The objectives of this study are to identify, evaluate and prioritize risks of Ban Paew hospital and to evaluate financial risks and their impacts to the hospital in the future. We used both qualitative and quantitative techniques to help identifying the risks of the Ban Paew hospital. We classified hospital’s risks into 4 categories: strategic, operational, financial and external factors. Each risk was evaluated and prioritized by staff members of the Ban Paew hospital. This study employed the usage of financial ratio analysis to evaluate the future financial risks. The statistics used in this study were descriptive statistics. We found that the important risks are the ability to expand new branches of Ban Paew hospital, insufficient marketing plans, insufficient welfare providing to its staff members, unclear strategic goal on medical revenue management, unbalanced growth of incomes and expenses, the revenue without donation was not adequate to compensate for the depreciation of the hospital assets, lack of funding channels can create liquidity issues for future investment and its operations, the policy of keeping reputation might not impact on hospital’s revenue, and the external risk such as a change in disburse rules of National Health Security Office.
In addition, the financial risks might consist of the followings. Ban Paew hospital should aware that future revenue might not be adequate to replace the current fixed assets and their depreciations. The money donated to the Ban Paew hospital might create money illusion. The growth of salary was higher than the growth of the hospital‘s revenue. The inadequacy of funds to open new branches in the future. It also might face customer risks due to hospital’s targeting niche customers. To prevent and deal with the risks mentioned above, the cooperation between the Ban Paew hospital, the Ministry of Public Health and the National Health Security Office and the Bureau of the Budget are very encouraged.


The objective of this study was to develop the management model of referral coordination center in provincial and region level. The conceptual framework is 4M; Management, Man, Material and Money. The sampleswere divided into 3 groups. The first groups are 8 executive of referral coordination center, 9 directors in general hospital and 15 directors community hospital. The second group is 24 operational personnel inreferral coordination center. The third groups are 40 patients. The instruments are observational formsand semi-structured form, data collection from in-depth interviews and focus group. Analysis data by descriptive statistic and content analysis. The study found that; 1. All Provincial Referral Coordination Centers (PRCC) has a similar management pattern. 1) Management mostly has chain of command clearly and be unity. There has a target work, referral practice guideline, but the structure of referral coordination center that still unclear. There are no strategy, no plan and no project that specific problems or role of PRCC. The PRCC operation was not beneficial to the community hospital. The database of PRCC has quality problem and can’t to analyze.2) The operational budget of PRCC from hospital subsidy but no project support. There is a full-time nurse who operated PRCC only 08.30-16.30.The executive of PRCC has not build
employee morale process. Allmaterial of PRCC join with emergency accident department but it wasn’t enough to work.
2.The Region of Referral Coordination Centers (RRCC) has a similar PRCC management pattern. There have a regional referral practice guideline and a full-time nurse who operated work only 08.30-16.30but still implementation problem, i.e., no strategies or plan to develop work and personnel skill, lack of development to make the strengthening in network hospital, technology computer was used but can’t link the data, no pattern for regional referral data analysis. 3.The Management model of reasonable, have 3 figure; 1) high level of Provincial Referral Coordination Center Model : H model 2) moderate level of Provincial Referral Coordination Center Model : M Model 3) level of Region Referral Coordination Center Model : R Model.


Diabetes mellitus (DM) is the major public health burden in Thailand. DM is the significant risk factors of cardiovascular disease, end stage renal disease and cancer. Therefore, to decrease morbidity and mortality from diabetic complications, prevention of DM is an important issue. Insulin resistance and pancreatic β-cell dysfuction are the major mechanisms of developing DM. These 2 mechanisms lead to abnormal glucose regulation, called prediabetes that comprises of impaired fasting glucose or impaired
glucose tolerance. Previous evidences found that prediabetes is a significant risk factor of DM. Around 60% of diabetic patients had prediabetes 5 years before developing DM. Until now, there has been no study that investigate about the progression rate to DM in Thai prediabetes patients. In addition, currently, there is new proposed risk factors of DM such as serum uric acid and sleep factors. Therefore, this study aims to estimate the progression rate to DM and assess the association between sleep factors, serum uric acid, and HbA1C level.


