
Findings from the phase 1 and 2 of this study show three groups of problems and obstacles in vertical purchasing systems:
•	Principle-level and conceptual problems of the health care purchasing systems unclear and inconsistent principles or concepts applied by NHSO teams and staffs lead to inconsistent planning and decision making, as well as problems and obstacles in operations.
•	Problems in designs of systems and mechanisms of health care purchasing: Unclear and defective system design and mechanisms, particularly practice guidelines, budgets, payment mechanisms, communications and information systems. These adversely impact actual practices.
•	Deployment problems: problems in deployment and implementation of design systems to inconsistent planning and decision making, as well as problems and obstacles in operations.
•	Problems in designs of systems and mechanisms of health care purchasing: Unclear and defective system design and mechanisms, particularly practice guidelines, budgets, payment mechanisms, communications and information systems. These adversely impact actual practices.
•	Deployment problems: problems in deployment and implementation of design systems and practice guidelines. These were caused by limitations of internal management systems of NHSO, inadequate supports from information systems, providers or other external factors, such as beneficiaries’ behaviors.
Taking into account all study findings, therefore, the systems purposes for developing health care purchasing may include:
•	Increase ability to access services
•	Create care standards
•	Improve continuity of care
•	Stimulate and promote disease prevention, delay disease progression and complications
•	Respond to specific requirements of target populations
•	Enhance efficiency in resource utilization
•	Increase management efficiency using information systems
Considering characteristics of health services and purposes of purchasing systems, health care purchasing can be divided into five systems:
		1)  Disease management system for chronic diseases
		2)  Disease management for acute diseases and high-cost procedures
		3)  Vertical purchasing arrangement for health–risk control projects
		4)  Purchasing systems for health promotion and disease prevention services provided by health care providers
		5)  Purchasing systems for emergency medical services

Management  of the vertical purchasing arrangement should emphasize proactive services to reach target populations, application of clinical practice guidelines and health services guidelines, provider standards, strong networking and referral systems, information system linkages, attractive payment which also provides incentives for efficiency, monitoring and performance reviews, economy of scale, responses to local needs, and participation. All may differ by systems.

	Selection criteria for suitable conditions, disease groups and service types for vertical purchasing arrangement consist of three categories:
1)	Criteria related to burden of diseases, including high-cost care, diseases with high probability for emergency care in care of controls, diseases with high utilization of inpatient services or extended length of stay, chronic diseases or conditions that need ling-term care, diseases that outcomes or complications can significantly affect quality of life, preventable high-burdening diseases, diseases with high community impacts which require special attention and management
2)	Criteria related to national opportunities for improvement, including diseases that quality care can control disease progression or cure, prevent or reduce service utilization, including emergency services and inpatient care, which can decrease cost of patient care, disease groups that require multi-disciplinary team and networks of care to increase access and quality of care, disease groups with significant practice variations, diseases or health conditions that community participation in health care can enhance effectiveness and significantly reduce requirement for medical resources, diseases that standardized treatment approaches can increase resource efficiency, access and effectiveness, and diseases or procedures with cost-increasing new technology which requires close monitoring and evaluation against existing ones before becoming standard practices.

The study team, therefore, propose the prototype model for vertical health care purchasing arrangement that consists of five major steps, including (1)  Need assessment and selection of services suitable for vertical purchasing arrangement, (2) Design and contracting for purchasing services, (3)  Development of management systems and service networks,  (4) Piloting and preliminary assessment of the systems, and  (5) Performance review and implementation as normal operations. Details of all steps are shown in following picture:


