This study was aimed to develop the annual report of national
drug account with the built-in information management system.
The system was designed to maximize benefits from data utilization
for every stakeholder. The 36-month study period (March 2009 to
February 2012) was divided into three phases: the configuration of
the core structure of the national drug account, the information management
system design and development, and finally, the system
testing.
Finding Summary
1. From paper-based report to electronics report
A major change resulted from this study was switching from
the traditional paper based to electronic submission of the annual report
of manufacturing and importing values by pharmaceutical companies.
With an intensive participatory research process from all crucial
stakeholders especially policy makers and key FDA officers, the
developed information management system was naturally integrated
into the routine work. All transcribed errors occurred from the paper-based system
were eliminated by this deliberate designed system. Other errors
were minimized through the standardization of all related variables.
This research had initiated a feedback report on market oriented information
to manufacturers and importers submitting data to FDA as
a recognition of mutual benefits.
2. 2010 National drug account
By the operation of this newly developed system, it was
found that for the year 2010, the value of the domestically manufactured
drugs (excluded repacking) was ฿ 46,895,753,521, the import
value was ฿ 99,663,791,612 and the export value was accounted for
฿ 12,077,467,549. The overall drug value of domestic consumption
(at consumer price) was ฿ 144,570,906,916. ANTIINFECTIVES FOR SYSTEMIC
USE, CARDIOVASCULAR SYSTEM, and ALIMENTARY TRACT AND
METABOLISM were the three ATC groups with the highest consumption
respectively. New input data, the proportion of drug distributed via main
distribution channels, has been added into the 2010 annual report.
However, the data received did not adequately represent the market
value, since these data were never formally required and the platform
of electronic data entry process was quite complicated, causing
pharmaceutical companies had difficulty to comply. The distribution
channel survey was then conducted requesting overall distribution
percentage via 4 major channels from manufacturers and importers.
The itemized analysis on drug distribution could not be achieved.
The consumer price factor, price difference between net sale
price and listed price, for each channel of distribution was calculated
and used to adjust the overall domestic drug consumption at listed
price to derive national drug consumption at consumer price.
Policy Recommendations
FDA should amend the regulation on the additional required
input data, specifically the proportion of drug distribution via
main distribution channels.
FDA should set up a task force to maintain and update data
standard appended to the developed system.
FDA should develop a coordination network to ensure the
consistency in using the standardized data sets across all
involved departments and stakeholders.
FDA should develop and adhere 3-digits statistic coding system for pharmaceuticals based on ATC system by WHO/
CC to the 8-digits Harmonized System code of tariff. This
would facilitate data collection and verification of the report
on importing and exporting values.
Future Studies Recommendations
Calculate national drug consumption 2012.
Develop a comprehensive list of drugstores and hospitals to
be built-in as a supporting system for drug distribution and
mark-up variables.
Elaborate industry feedback information for example, sets of
indices monitoring drug market and consumption patterns.


This study assessed health and economic impacts of antimicrobial resistance (AMR) in Thailand
under societal perspective by using the secondary data on hospitalizations and nosocomial infections
from 1,023 hospitals. A total of 87,751 hospitalizations developed nosocomial infections due to 5 major
bacteria (Escherichia coli, Klebsiella pneumoniae, Acinetobactor baumannii, Pseudomonas aeruginosa and methicillin-
resistant Staphylococcus aureus) that are resistant to antibiotics in Thailand in 2010. These AMR infections
resulted in additional of at least 3.24 million days of hospitalization and 38,481 deaths. Regarding an
economic loss, the cost of antibiotics to be used for therapy of AMR infections were accounted for 2,539 to
6,084 million Baht. The indirect costs of morbidity and mortality due to premature deaths related to AMR
were at least 40,000 million Baht (in 2010 values). The aforementioned health and economic impacts of
AMR are much higher than the burden of many priority health problems in Thailand. Therefore, AMR is
a major and urgent health problem in Thailand that needs comprehensive and systematic approaches at
national and local levels to resolve the problem.


The study explored the patterns of antibiotic utilization, the antibiotic control and surveillance systems,
and measures in promoting rational use of antibiotics among public and private hospitals, health
promoting hospitals, clinics, and drug stores. A cross-sectional survey using self-administered questionnaires
was conducted in 9 purposive sampling provinces in Thailand during April-May 2012. The preliminary
results were analyzed from 484 returned questionnaires (30% response rate) from 10 large public
hospitals, 11 private hospitals, 53 district hospitals, 184 sub-district health promoting hospitals, 69 private
clinics and 157 drug stores. The findings revealed that all of 47 items of antibiotics listed in the questionnaire
were available in large public hospitals whereas private clinics and drug stores had 35 and 36 items
of antibiotics, respectively. Ceftriaxone, a third generation cephalosporin, and fluoroquinolones were available
in all levels of healthcare facilities as well as drug stores. A measure regulating prescription only sales
of all antibiotics created a wide range of disagreements among respondents from different health facilities
i.e. a vast majority of private hospitals (82%) but only 8% of drug stores agreed with such a measure.
However, the regulatory measure emphasizing prescription only sales of some antibiotics appeared to be
acceptable for all levels of health facilities and drug stores. The rate of antibiotic prescription for upper
respiratory infection and acute diarrhea in district health promoting hospitals (35% - 40%) was lower than
those in the private clinics and drug stores (43% - 56%). Most large public hospitals (90%) applied drug
utilization evaluation whereas almost all district hospitals (98%) implemented the antibiotics smart use
concept in promoting rational use of antibiotics. The study results demonstrated that operating systems to
strengthen antibiotic regulation and to promote rational use of antibiotics are strongly needed in all levels
of health facilities and drug stores.


Background: One of the important factors associated with overuse of antibiotics is a lack of knowledge
and awareness on rational use of antibiotics. The objectives of the study were to determine knowledge
and awareness of rational use of antibiotics for upper respiratory tract infections, acute diarrhea, and
simple fresh wounds among first year students of Mahidol University in the academic year 2011 at Salaya
Campus, Mahidol University. Methods: 2,700 first year students were given the questionnaire set I to
determine knowledge and awareness of rational use of antibiotics before the campaigns. The campaigns
were executed by distributing the media of the Antibiotics Smart Use program. The students were given
the questionnaire set II after one week of campaigning to determine knowledge and awareness of rational
use of antibiotics after the campaigns. Results: Sixty six percent and 74% of the students responded to the
questionnaire set I and II, respectively. The range of the correct responses of the questionnaire set I was
18.7% to 75.9% and that of the questionnaire set II was 51.7% to 82.2%. The average correct response of the
questionnaire set II was significantly higher than that of the questionnaire set II. The number of the
students who intended to use antibiotics for upper respiratory tract infections, acute diarrhea, and simple
fresh wounds for the next episode of such ailments was significantly less than the rate of antibiotic use for
such ailments experienced by the students. Conclusion: Knowledge and awareness of rational use of
antibiotics for upper respiratory tract infections, acute diarrhea, and simple fresh wounds among first
year students of Mahidol University in the academic year 2011 at Salaya Campus, Mahidol University
were insufficient. The knowledge, awareness and attitude towards rational use of antibiotics of the students
after the campaigns were much improved.


Objectives: to study the process of implementation of the increasing access to high-cost medicine
listed in the Category E2 of the 2008 NLEM policy to practice under public health insurance systems: the
Universal Health Coverage scheme (UC), Civil Servant Medical Benefit Scheme (CSMBS), and Social Security
Scheme (SSS) and in hospitals as well as to explore factors that promote policy achievement and
problems occurred during policy implementation. Methods: A qualitative approach was employed including
review and analysis of relevant documents. In-depth interviews and focus group discussions
with stakeholders, who involved in the Category E2, were conducted. Results: 1) The policy implementation
under public health insurance schemes: The NLEM subcommittee created the Category E2 guidelines
including other rules and regulations for the three public health insurance schemes to follow. However,
the UC was the only scheme which developed its internal regulations related to the Category E2.
Moreover, it was also found that the three public health insurance schemes had implemented some projects
to increase access to some medicine listed in the Category E2 before the policy initiation. Also, these
projects were, in some respects, managed differently from the rules and regulations of the Category E2
policy. 2) The implementation of the Category E2 policy in hospitals: Most administrators, clinicians and
pharmacists who involved in this study agreed with the policy of increasing access to expensive medicines.
The implementation of this policy would reduce hospital expenditure on medicines particularly
medicines for patients who were covered under the UC and promote a rational use of the medicine under
the clear guidelines. However, the rules and regulations regarding the Category E2 that developed by the
NLEM subcommittee and the three public health insurance schemes could cause problems in practice
because it may introduce confusion and various management systems in hospitals. There were also some
problems of compliance with the rules and regulations of the UC and prescription for people under the
CSMBS coverage. These problems were obstacles for patients’access to medicines listed in the Category
E2. Conclusions and suggestions: Policy implementation of increasing access to the Category E2 to practice
faced many barriers. Coordination among the NLEM subcommittee, public health insurance schemes,
and hospitals as well as policy monitoring and evaluation were necessary and facilitated the success of
policy implementation.