This study identified factors affecting health care expenditures and magnitudes of their associations for Local Government Medical Benefit Scheme (LGMBS). Specifically, the study compared population structure and health utilization pattern between LGMBS and Civil Servant Medical Benefit Scheme (CSMBS) that provides a comparable benefit package with a relatively higher expenditure. Based on data in fiscal years 2014-2015, major findings are as follows:
In 2015, persons eligible and registered to LGMBS amounted to approximately 0.6 million, a 6% increase from that in 2014. Comparing to CSMBS with 4.8 million members, LGMBS had a lower proportion in male (44 vs. 47%) and elderly people (26 vs. 33%). The LGMBS members in each age-group were less likely to be hospitalized in a year, as compared with the same-age CSMBS members (For female-male: children 6-8 vs. 10-11%; adults 7-5 vs. 7-6%; elderly 14-15 vs. 18-15%). Such a difference in the demographic profiles resulted in a lower patient proportion of the LGMBS than the CSMBS (all hospital types: 8.8 vs. 9.4%).
The second factor is socio-economic status. Members of LGMBS tend to have a lower education and living standards than CSMBS (Higher education 26 vs. 42%; Living in the top 20% richest households –quintile 5 26 vs. 50%). The key factor leading to choices of service use is resident areas, whereby 30% of the LGMBS members resided inside the municipality area and 58% of the CSMBS did so. Patients visiting health facilities with a higher and expensive care level such as university hospitals were lower in LGMBS than CSMBS (Outpatient, OP: 15-16 vs. 25-26%; Inpatient, IP: 9 vs. 15%).
After controlling for differences between the two Schemes in various characteristics, including hospitalization years, patient sex, age and disease severity, and health zone of hospitals, the LGMBS patients were less likely to be admitted to a provincial or university hospital (PH or UH), which is larger than a district hospital (DH) than the CSMBS (P<0.05) for 8 in 10 most common hospitalized illnesses by a magnitude ranging from 14% for pneumonia to 24% for diabetes (odds ratio, OR: 0.76-0.86).
Difference in the ages also led to a lower frequency of health utilization in the LGMBS patients (OP visits via direct disbursement: PH&UH 4.9-5.3 times and DH 4.6-4.9 times vs. 6.1-6.2 times; IP admissions: 1.5 vs. 1.6 times). For severity of the diseases leading to hospitalization, the LGMBS patients tend to have a lower proportion of severe-very severe levels than the CSMBS (Top 50-diseases: 19 vs. 24% and the rest: 17 vs. 22%). Such a difference could lead to a relatively shorter stay for LGMBS in all-type hospitals (6.9-7.0 vs. 9.0-9.1 days) and in each hospital sub-type (DH 4.4 vs. 5.1 days; PH 7.0 vs. 9.0 days; UH 8.7-9.1 vs. 10.4-10.7 days). Once hospitalization years, patient sex, age and disease severity, hospital types, health zone, and disease groups have been accounted for, the LGMBS patients stayed in hospitals shorter than the CSMBS by 0.32 days (P<0.01) for all-type hospitals and ranging from by 0.17 days in DH to 0.36 days in PH and 0.39 days in UH.
Demographic, socio-economic and residential characteristics plus clinical conditions stated previously are key factors that made the LGMBS expenditure per patient or per visit in 2014-2015 lower that the CSMBS (OP via direct disbursement: 6,019-7,019 Baht per patient or 1,092-1,170 Baht per visit vs. 1,667-1,623 Baht per visit; IP: 28,495-30,354 vs. 41,299-42,852 Baht per patient or 18,903-19,742 vs. 26,658-27,556 Baht per admission; and for adjusted RW: 2.1-2.2 vs. 2.7-2.7 units per patient or 1.4-1.4 vs. 1.7-1.7 units per admission). Furthermore, a significant number of LGMBS OP patients (30-34%) were not found to have a payment claim.After controlling for patient characteristics, hospitalization years, hospital types and health zones; the LGMBS patients had a slightly higher adjusted RW than the CSMBS for all-type diseases (by 0.018 units in all-type hospitals and by 0.067 units in UH). However, the LGMBS’ IP expenditure was relatively lower (by 529 Baht per admission in all-type hospitals, by 375 Baht per admission in DH and by 752 Baht per admission in PH). Specific to diseases, the LGMBS patients had a relatively lower adjusted RW (by 0.025 units in DH for bronchitis; by 1.19 units in UH for pneumonia; by 0.006 units for breast cancer with chemotherapy; and by 0.005 units for lung cancer without chemotherapy). The IP expenditure for LGMBS was also lower than CSMBS for all top-10 common diseases (diarrhea, pneumonia, diabetes, bronchitis, COPD, CKD, CHF, CVA, UTI and appendicitis) plus cervical cancer.
The facts that health expenditures for LGMBS were lower than CSMBS even after controlling for demographic and clinical characteristics of patients as well as hospital characteristics hint to additional factors remaining unaccounted for due to unavailability in analytic datasets. These could include socio-economic status, residential areas and choices of health technology such as use of expensive, non-essential medicines, which were found a higher use by the CSMBS patients in all hospital types. In addition, efficiency in the management system by National Health Security Office (NHSO) through the diagnostic related group (DRG) for IP and fee-for-service payment for OP services through direct disbursement and receipt systems.
Results from a model simulation predicting the LGMBS budget increase due to selective scenarios assuming the LGMBS patient characteristics comparable to the CSMBS as follows: (1) same age-sex structure: the LGMBS expenditure would increase by 14% of the current 2015-OP expenditure (2,566 million Baht) and by 29% of IP expenditure (1,656 million Baht) over the same year or in total by 830 million Baht (combined OP-IP); (2) same age-sex specific expenditure per patient: the LGMBS expenditure would increase by 29% and 10% of the current OP and IP expenditures, respectively or by 920 million Baht in total; and (3) assuming both (1) and (2): the LGMBS would increase by 45% and 41%, respectively or by 1,850 million Baht in total.
Results from the qualitative study using in-depth interviews with key partners, including patients, the LGO’s staff and health care providers revealed findings consistent with the quantitative analysis that due to a relatively young age of the LGMBS members, they were relatively healthier. Once they got sick, a health facility closed to their homes, whereby in provincial areas is typically a DH or health center is a usual source of services. Management by NHSO including for example reimbursement audit could reduce duplicating enrollment and rational drug use according to treatment guidelines. In addition, existing cost-containment measures on the use of non-essential medicines that have been implemented for CSMBS patients had a spill-over effect on the LGMBS.
Service users who were first-line relatives of the LGMBS beneficiaries may not be aware of eligible benefits or may opt out by paying out of their own pockets (OOP) or using private insurance. Results from an additional survey of the LGMBS patients found that 59% of users of private health facilities have paid OOP with the median utilization of 3 times in a year.
For perception on the services obtained, both LGMBS patients and providers did not distinguish the quality of care to be poorer than the CSMBS. In addition, they agreed certain patients did not understand about the eligible benefits.
Perceived improvement in the NHSO performance on managing the LGMBS included time taken for reimbursement through receipt system, co-ordination made by the NHSO Regional Office, member registration during work transition, direct disbursement to selected health centers, claim processing for selective benefits such as expensive medicines.