Public health insurance for low-income population	Social security	Public Health insurance for government employees
Accessibility and quality of public health services	•	Budget of 2,100 Baht per capita 2008.
•	Integrated health care.	•	Budget of 1,600 Baht per capita in 2006.
•	Exclude health promotion and prevention.	•	Budget of 4,000 Baht in  2006 and 6,000 Baht in 2008
•
Rights to choose health care providers	•	Recipients must register their service units and primary health care providers, which mostly are public hospitals. They do  not have enough personnel to meet patients’ demands.	•	Recipients must register health care providers contracted with social security administration. Most recipients choose private hospitals because of their perceived superior quality of services.	•	Recipients may choose to receive services from any government hospitals
- no private hospitals are allowed except in cases of emergency.
Rights to complain and receive assistance and compensation payments from public health services	•	The National Health Insurance Act of 2002 and the National Health Act of 2007 clearly specified the right to complain and receive assistance, and processes and procedures of managing compensation payments from public health services.	•	The Social Security Act of 1990 and its amendments did not specify consumer rights. It did, however, provide different venues for complaints such as office of Social Security Administration, Social Security Hotline, and Medical board, along with clear processes for grievances and compensation payments.	•	No laws determining employee rights to complain and receive compensation payments. The Central Budget Office coordinates with health care providers and government offices. Grievances are handled through courts.

Various laws guarantee consumer rights to receive public health information, such as the Consumer Protection Act of 1979,  the Information and News Act of 1997, the National Health Insurance Act of 2002, and the National Health Act of 2007. They also specify monitoring system. This study found, however, that consumers could not access to accurate information and did not know their rights guaranteed by laws. There was a communication gap between policy and implementation levels because of fear of  complaints to echelons.
The rights to participate in health insurance management system are granted by the related laws mentioned above and the Protection of Compensation claimants in Public Health Services Act of 2007. The insurance scheme for low-income populations has committees formed at national and local levels. The social security scheme has a national committed working with representatives from employees, employers, and government. However, their collaboration was still limited. Under government employees’ scheme, there was no participation from its recipients.
1.2	 The current situations of consumer protection in health insurance system in other countries
This study’s literature review included three countries representing different levels of development: the United States of America, South Africa, and Ghana. The review was aimed to find best practices of consumer protection in health insurance system. Through various channels. Recently, the country has implemented a voluntary social security system which will be converted to a mandatory system.
	Ghana-In the past, its citizens had health insurances through local communities which covered only a small portion of populations. Many people were neglected and refused treatments. Recently, the country has implemented a universal health insurance system where all citizens must be insured through either local community plans or private insurance. The state only subsidizes the former, however, Consumer protection mechanisms are at the national level through a committee that monitors quality and standards of services,.
2.  Efficiency and effectiveness of consumer protection processes in health insurance system in Thailand
2.1 Efficiency
Both public health insurance for low-income populations and social security schemes include consumer protection mechanisms. The former has clear processes at national, regional, provincial, and, organizational levels, while the latter national and regional levels. The government employees’ scheme only has national level mechanism which was the Central Budget Office’s monitoring reimbursement issues and escalading complaints to other agencies. In private sector, there are consumer protection agencies and networks that assist consumers in general.
	Even though several laws clearly guaranteed consumer protection, there were various problems at the implementation level. Besides a communication gap mentioned above, there were tensions between health care providers and patients regarding medical errors. Patients have higher expectations from treatments and demand more rights and services, especially low-income populations. Medical personnel are sued more and thus stressed. In addition, health care providers are experiencing budget and personnel shortage and unfair resource allocation. They have to cut costs which affect quality of health services. In addition, different laws guaranteed different rights, but did not define responsibilities of consumers. At a policy level, complicated structure of consumer protection created duplication of roles and thus conflicts among various agencies such as the Ministry of Public Health and Office of National Health Insurance.
	Although there is a mechanism of consumer participation through various committees, its implementation needs improvement. Under low-income populations’ scheme, there were more representatives from private sector than consumers. Local communities could not collaborate with health care providers because they lacked understanding of the laws. Under social security scheme, employees could not select the own representatives and did not know their representatives. Under government employees’ scheme, the Central budget Office needs to invite representatives from government offices and from government employee associations.
	Proper consumer protection processes should cover five sets of activities as follow. Medical errors were an example in this study where these processes may be beneficial when all sets of activities are utilized.
	1. Prevention-study nature of consumer rights violations, collect data, anticipate and prepare for problems, and develop new policies
	2. Monitoring-monitor expected problems closely
	3. Information dissemination-educate, motivate, and empower consumers
	4. Advocacy-establish complaints and grievance processes, and provide assistance and compensation payments
5. Fair law enforcement-enforce existing consumer protection laws fairly and ethically
2.2  Effectiveness
	2.2.1 Consumer protection provision – There were different problems that must be carefully examined, including accessibility, quality of care, coverage, effectiveness, efficiency, rights to choose primary health acre providers, rights to complain and receive assistance, rights to receive public health information, and rights to participate in health insurance management. Various processes must be restructured: policy implementation, law enforcement, consumer awareness and education, grievances and appeals and information dissemination.
		2.2.2 Health care provider satisfaction- Health care providers are under scrutiny especially under low-income scheme. They have a shortage of staff and resources while their patients have high expectations. This creates conflicts and complaints. The laws only protect consumers, but not health care providers, and neglect  responsibilities of consumers. They demand their rights, but did not know their responsibilities. Therefore, health care providers are under a tremendous pressure and stress. Equal treatment should not mean that consumers receive all treatments they wish. Rather, they have equal access to basic necessary treatments.
		2.2.3 Consumer satisfaction-Consumers could not access to public health information, were not aware of their rights and how to protect them, did not understand limitations of health systems, therefore had unrealistically high expectations which led to complaints and lawsuits, Sincerity form officers and continuity of assistance made consumers feel satisfied and motivated however.
	3. Based on results from this study, several suggestions to improve effectiveness and efficiency of consumer protection in health insurance system in Thailand are chosen. They are presented as follow.
1. Revise laws, regulations, and guidelines that hinder implementation.
2. Make various aspects such as consumer rights, grievances, information dissemination, and true participation in health insurance systems in three major health insurance schemes consistent.
3. Improve reimbursement processes to lessen level of discriminated services
4. Include responsibilities of consumers in related laws.
5. Enforce consumer protection laws to empower consumers and their networks
6. Institutionalize independent ombudsman services in local communities to assist consumers.
		7. Add monitoring component to consumer protection processes.
8. Add channels for information dissemination, including formal and informal education from kindergarten to higher education, and life long learning.
9. Analyze true causes of medical errors and solutions to reduce grievances and lawsuits, which could include personnel shortage, management, and consumers’ understandings of health care service limitations.
10. Develop professional consumer rights  activists who are educated, competent, and motivated to help consumers and improve effectiveness and efficiency of consumer protection processes.