Background: Capability building is a process of increasing knowledge and capacity of personnel to
accomplish their works in the organization and be able to evaluate the acceptance of their organization on
change for capacity building. The objectives of this study were 1) Create network among academic institutions
in Central and Regional area and local organizations and 2) Develop capacity building model for
organizations working on monitoring and evaluation. Research Methodology: Process of capacity building
started with creation of collaborative network among academic institutions in Central and Regional
area and local organizations that were working on monitoring and evaluation. The selection of network
members followed the study inclusion criteria. The development of capacity building model included
1) Identification of general and specific capacity, finding the gap (by comparing the existing situation
with the expected goal) and find solution for the gap, 2) Knowledge transfer and 3) Coaching and mentoring.
Results: Collaborative networks had been established among 1) Central academic institutions that wer
supporting institution on capacity building, 2) Regional academic institutions and 3) Network of GO,
NGO and leader of the volunteers in local area. The development of capacity building model was established
among the collaborative institutions working on monitoring and evaluation using 1) Identification
of general and specific capacity, 2) Knowledge transfer and 3) Coaching and Mentoring. Conclusions and
Recommendations: From the creation of collaborative and development of capacity building model among
academic institutions in all levels, the network on works and academics had been built under this model
for increasing capacity and sustainability. For the sustainability, the regional academic institution would
be the active institution for applying knowledge and experience on the capacity building model in the
future


The marginalized people who are non-Thai nationals consisted of stateless people, undocumented
migrant workers and refugees. These 500,000 people were still excluded from universal health coverage.
Poor health outcomes, 6 times less access to care, outbreak of infectious diseases especially malaria and
burden of hospitals’ budget were its consequences. By the literature review and analysis, the policy issues
to include all non-Thai nationals people in Thailand in universal health coverage were formulated as
follow; 1) the expansion of people with citizenship problems scheme to include the stateless people who
were in the registration system but still had no legal status, 2) the extension of undocumented migrant
workers scheme to accept the enrollment of stateless migrant workers and 3) the establishment of the new
reimbursement health insurance scheme for humanitarian purposes for the rest of non-Thai people who
could not join the two former schemes. The additional budget was 716.8 million Bath /year or 0.66% of
Universal Coverage Fund budget. However, the people with citizenship problems scheme should permit
its members to change their registration to their real living or working place for the real access to care.
Universal health coverage should be the right of everybody.


The use of benzoic acid and benzoates, food additives, are endorsed by the Notification of the
Ministry of Public Health No. 281. The permitted levels of benzoic acid and benzoates established in the
Notification should conform to international standards and protect consumer health. It needed to revise
the regulation according to the Codex General Standard for Food Additives (GSFA). Risk assessment tools
was employed for establishment of the maximum permitted use levels (MLs) to ensure consumers will
obtain appropriate level of health protection from over-consumption of benzoic acid. This study aimed to
assess the risk of dietary benzoic acid exposure in Thai population based on the MLs proposed in the
Codex food standard. The exposure was estimated by combining the MLs of benzoic acid in foods with
individual food consumption data received from the national food consumption surveys in 2004.
Probabilistic estimation was used to assess the exposure to benzoic acid at average and high consumption
levels. Risk was characterized by comparing the exposure with the Acceptable Daily Intake (ADI) of benzoic
acid. ADI is a safe level for human exposure to the chemical over a lifetime. The study found that the
average benzoic acid exposure in Thai population exceeded the ADI (126% of ADI). The population aged
3-5.9 years and 6-18.9 years had average exposures at 226 and 153% of ADI, respectively. This indicated
that there was an appreciable health risk for children and adolescences at long term exposure when using
benzoic acid in all food groups according to the GSFA. Long term exposure to high level of benzoic acid
can effect on liver and kidney functions. High consumption of carbonated water-based flavored drinks at
97.5th percentile in population aged 3-5.9 years and 6-18.9 years provided high exposure at 144 and 96 %
of ADI, respectively. Thus, the MLs of benzoic acid proposed in this standard should be reduced in food
categories contributed high benzoic acid exposure in children and adolescences especially carbonated
water-based flavored drinks, bakery wares, processed fruits and vegetables.


Shortage of physicians in rural areas was one of main problem in Thailand. Previous studies found
that there were several factors which related to the existence of a doctor in the community hospitals. The
major factor was financial issue. Thai government has launched special incentive money and professional
opportunity strategies to rural doctors since 2008. After these motivated strategies, the recruitment of physician had been rising in community hospitals. The purpose of study was to evaluate the opinion of
general practitioners on incentive money and professional opportunity strategies to the retention of
physicains in community hospitals. This was cross sectional descriptive study of the physicians in the
community hospitals nationwide covering 720 hospitals. Mail questionnaires were distributed and collected
data between 1st to 31st January 2011. Data were analyzed by SPSS-PC version 11.5 by reporting as
descriptive statistics such as frequency, percentage, average, and standard deviation including analytic
statistics with Chi-square and binary logistic regression. The results revealed that response rate was 38.52%.
Most of physicians were male 66.59%; average age was 35.92 years old. A 30 bed-sized community hospital
was the most current work place 52.64. The opinion of responders to incentive money and professional
opportunity strategies revealed that this financial strategy with incentive money related to the retention
of physicians and influenced longer duration of working up to 88.00%. There were 71.15% of physicians
that strongly disagreed to the exception of this incentive money. Moreover, professional opportunity
strategy directly affected physicians with high satisfaction rate 70.95%. This study demonstrated the
financial strategy such incentive money and professional opportunity strategy were the major factors that
related to the retention of physicians in community hospitals. These motivation strategies should be considered
and applied to human resource policy.


The Prince Mahidol Award Conference 2012 was held in Bangkok, Thailand during 24-28 January
2012 with the theme of “Moving towards universal health coverage: health financing matters”. The Conference
highlighted the importance of Universal Health Coverage (UHC) as one of the most effective
instruments that ensures human security and improves human development as well as fosters the concept
of all people’s rights to health care service. The Conference demonstrated that UHC was achievable
in many countries i.e., Japan, Thailand and others. It also highlighted equitable health systems financing
and other components of health system such as human resources, information system and other equally
important factors such as political commitment, government competency or civil society participation
that support the health system to achieve UHC. Last but not least, the Conference went successfully with
the hope to accelerate the movement towards UHC at the country level.


Hearing loss is a common condition. Hearing loss causes difficulty on communication
and social interaction of persons. It disturbs daily life, education, occupation, depression and
family burden. A simple, non-professionals required test that can be used as a mass screening
will help to find more hearing loss persons.
This research is aimed to study the sensitivity of Five Minute Hearing Test-Thai Version in
comparison with audiometry as a gold standard for screening hearing loss in the community
population.
558 persons, age ranged from 18 -87 years old, who live in municipal and non-municipal
area of Phuweang district, Khon Kaen province were included. There were 176 males (32%) and
382 females (68%). Unilateral hearing loss was found in 78 persons (14%) and bilateral hearing
loss was found in 136 persons (24.4%). Among those who had bilateral hearing loss, there were
107 cases of mild hearing loss, and 28 cases of hearing disabilities. One case had impact
cerumens and moderate hearing loss. When impact cerumens were removed, her hearing was
turn into mild hearing loss. The sensitivity and specificity of FMHT-Thai version to screen mild
hearing loss were 55.2% and 72.5%, while the sensitivity and specificity to screening hearing
disabilities were 86.2% and 69.4% respectively. The optimized cut-off point for total score of
FMHT-Thai version was 10.
FMHT-Thai version has appropriate sensitivity and specificity to be used as a screening
test for hearing disability in community.