Executive Functions (EF) is a higher-order, self-regulatory cognitive processes that aid in the monitoring and control of our thought and action for goal-directed behaviors.  EF is related more to success in school from preschool to university, than the IQ.  In Thailand, there is no information regarding the current situation of EF skill in young children.  The main objective of the present study is to develop tools and to construct the normative criteria for assessing EF skill in Thai preschooler age between 2-6 years.  Thirty-two items of behavioral checklists that indicated development of EF related behaviors (i.e., inhibit, shift/cognitive flexibility, emotional control, working memory and plan/organize) were designed to be appropriate with the Thai social context.  The behavioral checklist is friendly for teacher to observe their student’s behavior in the class room by using the rubric scales (0-5) which indicate the frequency of behaviors that has been observed during the past 3 months.  For construction of the normative criteria, children age between 2-6 years (N=2,965) both boys (51.6%) and girls (48.4%) from all regions across the country were participated in this study. They were selected by 3 steps simple random sampling.  First, sampling the child development centers in each region of the country, then sampling the rooms and finally sampling the number of children in each room.  Teachers were asked to rate child’s behavioral in the questionnaire. Data were collected and the T scores were constructed separately by sex and age of the children using the SPSS software. Our results show that children gradually improve their behavior related with EF skill during 2-6 years old. Although boy and girls have similar development at 2-2.11 years in their behavior related to EF skill, girls are more advance in EF development than boys at the age between 3-6 years.  Nearly 30% of children demonstrate the delay development in behaviors related to EF skill (T score<45). Moreover, 30% of children have behavioral problems related to EF dysfunctions (T score>55).  Delay EF development and/or EF dysfunction in childhood is associated with worse inhibitory control. They were more likely to be failure or drop out of school at adolescents, and less likely to be successful as adults. Thus, a child’s level of EF in early childhood likely contributes to a trajectory of success or failure in the future. Our results suggest that delay development of EF in 30% of Thai preschooler should not be ignored as EF skill can predict the quality of Thai people in the next 10-15 years, which can hinder the country's development in the long term. It’s time to re-thinking about how to scaffold EF development in young children in order to create a new generation of Thai people who can self-directed towards the success, who have the ability to cope with the dynamics change of the world in the 21st century, and who can leads the country successfully toward the Thailand 4.0 national policy.


Background : The idea of developing communication assistive device for disable persons who have lost their motor functions and cannot communicate is challenging.  Some paralyzed persons are aware of themselves and environments but cannot move their body parts except their eyes. With the use of an assistive device that can detect an eye or mouth status, these people can partially interact with the surrounding environments. Objective : The purpose of this present study was to develop a machine vision based system for a real-time eye or mouth status detection which can be further applied to be used as assistive controlling or communication device for patients. Material and method : This system composed of a web camera connected to a computer running with the developed software to detect the status of eye or mouth. The software prototype was developed in C++ on an MS Windows 7 PC using OpenCV and Dlib libraries and KNN classification technique. Result : The result showed that the accuracy of eye detection was at the highest accuracy (98%) at the middle distance (140cm), whereas the same distance result also observed with the mouth detection (94%). The results from the satisfaction questionnaire demonstrated that all users-healthy volunteers (n=20), dysarthric patients and caregivers (n=20) satisfied with the developed apparatus and software. The satisfaction score in the using of developed equipments was 4.02 (healthy subjects) and 4.21 (patients) from the highest score of 5. The satisfaction score in software using were 3.91, 4.14 (function test); 3.83, 4.09 (usability test) and 4.18, 4.28 (security test) in healthy subjects and patients, respectively.  Summary: In conclusion, our developed system can be efficiently used for further development of a communication or controlling assistive device for disable persons