The study on “The mechanism and process of handling complaining and  extending primary assistance in the health insurance system” employed the quantitative and qualitative methodologies. Its purpose is to study the mechanism and process of handing complaints and extending assistance regarding the health insurance system; efficiency and effectiveness of its mechanisms and process; the impacts of failure of providing health services giving effect to the service providers, the complaints, and society; including the implementation and constraints of Health Insmance Coordination Centers of People Sector concerning of participation in health insurance development and the independence of people sector in working with the local administration organizations in long term of community health management. The sample size of quantitative study composed of 3,015 respondents based in Bangkok Metropolitan and peripheral areas, including 11 provinces in 4 regions. While qualitative study used the in-depth interview of 59 key-performants, organizing a public hearing,  and case study of 5 cases. The finding of study are as follows.
	The mechanism and process of handing complaints and extending primary assistance in the health insurance systems show different standard among the universal coverage health insurance system, the social insurance system, and the medical welfare system of civil servants and employees of state enterprises, The universal coverage health insurance system has more mechanism of central, regional, provincial, and medical center level to manage the complaints. On one hand, the social insurance system has its mechanism of central, provincial, and medical center level, on the other hand, the Comptroller-General’s Department, Ministry of Finance is the main agency managing the medical welfare of civil servants and employees of state enterprises and controlling the budget disbursement for their medical expenses.
	Regarding the efficiency and effectiveness of the mechanisms and proves of handling complaints and extending primary assistance in the health insurance systems, it is found out that the universal coverage health insurance system and the social insurance system are more efficient and effective than the medical welfare of civil servants and employees of  state enterprises. However, each system has some weaknesses that needs to be improved in the process of handling the complaining and extending primary assistance.
	The impacts of failure of providing health services in the past has often caused the complaining and also caused the negative impacts to the complaints, e.g. wasting time, increasing their own and theirs family expenses. On the other hand, the service providers also suffered from stress, anxiety, losing credibility, and losing good relationship with patients and their families. In the mean time, the society as a whole has both positive and negative impacts. The positive impact is enhancing the public awareness to improve the health insurance system especially in terms of providing the quality of health insurance services to ensure public confidence. On the contrary, it dampened the public confidence in integrity and moral ethics of medical doctors.
	With regard to the performance of Health Insurance Coordination Centers of People Sector, most of the people have satisfied with the performance of health Insurance Coordination Centers Sector at the medium level. Its activities are effective to some extent. The main factor of less effectiveness is budget constraint due to source of budget come from government.
	According to the findings, an independent agency for handing the complaining should be set up, as well as the single standard of all three health insurance systems should also be assigned. The mechanism of handing complaining at medical center level should be empowered. Clients and the health service providers should having positive attitude towards the complaining. The creative conflict management should be promoted to create harmonization between health service provider and clients. Professional ethics. Should be conducted. The effectiveness of handing complaining should be improved. The restoration is used in dealing with conflict management. The equilibrium of medical doctor and population should be adjusted to each area, and also the local administration organizations should participate to strengthen health insurance system in each district. The effectiveness of three health insurance systems should be improved. Also Health Insurance Coordination Centers of People Sector’s potential have to be also improved.
	The further study should be focus on 3 topics as follow: (1) the role and function, committee members, process of undertaking the mission, and sources of financial support of the independent health insurance agency, and (2) the participation guidelines of civil servants and employees of state enterprises in the policy and implementation of theirs medical welfare services.