The selected Rajabhat University in this case study is a higher education
institution for a local development which has a long history in southern Thailand. There
is an institution for special education development which has offered a bachelor degree
for disabled students since the academic year 1994 and required only disabled students
who had impaired vision. Then, in 2007, the university operated according to the policy
to support the educational management for disabled people by the Office of Higher
Education Commission which included the disabled students who had impaired hearing
to enroll the program. The university also established a service office for supporting the
disabled students under the institution for special education development in February,
2007 in order to support the special education management at a higher education level.
By the academic year 1/2011, there were 24 numbers of disabled students who have
impaired vision, impaired hearing and imperfect body or movement, studied in the same
class with students who do not experience disabilities in the fields that the higher
education institution has offered.
The aim of the study of the assistances for disabled students in the higher
education institution was to understand the roles of the higher education institution in
assisting the disabled students, the adaptation of normal students and the values in
learning to live together which will lead to a proper policy recommendation to assist the
disabled students in a local higher education institution.
The research findings revealed that the structural arrangement of the organization
which aimed at decreasing of the working steps was found to be a barrier for communication
and cooperation. Each unit within the organization has been working separately: no work
cooperation among each unit to provide assistances for the disabled students, no effective
management for the university surroundings, buildings and facilities which still do not
facilitate the conveniences and security, and the accessibility for the disabled students. In
addition, the personnel here needs a knowledge development, working skills and attitude  which are corresponded to the educational management of inclusion education including
teaching and learning, student development activities, the management of surroundings,
buildings, and facilities. The overall educational management has been designed to facilitate
only students who do not experience disabilities including the enrollment, programs, the
preparation for necessary learning skills, learning media and technology, self-access
information system, the professional training experience and the preparation for future
careers which are the obstacles for the disabled students in order to make a living and to
learn.
Regarding the Disabled Student Services Center, although it has a potential
competence in service delivery as it is under the authority of the institution of special
education development which is the strength of the higher education institution, the
insufficient number of personnel and a higher turnover rate become barriers in handling
the services, including a punctuality in providing services, work coverage and working
skills. For student development activities, they have not yet facilitated for the change of
the role of disabled students from dependences or observers to be the co-practitioners.
Besides, there was a limitation in supporting the adjustment of normal students and learning
to live together with the disabled students. To live together with disabled students in the
higher education institution, the normal students has adjusted themselves with major values
in learning to live together under the four categories: see by heart and understand with
wisdom, not value people based on the physical appearance, understand own responsibility
and building success together.
The policy recommendations for the higher education institution were proposed
in five issues. The first issue is to develop the administrative system and arrange the
organization’s structure which facilitates the effectiveness of the educational management
for disabled students, including the measure for the planning management and the measure
in building the participation from outside institution. The second issue concerns the
development of the enrollment system which increases the opportunity to access the
education in both number of intakes and type of disability, cooperatively. These include
the measure for the intake of disabled students, the measure of programs, and the measure
of the preparation for students who are gifted. The third issue is about the system and
mechanism management to support and assist the disabled students in graduating as well
as the access to careers which include the measure for personnel, media, equipment and
facilities, the measure for education management, and teaching and learning management, the measure for student development, and the measure for supporting the
careers’ access. The fourth issue employs the human resource management as a mechanism
in solving problems and developing the education management for disabled students,
including the measure for the personnel development, the measure for motivation in
remaining the present jobs, and the measure for assigning works. The fifth issue brings
the qualitative management to develop the education system management which has a
continual quality, including the measure for the quality management development, the
measure for the knowledge management, the measure for the knowledge development and
creative innovation, and the measure for following up and evaluating the educational
management.
Accordingly, the five recommendations mentioned above provide four conditions
for the achievement. Firstly, having a set of a clear policy and transmit to the officers who
mainly have the role in managing education for disabled students in order to work in the
same direction. Secondly, providing the opportunities for disabled students, disabled alumni,
parents, representatives of the disabled, who acted as stakeholders, or other related people
to participate in providing information in order to develop the working procedure, design
work procedure or activities, and evaluate the work associated with the disabled students.
Thirdly, encouraging people to accept the disabled student and treat them similar to that
of normal students, including accepting them in terms of their educational knowledge and
abilities. In particular, they should be accepted that the physical impairment is not an
inferiority complex, without pities or a barrier in living and learning. Indeed, they need
the ability to access to media, equipment, aids, and facilities as necessary, and they also
want all personnel at all level and those normal students see the value of living together,
helpfully. Fourthly, the higher education institution shouldn’t perceive that the educational
management for the disabled is only the responsiveness of the law and related policies or
the routine work, but it is also the value creation and addition to the education institution
as well.


Background: Children with congenital hearing loss without treatment and rehabilitation of hearing,
language and speech have difficulty in daily communication, learning, and life living. It is necessary to
find tools for assessment and screening early language and speech problems to use for early diagnosis,
treatment and rehabilitation. That would help these children to have nearly normal language and
speech development. Objective of this study was to investigate reliability of tools for screening and
assessment language and speech development
Method: Assessments of language and speech development from caregiving’s report and test for 54
children with or without risk for delayed language and speech development in each age interval [6, 9,
12, 15, 18, 24 months (± 1 ½ months), and 30, 36, 48 months (± 3 months)] were done with Denver
Development Screening Test, Denver Development Screening Test in part of language (Denver II
Language), Thai Early Language Mile Stone for Children Aged 0-4 years: ELM) , Thai Speech and
Language Test for children Aged 0-4 Years Old (TSLT)
Report: Denver II and Denver II in part of language (Denver II Language) , ELM and TSLT had
Cohen’s Kappa coefficients range:κ rang from fair to good agreement (κ = 0.27 – 0.75 ) Denver II
language and TSLT both from caregiver’s report and test at moderate agreement (κ = 0.52 – 0.60 )
Denver II Language and ELM lead a good agreement (κ = 0.61 – 0.75 ) Investigators inter-rater
reliability in using these tools were very good agreement (κ = 0.86 – 1.00 ). TSLT from caregivers’s
report and test have moderate agreement (κ = 0.52 – 0.60 ).
Conclusion: For screening of language and speech development, investigaters can use Denver II
Language or ELM. Investigaters have reliability and standard in assessment language and speech in
children.


Chiang Mai University applied the concept of social work volunteers
managing a workshop camp under the project of Learning and Sharing Together to
Empower Society.
This project’s aims were to support and instill moral integrity and ethics for students
and participants. In cooperation with other local sectors and organizations in Chiang
Mai, this workshop organized various activities that gave opportunities for the
disabled in local areas to experience self learning and development by sharing
experiences with others. Participants learned about the value of life, equality in
society and an awareness of the disabled, different life styles and social problems.


The review of international experiences focusing on national policies on child health promotion
and disease prevention of the Middle East region was part of the development of health promotion and
disease prevention policies for children aged 0-5 years in Thailand. This article aims to draw lessons about
the selection, implementation, tools and management of policies that are relevant to identified health
problems in Thailand.
The Middle East region consists of many countries and even though they have fuel resources and are
relatively wealthy from oil exports, the poor education and instability of the government in some of these
countries worsen their quality of life. The World Health Organization (WHO) and other international
organizations conduct the majority of health promotion and education activities. In this review article, the
author found that the nutritional policies which point to mineral and vitamin supplements are interesting
because the distribution of these supplements in at-risk groups free of charge was effective. Another project
that is noteworthy was the flour fortification project because it fit well with the population’s high consumption
of wheat products and did not change their daily lives. The disease prevention policy through
newborn screening programs was well-developed. If appropriate screening tests that are applicable and
cost-effective in Thailand’s population are chosen, we might benefit from early detection and prevention
of additional diseases affecting child health in the future.


This study is a part of a joint research project between The Royal College of Paediatricians of Thailand,
Department of Health, and Health Intervention and Technology Assessment Program (HITAP),
entitled. The development of health promotion and disease prevention policies for children aged 0-5 years
in Thailand. This study aims to review health promotion and disease prevention policies for children aged 0-5 years in the USA. A scope of the review on the US child health promotion and disease prevention (PP)
policies include; preconception care, teen pregnancy prevention, newborn metabolic screening, quality of
day care, child maltreatment prevention, development and Autism screening, breastfeeding promotion,
obesity prevention, immunizations, newborn hearing screening, vision screening, preventive oral health,
and injury prevention. These are in-line with prioritised child health related problems in Thailand. Results
from this study will be useful for providing knowledge and lesson learned of available policies and
interventions in the USA that can potentially be adopted for the Thai PP policies.
Preventive health care for children aged 0-5 years in the USA is recommended by the AAP and there
are several interesting programs initiated by the federal government. The US Department of Health and
Human Resources and CDC play an important role in supporting evidence-based recommendations and
data monitoring for the nation. The major barrier to getting access to health care is the lack of health
insurance. However, with the health reform and the Patient Protection and Affordable Care Act, more US
people especially children can afford health insurance and gain more access to preventive health care.


Health promotion and disease prevention (PP) policy has played a critical role in the Thai health care
system for a period of time. However, the implementations of such policies were still fragmented without
a clear strategic plan and goals. The development of PP policy focusing on certain age group in a systematic
manner was expected to help tackle those barriers. Children aged 0-5 group was selected as a pilot
group for the development of PP policy recommendations for relevant PP agencies in Thailand. Extensive
document reviews and deliberative process which involved the participation of stakeholders was employed
in the health problems prioritisation process. This article aimed to share experiences and findings
from the review and prioritisation process.
Child health related policy and law were completely available in Thailand and covered almost all
aspects of health determinants. Those policy and law were under responsible of varied agencies; however,
a well-coordinate initiative at a national level was not observed. According to the prioritisation process,
three health related problems that stakeholders expressed as high priority were problems related to carers,
child development, and antenatal care. The identified problems were also categorised according to
type of problems and responsible agencies. Problems related to physical and mental health were mostly
taken care by the National Health Security Office (NHSO), meanwhile problems concerning health and
well-beings were under other agencies, i.e. the Ministry of Social Development and Human Security and
the Thai Health Promotion Foundation.
Experiences from this study affirmed the importance of priority setting for policy development process.
Although most of the stakeholders of the priority setting process were from health sector, prioritised
problems were not solely focused on physical health. Proposed problems also included other societal
aspects as well as environmental factors that might affect well-beings, e.g. teenage pregnancy, quality of
child development centres, lack of parental knowledge of carers. In addition, the stakeholders also aware
of an importance of child development as this would affect quality of the population and their quality of
life in the future. Obviously, these social and well-being concerns have never been included in the benefit
package for health promotion and disease prevention under the NHSO. Challenges included identification
of effective interventions to tackle those prioritised problems in order to develop decent policy recommendations
for the NHSO and other responsible agencies.


The Constitution of the Kingdom of Thailand mandated the decentralization of public services including
health; however, not only has there been no significant progress, existing evidence has not been
systematically synthesized. The purpose of this study is to identify the missing knowledge about health
decentralization in Thailand. Documentary research was employed to create the initial research framework,
which was then compared against the pool of existing evidence. The final framework was criticized
in order to bring forward specific research questions.
Three main research areas for health decentralization in Thailand were identified: (1) Regional Health
model development, (2) Capacity strengthening of local authority, and (3) People participation model in
health decentralization.