The ultimate aim of this study is to invent a ready to use immunochromatographic test (ICT) test kit for double diagnosis of leptospirosis and Dengue fever by means of antigen detection. The research activities on invention of ICT test kit for leptospirosis diagnosis were carried out sequentially which included: 1) determination of suitability of the pre-existing mouse monoclonal antibodies to Leptospira antigens (clones LD5, LE1 and LF9 from Faculty of Medicine Siriraj Hospital, Mahidol University and clones 3, 81, and 82 from Faculty of Medicine, Chulalongkorn University); 2) development of an ICT test kit using suitable MAb1-MAb2, MAb-PAb, or Pab-MAb format; 3) acquisition of serum samples of patients with febrile illnesses from collection of Prof. Dr. Yupin Suputthamongkol, Siriraj Hospital; and 4) validation of the ICT test kit which was performed in blinded manner in comparison to the previous laboratory and clinical diagnoses. The activity 1 was carried out by Dr. Surasak Wongrattanacheewin, Department of Microbiology, Faculty of Medicine, Khon-Kaen University (third party). It turns out that suitable monoclonal antibodies were from clones LD5 and LE1 (specific to pathogenic Leptospira) from Siriraj Hospital. Therefore, the MAbLE1 was used to conjugate with the colloidal gold particles and impregnated into the gold conjugate pad while the MAbLD5 was immobilized at the Test (T) line. Control (C) line was immobilized with goat anti-mouse immunoglobulin. Alternatively, rabbit polyclonal immunoglobulin to pathogenic Leptospira was used to conjugate with the gold particles, MAbLD5 was immobilized at the Test (T) line, and goat anti-rabbit immunoglobulin was at the Control line. Both formats of the ICT test kit had the lowest detection limit at 0.375 g of Leptospira whole cell proteins/strip. They are specific only to Leptospira and did not detect antigens of 27 other bacterial species.
Sixty serum samples of patients with febrile illnesses (kept frozen) were obtained from Prof. Dr. Yupin for use for the ICT test kit validation. They were subsequently known after the ICT testing to be 14 sera diagnosed leptspirosis, 16 sera diagnosed scrub typhus, and 30 sera diagnosed Dengue viral infections. All 14 sera diagnosed leptospirosis gave positive results by the ICT test kit. Nevertheless, 11 of the 16 diagnosed scrub typhus and 3 of 30 diagnosed Dengue viral infections gave positive results by the ICT test kit. Thus, the ICT test kit shows 100% sensitivity, 70% specificity, 77% accuracy, 0% negative predictive value and 30% positive positive predictive value. It is noteworthy that, we have sent the bands at the test lines of three samples diagnosed scrub typhus which were positive by our leptospirosis ICT test kit for mass spectrometry. The results of the mass spectrometry revealed the presence of Leptospira peptides and the absence of scrub typhus antigen; implying that the original diagnosis was inaccurate. The second batch of 248 serum samples was obtained from Prof. Dr. Yupin. Among them, 201 samples were positive for leptospirosis by the ICT test kit. However, we have not obtained the diagnoses of these sera from Prof. Dr. Yupin as yet.
We have prepared ICT test kit for detection of Dengue virus antigen. The monoclonal antibodies to Dengue virus were from Dr. Chanya Putthikhan, Siriraj Hospital. One MAb preparation (SI4) is a pool of 4 MAbs (2 MAbs were mouse IgG1 and the other two were IgG2b) and another MAb (SI1) is IgM. We have used the MAbSI4 to conjugate with gold particles and used the MAbSI1 at the test (T) line. Goat anti-mouse immunoglobulin were immobilized at the control (C) line. Because the supply of Dengue virus antigens and the MAbs from Dr. Chanya was inadequate for optimization of the test kit, we cannot accomplish the test kit invention as yet.


Pythiosis is a life-threatening infectious disease of both humans and animals living in Asia, Americas, Africa, and parts of Australia and New Zealand. The etiologic pathogen is the fungus-like organism Pythium insidiosum. The disease has high mortality and morbidity rates. Use of antifungal drugs are ineffective against P. insidiosum, leaving radical surgery the main treatment option. Prompt treatment leads to better prognosis of affected individuals, and could be achieved by early and accurate diagnosis. Since pythiosis has been increasingly reported worldwide, there is a need for a rapid, userfriendly, and efficient test that facilitates the diagnosis of the disease. This study aims to develop an immunochromatographic test (ICT), using the bacterial protein A/G, to detect anti-P. insidiosum IgGs in humans and animals, and compare its diagnostic performance with the established ELISA. Eighty-five serum samples from 28 patients, 24 dogs, 12 horses, 12 rabbits, and 9 cattle with pythiosis, and 143 serum samples from 80 human and 63 animal subjects in a healthy condition, with thalassemia, or with other fungal infections, were recruited for assay evaluation. Detection specificities of ELISA and ICT were 100.0%. While the detection sensitivity of ELISA was 98.8%, that of ICT was 90.6%. Most pythiosis sera, that were falsely read negative by ICT, were weakly positive by ELISA. In conclusion, a protein A/G-based ICT is a rapid, user-friendly, and efficient assay for serodiagnosis of pythiosis in humans and animals. Compared to ELISA, ICT has an equivalent detection specificity and a slightly lower detection sensitivity.