The study aims at analyzing Buddhist teachings, way of thinking and attitudes to supporting human dignity and self development in the disabled. The research also focuses on the disabled’s attitudes and expectations towards religious communities.
	The study methodology included documentary research and field work by participating, non participating observations and in depth interviews of 20 disabled persons and others living in Bangkok and suburbs. The results of this study are as follows. The “Etemal Principle” of Buddhist teaching never considers disability as a limitation for spiritual development in order to attain the highest goal, nirvana. However, some teaching and some monastic rules exclude religious participation, space and rights to the disabled e.g. ordination may be related to social and culture context. These problematic context may be the teachings in the level of cultural expression’. The disabled and society should be aware of there two levels of teachings. The disabled and society should also understand Buddhist teachings, such as the law of Kamma and Paticcisamuppade, holistically in order that a may empower human dignity and security of the disable and may support the both disable and society. It may also be good to reconsider the issues of ordinary in order to find a solution without offering monastic rules. Furthermore, dialogue between the disabled society and network should be held with the cooperation of the religious community. New technology for learning Buddhist teaching should also be produced it order to empower disabled to lead a perfect, happy and fruitful life. These factors may lead to higher level of self development.
	The result of the in-dept interviews indicated that the disabled negative perspectives towards themselves. Society does not offer good opportunity for them. The religious community (Sangha) is not yet able respond to the disabled as the source of Dhamman therapy, natural therapy and community therapy.
	The suggestions are: religious personnel and human resources in the religious community should change and develop positive attitudes, ways of thinking and the proper ability to empower.