Background: Prevalence of low back pain was always in the top among teachers and academic personnel
in Thailand. It might be beneficial to clarify risk factors for raising self-awareness and even program development for mass. Methods: The aim of this study was to study working posture and environments
related to low back pain, in order to determine risk factors. Subjects (n=713) were recruited from 4
regions, 56 provinces whom attended Health Leadership workshop during November 17, 2010 to March
6, 2011. Descriptive data was described with number, percentage, average and standard deviation, while
inferential statistics was analyzed by logistic regression. Results: 76.08% of participants reported low back
pain. The severity by the Oswestry Disability Questionnaire showed minimal disability average scores at
13.2 (± 9). While analyzing for risk factors, the interesting results demonstrated as followed: history of
accidents related to low back pain caused 6.64 times over no accidents; working with bending position
had 2.20 times higher risk and working with squatting down had 1.74 times risk compared to no squatting
ob.
Conclusion: Working positions is one of factors related to low back pain among teachers and academic
personnel; therefore, adjusting personal behaviors, appropriate working environments should reduce
symptoms. These would lead to improved efficiency and better quality of work life.


Currently, primary care expands its role for patients with chronic care who have a controlled condition.
Drug therapy is the major method for treatment of chronic diseases. Therefore, pharmacists should
take their responsibility in drug therapy management in primary care unit. Understanding of policy supporting
health services is necessary for pharmacists to work efficiently with health care team. Since diabetes
mellitus (DM) and hypertension are the most common chronic diseases that hospitals refer patients to
receive further treatment at primary care unit (PCU), there are several health policies and financial mechanisms
by National Health Security Office and Ministry of Public Health as the way to support capacity
building and service system in PCU. For system monitoring, quality indicators focusing on processes and outcomes have been developed. The specified prescribing quality indicators for secondary prevention
included prescribing rate of aspirin in DM patients aged at least 40 years and prescribing rate of angiotensin
converting enzyme inhibitors or angiotensin receptor blockers in DM patients with
microalbuminuria. Pharmacists should ascertain that drug items in PCU are optimum for providing care
for patients with concomitant diseases. Drug service system should be improved and health care personnel
in PCU should be trained for basic drug therapy management. Pharmacists should work with the
disease manager nurses to develop referral system for medication history information between the contracting
unit and its’ PCUs. In addition, data collection and data processing system for specified quality
indicators should be developed.


This study aimed to determine the level of confidence in medical and public-health competency, and
identify the relationship between such confidence with the Collaborative Project to Increase Production of
Rural Doctor (CPIRD) programme, regional medical school graduation and individual attributes. A crosssectional survey was conducted amongst newly medical graduates, who were making a contract with the
Ministry of Public Health for compulsory rural service in 2012, by using self-administered questionnaires.
Factor analysis and multiple regression were applied for data analysis.
The results showed that medical graduates were more confident in communication skill and
interprofessional collaboration, but less confident in obstretics, public-health and administrative competency.
Doctors in the CPIRD programme and those graduating from regional medical schools were more
confident in operative procedure skill and general medical knowledge than graduates in the normal track
and those graduating from medical schools in Bangkok and vicinity. In addition, being male and rural
high school graduation tended to increase the confidence in public-health and administrative competency.
Likewise, increasing age had a tendency to enhance the confidence in obstetrics competency.


Direct non-medical cost (DNMc), the cost incurred to patients and caretakers while receiving medical
treatment, is deemed essential in cost estimation from the societal perspective. However, information on DNMc is largely lacking in the Thai context. This study aims to assess DNMc of in-patients at Suratthani
hospital.
A cross-sectional survey was conducted to collect information from 241 patients at Suratthani hospital,
a provincial hospital in Southern Thailand, during 8 May - 7 July 2012. The cost data, including travel
cost, productivity cost, and costs of food and accommodation, were gathered by interviewing patients
and caregivers, with base year 2012. The costs of food, productivity, and accommodation during the 24
hours prior to the interview were counted.
Results showed that the average DNMc incurred by each in-patient was 1,457.10 Baht per day (24
hours). The average DNMc incurred to each caretaker was 1,160.60 Baht per day. With respect to the
household area, the daily average DNMc of in-patients who lived in the municipal area of Suratthani,
outside the municipal area of Suratthani, and outside Suratthani were 1,036.20 Baht, 1,468.70 Baht, and
2,283.40 Baht, respectively.
This study sheds light on the DNMc of in-patients and caretakers, which not only helps medical
professionals plan more efficient medical treatments, but is also an important piece of information used in
conducting economic evaluation research. Future studies, assessing DNMc in other provincial and community
hospitals, are recommended.


This study aimed to analyze pharmaceutical purchasing capability of public hospitals using the
Pharmaceutical Acquisition Capability (PAC) Approach. The 2010 purchasing data of public hospitals
was provided by the Drug and Medical Supply Information Center (DMSIC), Ministry of Public Health. the data analysis was done by selecting the drug items that were submitted to DMSIC by more than 3
public hospitals. Total 31 items were included in this study that were categorized into 5 pharmacological
groups i.e. 1) HMG-CoA-reductase inhibitors or Statin, 2) Proton pump inhibitors (PPI), 3) Blood-glucoselowering
drugs, 4) COX-2 selective inhibitor, and 5) Combination of Statin. It was found that a number of
markets held Gini coefficient higher than 0.500. This could be interpreted that purchasers in this market
could buy the product at lower price suggested by PAC-DSS. In addition, high average PAC was also
found in the market with multiple sellers, leading to the recommendation that purchasers could easily
negotiate their price in this market. The study estimated that if hospitals had purchased 31 drug items at
PAC-DSS suggested prices, these public hospitals as a whole would have gained 77 million baht saving.
The standardization and development of data entry system is strongly recommended for better outputs.
The future study on additional invention of feedback information is also suggested to benefit users.


This case study was aimed to explore the processes of developing result-based strategic plan for
health promotion, prevention and disease control. Participants were 13 staff members who highly involved
with the processes of strategic development and plan of Bureerum Provincial Public Health Office.
They were purposive selected. Data were collected using focused group interview. Findings from the
study revealed three major processes of strategic planning including preparation, reviewing strategic agenda and binding up the master plan. The process of preparation involved seeking a better understanding,
early planning and data preparation. The steps in reviewing strategic agenda consisted of linking policy
from central level to the provincial needs, brain storming and revising the strategic agenda. Binding up
the strategic plan consisted of developing master plan, integrating projects and outcome indicators and
making plan more flexible. Suggestions to the findings of this study are to promote the strong intention of
the provincial admistrators in using result-based strategic planning for their administration and to promote
development of essencial competencies and skills related to the planning for their human resources.
The survey of core and functional competencies in relation to result-based management may guide the
plan for human resource development in diferrent levels of their team as well as promoting continuing
development of working processes covering overall areas in relation to the plan.


The objective of this paper was to study the epidemiology of blindness, low vision and eye diseases
in Thai children population by analysis the secondary data of surveyed sample aged 1-14 years totally
2,743 cases in the First Thai Visual Impairment Project 2006-2007. The surveyed data weighted on the
basis of stratified cluster random sampling represent the whole country was collected in 22 provinces.
The study found that the prevalence of blindness and low vision were 0.11% and 0.21% respectively.
The estimated number of blindness and low vision in Thai children population were 13,101 cases and
26,670 cases respectively. The causes of blindness were retinopathy of prematurity (ROP) 66.67% and amblyopia from uncorrected high myopia (-9.00 diopter both eye) 33.33%. The causes of low vision were
amblyopia from uncorrected high myopia (-6.00 and -11.00 diopter both eye) 28.55%, cortical blindness,
congenital cataract, optic atrophy, corneal disorders and congenital nystagmus 14.29% each. Top five of
eye diseases with visual impairment were refractive error 19.36%, strabismus 1.24%, amblyopia 0.36%,
cataract 0.25% and eyelid disorders 0.22%. Top five of eye diseases without visual impairment were glaucoma
suspect 0.73%, allergic conjunctivitis 0.22% and nasolacrimal duct obstruction, epiretinal membrane,
pterygium, retinitis pigmentosa 0.12% each.
Thus the Ministry of Public Health and the Department of Medical Services who have the responsibility
to take care the health of the population, should have the effective policy and strategy to reduce the
prevalence of childhood blindness and low vision. The comprehensive projects cover early detection,
proper intervention and referral system for complicated cases with participation of the community were
the key of success factors.


The purposes of this cross-sectional study were to study the disease and injury preventative behaviors
and to exam factors related to disease and injury preventative behaviors of garbage collectors during flood crisis. Data collection took place during February to March 2012 by using self-reported questionnaires
from non-randomization of 186 garbage collectors who worked in one district office of Bangkok
Metropolitan. Employing descriptive statistics, chi-square and multiple logistic regression, the overall
results found that the garbage collectors had the disease and injury preventative behaviors at a low level
(60.5 %). The relation between factors and the disease and injury preventative behaviors after adjusted for
the other variables in the model showed: 1) using self-preventative equipment behaviors statistically correlated
with the provision of these procured by the office for individual prevention tools at a high level
[ORadj (95% CI)=15.37 (4.24, 55.69)] and at a middle level [ORadj (95% CI)=4.63 (1.64, 13.09)] and appropriated
income with responsibility during flood crisis at a high level [ORadj (95% CI)=10.21 (2.56, 40.74)] and
at a middle level [ORadj (95% CI)=3.94 (1.46, 10.66)] respectively. 2) injury preventative behaviors statistically
correlated with the appropriated income at a high level [ORadj (95% CI)=6.76 (2.31, 19.79)] and thoughtfulness
and admonition of colleagues for during work accidents at a high level [ORadj (95% CI)=5.25 (1.50,
18.31)] respectively. And 3) risking injury occupational behavior statistically correlated with worked training
at a low level [ORadj (95% CI)=9.28 (2.71, 31.81)] and at a middle level [ORadj (95% CI)=4.05 (1.11, 14.73)]
respectively. In conclusion: Collecting garbage during flood crisis, the responsible office should plan and
modify predisposing factors, enabling factors and reinforcing factors for management in order to prevent
the diseases and occupational injuries.