Purpose To investigate the immunity of Diptheria from Corynebacterium diphtheriae, pertussis from Bordetella pertussis and tetanus from Clostidium tetani in Thais Subject and method Firstly, commercial kit for the detection of antibodies to diphtheria, tetanus and pertussis using indirect ELISA (EUROIMMUN, Germany) were pre-evaluated. Secondly, the seroprevalence of antibodies to diphtheria toxin IgG (anti-DT), tetanus toxin IgG (anti-TT) pertussis toxin IgG (anti-PT) were performed in 965 sera from blood volunteers in 2014, aged between <20 and >60 years, who attending at regional blood center from the North (240 sera from Chiangmai, Pitsanulok, Lampang and Nakon Sawan provinces), the Central (243 sera from Lopburi, Ratchaburi, Chonburi and Bangkok provinces), the Northeastern (240 sera from Khonkaen, Nongkhai, Nakhon Phanom and Ubon Ratchatani provinces) and the South parts (242 sera from Krabi, Songkha, Pattani and Prachuap Khiri Kan provinces). Result Overall the seroprevalence at the protective level (>0.1 IU/ml) of anti-DT was 62.9% [GMT (geometric mean titer) 0.19 IU/ml, 95%CI 0.13-0.25)] and anti-TT was 87.8% (GMT 1.16, 95%CI 0.73-1.59). Anti-DT level from provinces in the South was higher than other parts (p<0.05, Chi square and Kruskal Wallis). Anti-DT level in Bangkok was the lowest prevalence (43.3%) and low anti-DT level might be seen at all age groups in some area such as Nakornsawan, Lopburi and Ubonrachatanee provinces. Regarding to pertussis, no information of the protective level of anti-PT was documented. In this study, the prevalence of anti-PT was 52% based on the presence of antibody in subjects bearing at 5 IU/ml (criteria for vaccine trial) and was only 12.9% based on antibody at 40 IU/ml (criteria for diagnosis based on kit) with GMT of anti-PT 10.16 (95%CI 6.93-13.39). This will be implied that Thai population might be risk of pertussis due to low prevalence of anti-PT antibody. No significant difference of gender was found in these 3 specific antibodies. Conclusion The information from this study might be the useful for the consideration to stimulate the immunity by vaccination at high risk group of waning antibodies. In Thailand, booster vaccination against diphtheria, tetatnus and including pertussis should be considered in Thai adult.


Wheezing is an important health problem in Thailand. Estimating costs of wheezing treatment in preschool children under societal, provider and patient’s perspectives were also studied. Cost data of 234 six participants who admitted with asthma and wheezing at Thammasat hospital, King Chulalongkorn Memorial hospital, Bhumiphol hospital and Saraburi hospital were available for this analysis. Data from hospital financial database and caregivers’ expenses were collected. Cost-to-charge ratio method was employed for valuation of direct medical costs.Informal care cost was determined by human capital approach. It is found that societal, provider and patient costs per admission were 20,269±20,537, 18,126±16,898 และ 3,119±6,655THB, respectively. The main cost component in all perspective was hoteling cost during admission.  The economic burden of asthma and wheezing admission of preschool children in Thailand was estimated as 759 million THB per year. To decrease length of stay and admission rate will save costs of asthma and wheezing care in preschool children.
	The participants in this study were 240 pediatric patients hospitalized with acute wheezing in Thammasat hospital, King Chulalongkorn Memorial hospital, Bhumiphol hospital and Saraburi hospital. The participants were boys (62.7 %), recurrent wheezing (59.1%). According to laboratory results, Atopy (specific IgE level >0.35 kUA/L of  any allergens being tested) was found in 75.5 percent. He highest prevalence of hypersensitivity was cow’s milk protein (75.5%), following by egg’s white (52.9%). Vitamin D insufficiency (25-hydroxy-vitamin D level < 30 ng/ml) was found in 24.8 percent. Concerning 12 months of follow-up, completed data for analysis was available in 195 cases (81.3%). The one-year incidence of re-hospitalization with acute wheezing was 23.1 percent (95% confidence interval: 17.5% - 30.0%). The one-year incidence of emergency visits with recurrent wheezing was 49.7 percent (95% confidence interval: 42.5% - 57.0%).


This study aimed to determine in vitro sensitivities of artemisinin derivatives and their partner drugs in artemisinin derivative based combination therapy (ACT) and genetic characterization of resistant genes in 95 Plasmodium falciparum isolates collected from Thai-Myanmar and Thai-Cambodia borders. Almost all isolates were sensitive to artesunate และ dihydroartemisinin. Approximately seventy seven percent of the samples had a mutation on an artemisinin-resistant gene, Kelch13 propeller which C580Y mutation was predominant. All parasites isolated from Thai-Cambodia border contained 184F allele with 1 copy number of pfmdr1 gene. In contrast, the parasites collected from Thai-Myanmar border had the pfmdr1 184F allele at 47.2% and contained a few copy number of the pfmdr1 gene with the average of 2.5 copies. Most isolates were resistant to mefloquine which might lead to treatment failure of artesunate-mefloquine in Thailand. Consequently, The Ministry of Public Health has changed the first-line treatment for falciparum malaria to dihyroartemisinin-piperaquine. The present study shows that the parasites containing the pfmdr1 86Y allele exhibited reduced piperaquine sensitivity. Prior to nationwide implication of dihydroartemisinin-piperaquine usage in Thailand, efficacy testing should be conducted. In addition, regular monitoring should be properly performed especially in Thai-Malaysia border where most parasites contained the pfmdr1 86Y allele. Artesunate-pyronaridine is a new effective ACT. The parasites’ pyronaridine IC50 in this study were 3-220 times lower than the IC50 of a recrudescent parasite previously reported in Thailand. In addition, there was no significant difference of pyronaridine IC50 among the parasites with different haplotypes. Thus, artesunate-pyronaridine may be a suitable ACT of choice in the area containing parasites with varied resistant haplotypes especially the pfmdr1 haplotypes. In vitro sensitivities and genotypic characterization of the resistant genes of P. falciparum should be continuously monitored in order to detect the emergence of antimalarial resistance. Rationale drug use can be guided using this information.