The health insurance system in Thailand is currently separated into three main programs,
namely the Civil Servants System (CSS), the Social Security System (SSS) and the National
Health Security Program (NHSP). Each of these programs has been developed and implemented
for different groups of beneficiaries. The CSS was created to finance the provision of health care
services for civil servants and their family including their parents and children under the legal
age. The SSS, on the other hand, aims to provide the social welfare for private employees. The
NHSP is the health care coverage scheme for the rest of population who do not benefit from the
first two schemes.
The multiple programs proved rather problematic as they lead to inequality of health
benefits and inefficiency due to duplicate administration and management.
This study aims thus to analyze the governance of Thailand’s national health system with
the objectives to establish equity in terms of benefits from the health care schemes among Thai
population as well as to create the budgetary sustainability for the health insurance system.
Reviews of health care regimes overseas reveal that multiple health care schemes (such
as in countries where health care benefits are provided through the social security system) is not
necessarily problematic if all are overseen by a single authority responsible for national public
health policy. However, the three healthcare programs of Thailand are governed by three different
public agencies: Ministry of Finance, Ministry of Public Health and Ministry of Labor, which
manage the CSS, the NHSP and the SSS respectively. Overlapping and duplication of
administration and management lead to inefficiency and more importantly, inequality of health
benefits as elaborated below.
1) Different charges of health insurance: the insured persons of the SSS are obliged to pay
their health insurance charges regularly in order to benefit the insurance co-payment from
their employers and the State. Whereas the beneficiaries of the CSS and the NHSP are
not to but still benefit the rights on health care services.
2) unequal health benefits: members of the “fee-for-service” CSS system are allowed to
obtain health care services provided in any public hospitals nationwide, while SSS and the NHSP members can obtain the services only in hospitals or health centers where they
have previously registered as a beneficiary under the “per capitation payment system”.
3) Discriminatory treatment: patients with “fee-for-service” health care scheme normally
obtain better treatment than those with “per capitation” counterparts. Also, different
schemes often use different DRGs. Different rate of reimbursement leads to different
service quality.
In terms of efficiency, the administrative separation of health insurance system into three
schemes leads to high costs for both the health services providers (hospitals) and the payers
(public agencies).
1) For the providers, the costs are generated from the complication of reimbursement
systems because each scheme necessitates different beneficiaries’ data collection and
documentation. The NHSP uses the database software called “NHSO” while the SSS and
the CSS require the “SSdata” and the “CSMBS” respectively.
2) For the payers, the costs are caused in the process of overseeing the systems separately.
This means that the State has to duplicate the process such as financial audit and clinical
audit for each scheme.
Consequently, the current health insurance system in Thailand needs to be reformed
regarding its structure and governance in order to
1) improve the efficiency and reduce the costs of administration and management and
2) reduce inequality in terms of health benefits and quality of services for beneficiaries
covered by each program.
To attain to the objectives mentioned above, Thailand has to choose whether its health
insurance system is operated in the same model as the Social Security or not.
The research team finds that Thailand’s health insurance system in the future
should be based on a single scheme and that this scheme should be fully funded by the
national budget. This is because the SSS covers only 10.3 million of over 40 million work force. This is because Thailand has a very large informal economy. The CCS, on the other hand, does
not make a feasible national scheme due to the uncontrollable surge in costs.
It is recommended that national health care scheme be managed by a single authority,
which should be the Ministry of Public Health so that the system is coherent and is easily
accountable. However, since the Ministry, with many hospitals and health centers under its
supervision, is also a service provider, the designated public agency in charge of the system
management should therefore be independent from the Ministry to avoid the problem of conflict
of role between policymaker/regulator and service provider.
In case the State finds that it is more advantageous to run Thailand’s health insurance
system under the same model as the NHSP with the financing from public funds, the practice
standards for the agencies integration should be the following;
1) Provide every citizen with standard health benefits currently offered by the NHSP free of
charges. The CSS and SSS may nevertheless offer additional peripheral benefits as “add
ons”. For example, the SSS may offer supplementary income for forgone earnings
during sick leave. However the calculation of the premium should be only based on the
cost of the add-on benefits only and not the standard healthcare.
2) Transfer the responsibilities of the Social Security Office (SSO) regarding the health
insurance to the National Health Security Office (NHSO).
3) Provide newly hired civil servants or public employees with the standard health benefits
according to the NHSP rather than the CSS and offer financial payment to compensate
for the lost healthcare benefits.
4) During the transition period, inequality of health benefits between the CSS and the two
other schemes can be avoided by
(1) Implement the same “DRG” for all schemes
(2) Revise the current drug reimbursement regulation which provides incentives for
hospitals to prescribe expensive drugs to CSS patients in order to eliminate the
perception about the discrepancy in drugs benefits between the CSS and the
other two health care schemes.


This study analyzed the cost effectiveness of Alendronate (generic product) and Risedronate (original product) for the primary prevention of fractures in postmenopausal women with clinical risk factors, including rheumatoid arthritis, long-term use of oral glucocorticoids, a parental history of hip fracture,
high alcohol consumption and current cigarette smoking. A Markov model with nine health states was
applied to estimate total costs and effectiveness for eight age-groups (45, 50, 55, 60, 65, 70, 75 and 80 years
and above) under the healthcare provider perspective. The model used a 10-year time horizon and assumed
the 5-year duration of medication with a linear efficacy reduction after stopping the medication,
and 50% medication adherence. Epidemiological data on natural history of disease, clinical efficacy, cost
and utility data were obtained from literature review. An increased risk of fractures in patients with the
risk factors was adjusted according to the relative risks, which were estimated using the FRAX® model
under the conditions of the bone mass density (BMD) t-score of -2.5SD and body mass index of 24 kg/m2.
The results showed that incremental cost-effectiveness ratio (ICER) of Alendronate and Risedronate for
the primary prevention of fractures in the postmenopausal women who had no clinical risk factors was
equal to 801,353-7,012,743 and 1,727,023-13,967,461 Baht/quality-adjusted life year (QALY), respectively.
The ICER was higher than three times of gross domestic product (GDP) per capita. When clinical risk
factors were considered, the use of Alendronate was cost-effective for women who were 75 years or above
and had the parental history of hip fracture (ICER, 202,089 Baht/QALY) or had the long-term glucocorticoid
use (ICER, 473,821 Baht/QALY). Risedronate was cost-effective for women who were 80 years or
above and had the parental history of hip fracture (ICER, 399,114 Baht/QALY).


Previous research has demonstrated the incurred direct non-medical costs (DNMc) of in-patients in
Thailand. However, the extent to which individual factors are associated with the DNMc is as of yet
unknown. The purpose of this study is to examine factors influencing the DNMc of in-patients at Suratthani
hospital.
We conducted a cross-sectional study to estimate DNMc from 301 in-patients who were admitted at
Suratthani hospital during 8 May - 5 September 2012. Travel costs of the patients and the daily DNMc of
the caretakers were estimated using 2012 as the base year. The associations between DNMc and relevant
attributes, including admission ward, gender, age, household area, and the chronic condition for which
the patients were admitted, were assessed using statistical methods at the significance level of 0.05.
The mean travel cost of the patients was 251.9 Baht, and the mean of the 24-hour DNMc of the
caretakers was 1,417.0 Baht. Evidence indicates that factors associated with patients’ travel costs include
ward (p-value<0.0005), gender (p-value=0.02) and household area (p-value<0.0005). For caretakers, factors
associated with the daily DNMc were ward (p-value<0.0005), gender (p-value=0.005), age (p-value =
0.02) and household area (p-value<0.0005).
The results of this study indicate that admission ward, gender, and patients’ household area play an
important role in determining patients’ travel costs and DNMc of the caregivers. Future research should
focus on identifying underlying factors influencing the DNMc across these relevant factors. In addition,
measures to reduce this hidden cost, such as improving the capacity of the community hospitals for managing
certain common diseases, are highly recommended, with the aim of alleviating economic barriers to
hospital access by patients.


Since May 2011, CSMBS patients have been allowed to get certain elective surgeries in accredited
private hospitals. The scheme pays private hospitals by case-based payment, Diagnosis Related Group
(DRG), and the hospitals can charge extra for bed and board and doctor fee. This study aims to assess
utilization trend of CSMBS patients for certain elective surgeries in both public and private hospitals prior
to and after policy implementation, and its impacts on service utilization of UCS members, efficiency of
service provision, and burden of expenditure on patients and the scheme. Claim administrative databases
of the CSMBS and UCS were employed in the analysis.
Results reveal that Intraocular Lens (IOL) Replacement for cataract was major procedure used in
private hospitals, 80%, followed by childbirth (5%) and knee replacement (3%). the number of patients
receiving IOL has been prominently increased following the policy. This was due to relatively high payment
rate for IOL, active screening for patients with cataract in communities together with no co-payment
policy and free transportation provided by one private hospital chain who was major provider under this
policy (74% of cases). Shifting of CSMBS patients to private hospitals let public hospitals having more
available beds and doctor’s time for UCS patients. The numbers of childbirth and knee replacement in
private hospitals under the policy were low due to lack of active marketing, relatively high copayment
especially for knee replacement. Negative impact on public hospitals located in provinces where many
patients got care from private hospitals was not found. Under prospective payment system, private hospitals
were more efficient in managing resources. Private hospitals selected better paid procedures in the
provision; moreover, there was huge variation in the level of copayments for same procedure of different
private hospitals. The policy increased expenditure on private inpatient care; however, it did not affect
overall expenditure of the scheme.
In conclusion, the policy increased access to IOL replacement for cataract patients among CSMBS
members; however, monitoring and evaluation system should be strengthened before scaling up the program.