Bats are natural reservoirs of Coronaviruses (CoV), which includes the genera
Alphacoronavirus (alphaCoV) and Betacoronavirus (betaCoV). Bat CoVs are also closely
related to human pathogens such as severe acute respiratory syndrome (SARS) and
the Middle East respiratory syndrome (MERS). Thailand has previously detected viruses
in the same lineage as SARS-CoV, in the Hipposiderous larvatus, and MERS-CoV from
unidentified bat guano. Thailand houses 139 different bat species, including
Tylonycteris spp., Pipistrellus spp. and Taphozous spp. These species have been
reported to carry MERS-CoV in other countries. It is thus important to conduct a study
to monitor these bat species and identify the viruses they harbor. Specimens from 645
bats, 33 species, were collected between 2011 and 2015, from 10 provinces (13
locations). Rectal swabs from these bats were analyzed using PCR, specifically for the
RNA-dependent RNA polymerase gene. Fifty seven (8.8%) of the samples were positive
for CoV; alphaCoV (19/57) and betaCoV (36/57). Two bats were found to be coinfected
with viruses of 2 different genera. Eight samples were positive for MERS-CoV
lineage, which is classified under betaCoV lineage C. Two of these samples were from
Tylonycteris robustula, the same bat species previously reported to harbor the virus in
China. Six samples were found in the Chaerephon plicata, which has never been
known to harbor CoV. Two samples from Rhinolophus malayanus were also positive
for SARS-CoV lineage, also previously reported in China from the same bat genus.
Detection of viruses in the same lineage of MERS-CoV and SARS-CoV in Thai bats
indicates the need for vigilant zoonotic disease surveillance to monitor virus jump
species to new hosts that may cause severe disease in humans or other animals, in
addition to the measures in place to contain disease outbreak. Thailand’s
preparedness and prompt diagnosis of the two imported (from Oman) MERS cases,
whose genetic analyses from whole genome sequencing revealed to be the same
strain as the outbreak in South Korea, prevented an outbreak in Thailand. Early
detection for cause of disease in patient and pre-identification of new pathogens from
natural reservoirs that can potentially case disease in humans can reduce the scale
and severity of next outbreak.


Acquired immune deficiency syndrome (AIDS) remains a major public health problem in Thailand. Treatment of HIV-infected patient using highly active retroviral therapy (HAART) can suppress viral replication and increases maintain the level of CD4+ lymphocyte cells. Adherence to HAART can improve health and prolong life of HIV-infected patients. However, non-adherence to antiretroviral drugs leads to develop of HIV drug-resistance strains. Therefore, the high costs of new generation antiretroviral drugs are needed. In this study, we aimed to develop a high throughput assay for examining the enzymatic activity of HIV-1 protease (PR) and integrase (IN). These assays will be applicable for assessing the level of HIV-1 protease inhibitors (PIs) and integrase inhibitors in HIV-infected patients who recived antiretroviral treatment. The novel immunochromatographic (IC) strip test for determining of HIV-PR activity was developed by combining proteolysis activity of HIV-PR and an immunochromatographic reaction. This IC strip could adaped to evaluate the biological activity of PI and also semi-quantify the level of PI in HIV-1 infected individual. Furthermore, we established a non-radioisotopic testing based on real-time polymerase chain reaction (PCR) assay to determine HIV-1 integrase activity. This assay has been shown to be effective and inexpensive for a high-throughput screening of novel IN inhibitors. The novel development of enzymatic activity assay of HIV-1 protease and integrase using immunochromatographic strip test and real-time PCR assay could provide as a high-throuput screening platform for discovering new synthetic antiretroviral agents or natural compounds from Thai medicinal plants by Thai reseacher. This study might be able to reduce the importion of new generation antiretroviral drugs from other countires.