The Civil Servant Medical Benefit Scheme has extended its’ benefit by allowing beneficiaries to get
elective surgery in accredited private hospitals with some cost sharing since May 2011. Three are 77 avail-able procedures in 32 private hospitals for this matter; however, three main procedures, intraocular lens
replacement for cataract, knee replacement surgery, and cesarean section, accounted for 88 percent of all
procedures. This study aimed to assess patients’ experiences in getting elective surgery from private hospitals
in terms of channels of receiving information and access to private hospital, burden of expenditure,
and their satisfaction. The study employed a telephone interview with patients or care givers, who received
any of the three main procedures, within a week after being discharged from private hospital.
Results reveal that majority of users were those with age60 and above and were parents of civil servants.
Main channels of information about this benefit gotten by the patients included physician who provided
care for them, message from friends or relatives, and public relation of private hospital. Apart from community
screening for cataract, physician who works in both public and private hospitals was key actor
bringing the patient to private hospital. Main reasons for getting care from private hospital include shorter
queue, convenience in transportation, and following their preferred physician. Majority of them were
informed about the payments prior to admission; however, most of them did not know that they could
compare the price with that of other hospitals prior to making decision. It was found that the level of cost
sharing for knee replacement surgery varied greatly, ten times, among private hospitals. This let some of
them reporting incurred financial burden even though it was unclear whether it was catastrophic for
them. However, this made some of them would not recommend the others to use private hospital. Despite
the cost sharing, majority of them had high level of satisfaction in using private hospital and would recommend
the others to use private hospital for elective surgery.


The Civil Servant Medical Benefit Scheme has expanded its benefit by poviding access to 77 elective
surgeries in contracted private hospitals since May 2011. This study aimed to assess institutional capacity
of the Civil Servant Medical Benefit Scheme (CSMBS) in regulating contracted private hospitals. Issues of
assessment included system design, factors influencing effectiveness of the regulation, and implementation
of the policy in regard to provider’s responses and medical record audit. We conducted in-depth
interviews with key stakeholders and analyzed medical record audit reports. Content analysis and descriptive
statistic were employed in the analysis.
Results show that the policy aims to increase choices of access and reduce waiting time for elective
surgeries among CSMBS beneficiaries. Moreover, the policy will increase level of patients’ satisfaction
while costs of the scheme remain contained. The policy was carefully designed in order to prevent fraud,
inappropriate care, and protect consumer’s right. Minimal standard regquirement of enrolled hospitals
was set including authorization process, and information needed for claim submission. However, limited
institutional capacity of the Comptroller General’s Department under the Ministry of Finance who manages
the scheme remained a major constraint in policy implementation; moreover, errors coding of diagnosis
and procedure was urgently needed for improvement before scaling up the program.


Use of expensive non-essential drugs is a major driver of rapid growth of health care expenditure,
especially for Civil Servant Medical Benefit Scheme (CSMBS). This study reviews past and ongoing national
policy interventions aiming to promote rational use of drugs (RUD) in public sectors, with respect
to National Lists of Essential Medicines (NLEM) and public insurance schemes. The study employs the
World Health Organization framework on recommended interventions, including (1) national drug policy
body, (2) NLEM, (3) monitoring and auditing system, (4) financial and payment incentives, (5) sufficient
government expenditure to ensure availability of medicines, (6) ethical criteria for drug sales promotion,
(7) clinical practice guidelines based on evidence-based medicines, and (8) the hospital pharmacy and
therapeutic committee. In summary, the NLEM is a basic measure for promoting RUD and assuring sustainable
insurance systems. The Sub-committee on essential drug list development under the national
committee on drug system development has played a unique role in selection of drugs suitable for use in
hospitals. The national agenda should advocate disincentive in the use of drugs outside the NLEM, using
appropriate provider payment mechanism. The CSMBS board should encourage a rapid introduction of
the prospective payment system. During a transition phase, hospitals should be closely monitored and
audited for prescribing patterns. The newly appointed Drug and Medical Management and Reimbursement
Committee should take a leading role in engaging co-operation from the hospitals and in harmonizing
across the three public insurance schemes. Development of the education system in all levels to ensure
rational drug use is urgently required as it has not been committed before.


This study aimed to evaluate outcomes from Diabetes Medication Therapy Management (DMTM)
project in patients with type 2 diabetes who used insulin in Tha Uthen Hospital. The outcomes were
measured in economic and clinical aspects comparing before and after DMTM project. The follow-up
treatment continued for at least 2 times every 1-3 months during the study in July 2010 - December 2010.
Humanistic outcome evaluation was done after the DMTM project during May 2011 - February 2012 to
assess the patient’s quality of life using the World Health Organization’s quality of life questionnaire in
Thai version.
This study enrolled 115 cases but only 103 cases who completely followed up. They were female
(74.76 %) and the mean age was 60.74 years. The economic outcomes revealed that the direct costs after the
DMTM project was increased significantly (P≤0.05) from 493,105.18 to 580,791.30 Baht while the indirect
costs was reduced from 51,496 baht. Therefore, the total cost was increased from 544,601.18 to 628,351.30
Baht. Regarding the clinical outcomes, it showed that average HbA1c level was significantly decreased
after DMTM project (P≤0.05), from 9.01 to 8.18. However, the HbA1c level was still higher than the standard
level. In term of the humanistic outcomes, the overall patient’s quality of life situated in the moderate
level.


This study evaluates informal care for disabled stroke survivors in Thailand. It applies the proxy
good method to determine monetary value of the care. Market prices of labor similar to informal care
activities were used in the cost calculation. Data were collected by means of interviews conducted during
2006. The sample consisted of 101 disabled persons who had suffered a stroke at least six months prior to
the interview, and had a functional status score of less than 95 as measured by the Barthel Index. Average
monthly time spent on informal care was 94.6 hours. Time spent for household activities of daily living
(HDL), health care activities (HCA), activities of daily living (ADL) and instrumental activities of daily
living (IADL) was 29, 24, 38 and 3 hours/month, respectively. The average monthly monetary value of
informal care was US$136 (at 2010 prices). Variations of the market price of labor caused changes in the
cost of approximately 50% (both increase and decrease). Severity of disability and urban area had significant
effects on the cost. The informal care value was less than that found using the opportunity cost
method of calculation. It was much more than the current welfare payment for disabled people (500 Thai
baht, or approximately US$16 per month). The findings should be considered as inputs for revision of
welfare payment for people with disabilities, particularly those who are also elderly.


Approximately 1.3 million people have been registered as persons with disabilities (PWDs) according
to the Persons with Disabilities’ Quality of Life Promotion Act (2007) of Thailand. There have been a
number of regulations across multiple governmental organizations launched as following actions recommended
by the United Nation Convention on Rights of Persons with Disabilities. There were, however,
quite a few rehabilitation projects implemented by local level policies. One possible reason could be the
lack of comprehensive database which can be shared among different organizations providing rehabilitation
services for people in need. The International Classification of Functioning, Disability and Health
(ICF) was introduced by the World Health Organization to be used to record functions and levels of disabilities
in a person. The author applied a questionnaire based on the concept and ICF classification system
in face-to-face interviews with 328 PWDs in the Mahasarakham Municipality. Database comprised of
types of impairment, ability to perform activities of daily living, needs for education, vocation, social
participation and benefits entitled. The database can be used to develop individual multidisciplinary
rehabilitation plans which could be regularly monitored and evaluated whether rehabilitation goals are
achieved. The database should be user-friendly, easily accessible and timely updated. Another factor that
should be created is an organization perform as a coordinator across multiple organization to emphasize
the success of the improvement of PWDs’ quality of life.


Objective: To explore policies and effects of Free Trade Agreement on nursing workforce.
Research design: Qualitative research design Methods: 1. Relevant documents were collected; content was attracted and classified into research questions. 2.Ten key informants were interviewed under semistructured
questions to summarize policies, state plan, problems and effects of FTA, AFTA, AFAS and
AEC related to health care services and nursing workforce. Results: This study revealed that Thailand had
a good potential to be a World Class Health Care Hub. Notable cost, quality of medical care and Thai
hospitality led to a rapid increasing number of foreigners who came to Thailand seeking for medical
treatment. Number of registered nurse working in private hospitals in 2010 had increased for 66.08 %
comparing to the year 1999; the highest increasing rate was 83.59% in 2007. On the other hand, it deteriorated
nurse shortage in Thailand and un-equivalent accessibility to health care among Thai people. The
Priority Integration Sectors (PIS) of AEC targeted in 2015 facilitates travelling across boarder among ASEAN
people but two anticipated problems were identified; 1) aggravating the increasing number of patient
seeking medical treatment and worsen the situation of nurse shortage, and 2) nurse migration from ASEAN
countries. As nursing education systems are much different among ASEAN countries, problems of unequivalent
education of nursing personnel are encountered and may harm patients. Preparation for FTA
in health care services in Thailand has not been very well arranged. Strategic plan, action plan and hosting
organization were not clearly identified resulting in fragmentation of work of related parties and imbalance
services provided to Thais. Policy implications: Leading organization is essential for driving nation
strategies of the government. Ministry of Public Health, Ministry of labor, Ministry of Education and
Ministry of Commerce must be liable. Roles and responsibility of private hospitals must be heightened
and be integrated with the government to balance benefit and loss from being World Class Health Care
Hub for better health service system and good quality of life of Thai people, ultimate goal of the nation.