Immunization was first practiced in Thailand in 1977 through the National Expanded Program
on Immunization (EPI) with the aim of significantly reducing morbidity and mortality from common
vaccine-preventable diseases. When first introduced the EPI program coverage level was very low:
about 10-20 percent for many diseases. By 2000 vaccine coverage for nearly all vaccines in the EPI
program was more than 90 percent. Consequently, rates of vaccine preventable diseases (such as
diphtheria, measles, and rubella) in Thailand are very low.
Despite high vaccine coverage in Thailand, however, there has been a resurgence of some
vaccine-preventable diseases. For example, there was a resurgence of diphtheria in eight provinces in
2012, and measles outbreaks occur among children every 3-4 years. There are a few possible
explanations for the return of vaccine-preventable diseases in Thailand. The first possible reason is
population movement, in particular migration to Thailand. Next is low immunization coverage (below
the critical threshold) in particular locations among children aged less than five years old. The other
possible reason for the resurgence is waning immunity in adults. An evaluation of these possible
reasons for the resurgences would help us to identify effective measures to protect against a return of
vaccine preventable diseases in Thailand.
During the period (2012) of the diphtheria outbreak, Bueng-Kan which is located at the border
between Thailand and the Lao People's Democratic Republic, there was an outbreak of hepatitis A
with a case rate of 355 per 100,000. Investigation of this outbreak suggested that contaminated water
and ice were sources of infection. During the past decade Thailand has faced several major
outbreaks of hepatitis A, which resulted in thousands of infected people and hundreds of
hospitalizations. Currently, the hepatitis vaccine is not included in the EPI program.
There are more than 3.5 million persons without Thai nationality living in the country,
including many long-term residents and children of migrants born in Thailand. The approximately 3.1
million migrants working in Thailand comprise about 8 per cent of the labour force. Because of
Thailand’s relative economic and social stability, it is a primary destination for many regional worker
migrants. Those migrants are vulnerable to health risks due to limited or inadequate access to basic
health services and poor living conditions. However, there is little or no data on the immunization
coverage of this group as well as on their movement inside Thailand.The resurgence of vaccine preventable diseases in some parts in Thailand raises the
following questions. What are the reasons for these resurgences? Will the epidemics of these
diseases expand to others part of Thailand? How can they be controlled? Is Thailand sufficiently
protected against a return of vaccine preventable diseases such as diphtheria, measles, rubella, and
hepatitis A?
In order to gain insights into the resurgence of vaccine preventable diseases in Thailand, this
project propose to: 1) explore the epidemiology and dynamics of the resurgence of vaccine
preventable disease epidemics in Thailand; 2) determine the seroprevalence of vaccine preventable
diseases among migrant populations in Thailand; 3) determine contact and movement patterns of
migrant populations in Thailand; 4) use mathematical models to demonstrate possible scenarios for
the spread of vaccine preventable diseases among migrants and Thai nationals taking into account
the effect of population movement patterns and to suggest optimal control strategies; 5) use
mathematical models to evaluate the spatial dimension of vaccine preventable disease spread among
migrants and the Thai population; and 6) determine the cost-effectiveness of implementing vaccination
campaigns for the migrant population in Thailand. The end result of the whole project will be an
evidence base which can be practically used by the public health sector for epidemic mitigation,
prevention and control.


Obtaining quality research that can benefit country development requires systematic management
of relevant agencies including research funding agencies. This study aimed to provide research funding
agencies recommendations regarding the management of health research in Thailand. The study was
carried out by reviewing literature and documents related to experience in health research management of both national and international government research funding agencies. Additionally, key informant
interviews and focus group discussions with experts involved in research systems were conducted.
The study analyzed and compared research management components of various countries with
those of the Thai research funding agencies under 9 different dimensions. The study showed that health
research management in Thailand still needed to be developed. In particular, health research management
needs to focus on the coordination of relevant agencies in national health research policy formulation,
reduction of budget support in unclear strategies, development and increase in the role of research
managers in order to support research utilization, and lastly, monitoring and evaluation using comprehensive
indicators to measure input, process, output and impact of research.


The purposes of this review article were to determine situation changes affecting performance of
village health volunteers. The data were collected by reviewing documents and related research and then
synthesized data in accordance with the objectives. The results showed that from the past to the present,
there are many changes, from policy, finance, social and information technology. These changes affected
the performance of village health volunteers and community health. Managing community health problem,
governments could not manage alone. They needed participation of public sector, especially village
health volunteers who were the mainspring of the public sector because they have lived in the community
and known the background of their area, therefore, they have received the trust of the community. The
recommendations concerning increasing operational effectiveness of the village health volunteers included
the following: promoting income generation, strengthening information technology skills, and building
up the coordinator or community mentoring role.