Background WHO Framework Convention on Tobacco Control (WHO FCTC) was the first ever
global public health treaty under the auspices of the World Health Organization. The FCTC is the treaty
that emphasizes on the right of public health by providing a framework for tobacco control measures.
Thailand as the Party to the WHO FCTC has obligations to develop and implement national tobacco
control strategies, plans and programs in accordance with this Convention including Article 5.3 focusing
on protecting public health policies from commercial and other vested interests of the tobacco industry.
Objective To analysis and evaluation of the preparedness of Thailand to implement FCTC Article
5.3 and best practices in Canada, Philippines and Kenya.
Method Qualitative methods were employed for the study including: literature review and documentary
analysis and in-depth interview.
Results The findings are Thailand has some progress in implementing WHO FCTC Article 5.3, for
example, the Department of Disease Control, Ministry of Public Health issued the regulation regarding
measures to limit interactions with the tobacco industry. The comparison studies of Canada, Philippine
and Kenya show that all of these countries have the best practices and more progress than Thailand in
some aspects. Thai government and Ministry of Public Health should revise laws, regulations and issue
some measures regarding WHO FCTC article 5.3, for example, the Regulation of Prime Minister’s Office
concerning the article 5.3 and propose new tobacco control law in order to set up the national tobacco
control board.


Unhealthy diets consumption in particular early starting in children is a crucial determinant of health
conditions and diseases. There is less research on diet purchasing and eating behaviors among children in Thailand. The objectives of this study were to explore food and beverages purchasing and eating behaviors
of primary grade 6 students. A hundred of students were randomly selected from 453 students in two
provinces. The students were asked to complete a self-administered questionnaire on food and beverages
consumption. They received a certain amount of cashes to buy any food and beverages in convenience
stores; type and prices of food and beverages they bought together with purchasing behaviors were observed.
To gain more understanding of students’ eating and purchasing behaviors, 39 out of them were
drawn for semi-structured in-depth interview. Descriptive statistics and content analysis were applied to
these data. Of total 100 students, most of them had good eating behaviors as consuming breakfast (89%)
and vegetables and fruit (97%). The proportions of students reported eating unhealthy diets: snack, bakery,
fast food, candy and sweetened beverages were 100%, 98%, 97%, 90.9% and 90.9%, respectively. In
purchasing part, the most bought unhealthy food and beverages were sweetened beverages (91.7%), followed
by snack (67.9%), bakery (46.4%) and candy (39.3%) which expenses were between 21 and 40 baht.
It was explained that not only food and beverage taste and personal preference but also environmental
factors as family roles, availability and location of outlets around schools, and ease to access as arrangement
in front of the counter together with advertisement of unhealthy food and beverages had potentially
influence on students’ eating and purchasing behaviors. The findings of this study illustrate that children
substantially consume unhealthy food and beverages. Therefore, there are needed for more attentions and
measures at both individual and environmental levels.


All poisonous patients presenting to the hospital always have medico-legal aspects. The medicolegal
evidences in forensic toxicology are very important for the legal viewpoint concerned especially
with reference to concepts of “proof“, “causality” and “blame“. The health care providers must concern
their role and responsibility to protect the medico-legal evidences obtained from the poisonous patient as
well as treatment especially in the primary care hospital. The knowledge with technique in forensic toxicology,
chain of evidence, and related legal rules should be applied to deal with all poisonous patients for
reliability, accuracy, and legal fairness.


This report aims to analyse and link between sub- studies under the research project entitled ‘the
development of health promotion and disease prevention policies for children aged 0-5 years old in
Thailand’. The two sub-studies employed in this analysis include the list of prioritized health problems
among children aged 0-5 years, review of relevant existing interventions and policies in Thailand, and the
studies of interventions and policies in five selected countries. The study of international experiences
aims to provide lesson learned that might be useful for the development of related policies in Thailand. Results: Basic care packages for children aged 0-5 years old and pregnant women are similar. Developmental
screening tests are mostly based onthe Denver Developmental Screening Test-II. All countries
provide vaccines against diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps and rubella. Neonatal
screening for congenital hypothyroidism is implemented in every country, whereas screening for
other conditions in the neonates and pregnant women are varied. Screening for hearing loss in the neonates
is provided in the United States of America, Canada, Taiwan, and the United Arab Emirates. Legislative
measures are used in many countries for ensuring access to health promotion and preventionservices,
reduction of low birth rate, prevention and treatment of genetic diseases and metabolic disorders, control
of artificial fertilization and obesity, prevention of child abuse and quality control child care centers. Canada
has a comprehensive system for empowerment of parents for child care. Recommendations for the betterment
of well-being of Thai children from good practices in these countries have been proposed.


Strategies for health promotion in Taiwan were developed based on the Ottawa Charter for Health
Promotion. The main health projects are broadly implemented in hospitals and health stations in communities
as well as in cities, schools, and workplaces. Health projects that are related to infants and young
children include the newborn screening program for 11 genetic metabolic disorders, child health check-up
preventive services, vaccination services, early detection and reporting of children with retarded development,
and management of rare diseases. At birth, every newborn is screened for 11 common genetic metabolic
disorders. An infant who has any of these metabolic disorders would be sent for further diagnosis,
treatment and monitoring. Expenses related to medication and nutrition supplements are supported by
the National Health Insurance system as specified under the conditions of the Rare Disease and Orphan
Drug Act. Moreover, the early intervention service (EIS) for children with developmental delay is an integrated and inter-discipline service. The implementation of screening and prevention of developmental
delay is started from antenatal period and continued to the age of seven years old. Suspected cases of
children with developmental delay will be referred to special health centers for further investigation and
treatment. The immunization coverage rate is as high as 95 percent due to an efficient national immunization
information system. Taiwan is also the first nation that uses a “stool color card” in a well child visit
book. The screening helps with the early detection and treatment of infants with biliary atresia.
In conclusion, health promotion policies in Taiwan aim at increasing birth rates, providing early
screening, and maximizing the child’s potential development. However, most references in this review
were from the government, a situation which may reflect only favorable aspects of public health policies.


The primary objective of this study is to assess and compile lessons learned in respect to impacts of health center devolution policy. Focus of the assessment is on administration and management, response to local health needs and increase access to health care of the devolved health centers. This study also aims to analyze contextual factors that explain the impact differences. Qualitative approach relying on data collection methods like in-depth interview, observation and documentary review was employed where study sites included 28 health-center- devolved areas. Data collection was carried out during the months of November 2011 and May 2012.
The study reveals that situation of the devolved health centers varied from area to area. Overall, about two-third of the health centers (16), their roles were not different from those during the period prior to the devolution. Only one-fourth (7) could fulfill the ideal roles (i.e. the provision of primary curative services, doing health promotion and prevention campaigns and inventing innovations to specifically respond to the local people’s health needs). In respect to transfer preparation, time and efforts for making both health center staff and local government’s officials and leaders prepared were found too short and less systematic. Problems of career development, capacity building and budget support from Contracting Unit for Primary Care-CUP abounded yet improving. No specific structure and system had been set up to curve the problems; most of the devolved health centers their vacant positions were mostly unfilled.
From the evidences gathered, it could be inferred that impacts of the devolution on health conditions, more equitable and easy access to health services were uneven. In the area where the transfer was smooth and health workers and local leaders could work harmoniously, a variety of innovative projects were created making services more accessible to the needy especially the chronically ill and the elderly. In some area doctors was employed as part-time staff. Yet, for the rest, insignificant difference of the service before and after the devolution was common.
This study concludes and recommends that 1)lessons learned from the 28 devolved health center shows successful tendency of health decentralization 2) Department of Local Administration-DLA and Ministry of Health-MOH have to seriously develop special policy and mechanisms to help make the devolution realistic especially the filling of vacant positions in the transferred health centers, 3) it is necessary for the policy bodies- DLA, MoH and the National Health Security Office-NHSO to have a clear and more committed policy direction to push forward the devolution of health centers; standard of practice guidelines and clear signal requiring CUP to support the devolved areas should be made explictely.


After Universal Health Coverage policy was implemented in 2002, accessibility to
health services of Thai citizens have been increased especially catastrophic treatment.
Health outcomes have been improved. Nevertheless, there is constrained in the supply side
of the health care, shortage and inappropriate distribution of health facilities and human
resources in health. Public-private mixed in Thailand is also not efficient.
Thailand will be changing dramatically in the next 20 years from rapid progress of
technology, changing of socioeconomic situation and environmental changes. Thailand will
be aged society within next 20 years. Chronic disease and diseases of inappropriate lifestyle
will be a major burden of diseases.
This study used both qualitative technique and quantitative techniques. Researchers
developed 4 scenarios of health care. SC-0 is the situation that Thai social health protection
is fragmented. Harmonization is not success. SC-1 is the situation that Thai social health
protection is harmonized. However, Health literacy of people is low. Health care is provided
using passive approach. Health care facilities and health care personnel are inadequate and
distributed inappropriately. SC-2 is the situation that Thai social health protection is
harmonized. Health literacy of people is low. Health care facilities and health care personnel
are adequate. Morbidity expands from the increasing number of elderly with chronic
diseases. SC3 is the situation that Thai social health protection is harmonized. Health literacy
of people is good. People have appropriate lifestyle. Health care is provided using active
approach. Health care facilities and health care personnel are adequate. Morbidity is
compressed. Regarding the macroeconomic situation in the next 20 years, there are 3
scenarios. Potential economic growth scenario used previous trend to project Real GDP
growth. Prolonged Middle Income Trap scenario is the situation that Thailand has
institutional weakness. And Overcoming middle income trap scenario is the situation that
Thailand can reform institutions.
According to Potential economic growth scenario, SC3 need more money in the
initial period. However in the long run, the impact of people who are in better health status
will reduce health care expenditure to 3.03% of GDP. In contrast, if management of health
service system is inefficient and people still are low level of health literacy as in SC2, healthcare expenditure will increase to 3.5% of GDP. If the social health protection schemes
are harmonized alone without adequate supply side, health care expenditure in the long
run will increase to 3.08% of GDP in 2031, which is higher than the SC3.
Financial sustainability (Public debt less than 60% of GDP) of the social health
protection schemes depends mainly on economic growth. There is no financial sustainability
problem under Potential economic growth scenario and Prolonged Overcoming middle
income trap scenario. However, the problem of fiscal sustainability will be occurred in the
Middle Income Trap scenario. If policy makers would not like to decrease other public
spending, while maintain the level of health care expenditure. Reform of tax policy is
inevitable.


This study aimed to examine principles and ways to arrange a centralized mechanism
of health insurance programs in Thaialnd and other countries in managing care for high-cost
the chronically ills, and develop guidelines for the three Thai national health security schemes,
including commonalities and differences in cancers, chronic care for end-stage kidney diseases,
and HIV/AIDS. In addition, it explored how Thai secondary- and tertiary-care hospitals provided
care for these three groups of patients under conditions set by the three health security
schemes, and identified any impacts on treatment and continuity of care for high-cost chronic
diseases, particularly when patients switched schemes. Finally, the study purposes included
development of policy proposals for reorganizing management systems for high-cost chronic
care of the health secuirity schemes. Three major methologies were applied, including
literature review on Thai and international experiences, key stakeholder interviews and case
studies in six selected public hospitals.
The study found that management systems of the three health security schemes of
Thailand for high-cost chronic diseases varied in terms of conceptual thoughts, policies,
implementation, as well as performance monitoring. The variations were identified both among
programs within the schemes, and between the schemes. There was no central information
system and management mechanism that was designed with patient-centered intention, or with
particular aims that differed from acute care, namely focusing on continuity of care. Thus, the
systems did not support coordination and monitoring beneficiaries’ data to allow tracking
scheme changing, health service utilization and health outcomes in order to review health
benefits, service operation, as well as predict and manage health expenses in caring for the
diseases and their complications.
Assessed from governing bodies of the scheme and current operations, The Civil
Servant Medical Benefit Scheme (CSMBS) had the most limited capability to issue proactive
policies in managing high-cost chronic diseases. The Universal Coverage Scheme (UC) and
the Social Security Scheme (SSS) seemed to have quite similar directions in defining benefit
packages, despite differences in designing approaches. Each scheme had its own processes
and patient access channels, which resulted in patient re-registration and in coverage gap of
15-45 days when patients need to change schemes.More differences could be found in payment mechanisms for different services and
payment methods. In addition, they differed in quality management, requirements and
standards, some of which affected patient access to care, service arranagement in hospitals or
other service providers. Hospitals did not separate clinics or service units for chronic patients
from different schemes, except in some hospitals for chronic hemo-dialysis.
Policy recommendations for management of high-cost chronic diseases may include
integrated policies for managing the diseases among the three national health schemes, aiming
for coverage, access, quality, efficiency and equity, having an integrated governing body at a
policy level to determine criteria for selecting and designing health benefits for eligible high-cost
chronic diseases, especially benefits for particular disease groups such that they would be
flexible, up-to-date, appropriate and cost-effective. Moreover, clinical practice guidelines and
recommendations applicable for all schemes should be reviewed and developed. They should
take into account capabilities and limitations of the health services system of the country,
suggesting areas for development and not aggravating unrealistic expectations among patients.
Besides, critical points or areas of the services should be determined and subsequently used to
monitor quality of care and access.
In addition, a common system for registering chronic patients should be set up, or
linked among different relevant databases to enable patients to receive continuous care and
ensure portability of benefit coverage in order to avoid coverage gap. Quality assurance
activities for the providers should also be standardized. Care should become multidisciplinary
and makes best use of existing database. Key performance measures should be set up and
used to provide feedback for providers with recommendations for improvement. They could
also be applied during site visits and contract reviews, as well as feed back to primary service
providers of targeted population.


Decentralization is an important management strategy to improve local government efficiency and services. However, such efficiency will not occur without the self-governing ability of local authorities and communities. This study analyzes the capacity and preparedness of local administrative organizations and communities in taking over the healthcare responsibilities from the national government. The local health management capacity is divided into two (2) elements. First, institutional capacity refers to a local administrative organization’s ability to offer high-quality and adequate health services. The institutional capacity consists of three (3) dimensions: (1) political leadership and local executives’ attitude towards healthcare, (2) organizational structure and adequacy of local healthcare personnel, and (3) local fiscal capacity. Second, community capacity refers to a local community’s ability to participate meaningfully in the local policy-making process. This consists of two (2) dimensions: (1) local citizens’ attitude towards their health and (2) forms of citizen participation in social and political activities. Based on these two (2) elements of local health management capacity, this study examines six (6) local administrative organizations: Nongbua Lumphu Provincial Administrative Organization, Udornthani Provincial Administrative Organization, Udornthani Nakorn Municipality, Nongbua Lumphu Muang Municipality, Naphu Tambon Administrative Organization, and Nasee Tambon Administrative Organization.
	This study finds that the three (3) “model communities” –including the Nongbua Lumphu Provincial Administrative Organization, Udornthani Nakorn Municipality, and Naphu Tambon Administrative Organization—demonstrate more institutional capacity than the other three (3) local administrative organizations. The model communities’ mayors exhibit positive attitudes towards healthcare responsibilities and the need to collaborate with the Ministry of Public Health and civil society.  Also, research findings indicate that each model community has         a local health department with adequate healthcare personnel to serve its constituents. Nonetheless, all six (6) local administrative organizations in this study encounter difficulty with revenue collection. Even the model communities still rely heavily on intergovernmental transfers to finance their operations and services.
	In terms of community capacity, the model communities are more prepared than the other three (3) local administrative organizations. This is due to the diversity and enthusiasm of civil society organizations that offer a variety of health-related activities in the model communities. Such diversity and enthusiasm come from a wide range of news media outlets and other information sources that make local citizens aware of the importance of maintaining healthy lifestyle. Also, the local healthcare personnel’s proactive approach plays an important role in inculcating health awareness among local citizens.


Thailand, especially the south, more frequently faced natural disaster with more
severity which cause loss of life and property of affected population and also have
effect on public health system. Development of disaster management system is of
paramount importance to minimize such effect, however, no study of public health
disaster management in Thailand was found. This project studied 3 southern provinces
that have past experience on disaster management namely Phuket, Nakorn Sri
Thammarat and Songkhla to learn from their direct experience in order to recommend
disaster management for public health sector. The study included disaster prevention,
preparedness, response, mitigation, recovery and development during pre-disaster,
disaster and post-disaster phases. Methodology used in the study was mixed method,
quantitative and qualitative. This study also emphasized on the participation of the
participants from public health and relevant organization to build their capacity in
disaster-related data collection, management, analysis and utilization and team learning
by sharing experience among multi-disciplinary participants. Data collection was carried
out by document review, focused group discussion, in-depth interview and questionnaire
survey among executive, practitioner and the affected people.
The study found that the 3 provinces had developed from passive disaster
management focusing on public health service to active, integrated disaster management
with collaboration with relevant organizations at various levels from local, national to
international. Phuket had its forte in disaster preparedness especially with capacity
building and resource management and collaboration with academic sector. Its strong
leaders can also mobilize resource and link to national and international authorities.
Nakorn Sri Thammarat had strength in disaster response with multi-sectoral collaboration
and civil society participation while Songkhla excelled in community engagement to
prevent and mitigate the disaster with its strong community self-sustainable identity and
participatory public policy mechanism. However the three settings still had room for
development in the area of risk communication, information and early warning system,
systematic, effective aid management, long-termed recovery that integrated with
community development and knowledge management to improve disaster management
in the future.
The challenging recommendation to public health system from the experience of
these three settings is; public health system has to shift its paradigm from “medical
disaster management” to “health disaster management”. It should be more actively
engaged in integrated multi-sectoral disaster management with the multi-disciplinary
relevant organization including the civil society. Public health system, its facility and its  human resource have to be inclusive as a part of the community in disaster
management especially in prevention and preparedness.