The purpose of this study is to identify graduation rates of Doctor of Medicine (M.D.) program of
Khon Kaen University during the academic year 1973-2012, with total number of 5,598 students from 40
admission classes. There were 3,966 alumni from 34 graduated classes. The information was collected
from the Registrar Office, Student Development Unit, and School Alumni Database, using percentage for
data analysis. The M.D. program responded to the policy of the Human Resources for Health Committee,
the admissions of students (classes# 1-40) were under two core projects: 1) Normal Project (including the
extra quota admissions), and 2) Mega Project for producing medical practitioners (the Collaborative Project to Increase Production of Rural Doctor or CPIRD and the One District One Doctor or ODOD), at 81% (or
4,545 persons), and 19% (or 1,053 persons), respectively. The graduation rate of MD program from 34
classes, was 95.71% (3,796 persons). The on-time graduation rate was 84.06% (3,191 persons); while delayed
graduation rate was 15.75% (598 persons). Under the Normal Project, the graduation rate was 95.81%
(or 3,434 persons), of which on-time graduation was 83.49% (or 2,867 persons). Under the Mega Project
(CPIRD and ODOD), the graduation was 94.76% (362 persons), of which on-time graduation was 89.50%
(324 persons). The graduation rate under the Direct Admission group was 96.09% (or 2039 persons). Additionally,
the graduation rate of Central Admission group was 95.74% (1,348 persons), the CPIRD 1 with a
maximum rate of 96.55% (196 persons), the CPIRD 2 93.25% (152 persons), and the ODOD 87.5% (14
persons). When studied on graduation rate in every 10 years, Phase 1: Year 1st - 10th (1973-1982), the
Normal Project admitted 584 students with graduation rate of 93.87% (or 551 persons), and on-time graduation
rate of 82.94% (or 457 persons). Phase 2: Year 11th - 20th, the Normal Project and CPIRD 1 admitted
1,284 students with graduation rate of 95.87% (or 1,231 persons), and on-time graduation rate of 78.15%
(or 962 persons). Phase 3: Year 21rd - 32nd, the Normal Project and CPIRD 1, admitted 1,571 students with
graduation rate of 96.69% (or 1,519 persons), and on-time graduation rate of 87.29% (or 1,326 persons).
Phase 4: Year 33rd - 40th, only 2 classes, i.e. Class# 33 - 34 (538 students) wer e graduated at a rate of 94.42%
(or 508 persons), and on-time graduation rate of 90.75% (or 461 persons). The academic achievements of
Direct Admission and Central Admission, under Normal Project, were relatively similar and the CPIRD 1
reached maximum academic achievement.


Moving out from the area of health workforce affects staff shortages. Job satisfaction is the key factor
in the decision to remain or move. Satisfaction analysis will lead to a plan to tackle in the future. This
research aimed to identify the factors that were associated with job satisfaction and satisfaction level. The
instrument was a questionnaire of motivation, morale and satisfaction in their work. All health personnel
included health professional, supporting staff and employees. A questionnaire was filled out by hand.
Data collection was completed in June 2013 with response rate of 52.4%. The research found that most health personnel were satisfied with the work at a moderate level (31.4% satisfied at quartile 2). Quantile
regression showed that working relationships with colleagues and administrators had significant effect
on satisfaction of personnel who were satisfied at a moderate level (coeff. = 3.00; 95% CI: 0.33, 5.67). Life
balance had significant effect on those who had a high level of satisfaction (coeff. = 3.00; 95% CI: 1.60,
4.40), while advancement opportunities significantly influenced satisfaction at all levels. The researcher
proposed that the support of health worker should take into account the different levels of customer
satisfaction through organizational development, behaviors and shared value formation, including proper
appointment and special compensation.


Alcohol marketing and advertising are critical factors influencing youth’s attitude toward alcohol
consumption and consequently heavy drinking and related problems. This study describes situation on,
gaps of, and opportunities for alcohol marketing and advertising control in Thailand. The study analyzed
two issues: the policy or measure on alcohol marketing and advertising, and the body of knowledge on
alcohol marketing and advertising in Thailand. The documentary review of regulations on alcohol marketing
and advertising control in Thailand found that the current laws could partially control the marketing
and advertising of alcohol. There were technical problems in interpreting the laws. Furthermore, regulators
and the public lacked of understanding the laws. Additionally, alcohol marketing and advertising
strategies had been developed every time which led to needs of knowledge to understand the new situations.
Finally, there had been no study in Thailand in particular a longitudinal study to examine effects of
marketing and advertising on alcohol consumption. Therefore, the development of knowledge together
with improvement of the laws is urgently needed to effectively control alcohol marketing and advertising
in Thailand.


When getting old, health usually becomes decelerating. Generally, it is believed that health literacy
could replenish the elderly to good quality of life; hence the research tried to prove this belief. This study
is a descriptive research comprising two objectives. Firstly, it aimed to investigate the level of the elderly’s
health literacy according to the ABCDE behavioral campaign by the Ministry of Public Health (A: Alcohol
abandon, B: Baccy, no tobacco smoking, C: Coping with emotion, D: Diet consumption, and E: Exercise).
Secondly, the research examined the relationship between health literacy and the quality of life of the
elderly in the Central Region of the Northeast. The research was done with 600 elderly living in Roi-et,
Khon Kaen, Mahasarakham and Kalasin. The data were collected by interviewing conducted during January
to March, 2015 and were analyzed by frequency, percentage, mean, standard deviation and Pearson’s
correlation coefficient. The results revealed that the overall level of the elderly health literacy according to
the campaign was low but the quality of life of the elderly was high. The relationship between health
literacy and quality of life of the elderly was positive (r=0.305, p<0.01). From the findings, the researcher
suggested that there should urgently be wider assessment of the elderly health literacy at both individual
and community levels in order to know the real health status of the elderly. The result of the wider assessment
will be useful for creating qualified strategic plan appropriate to the situation of the elderly increase
in the future. The strategic plan in the future should focus on urgent needs in developing the elderly’s
skills such as; information access, communication, and media literacy.


Incidence of death and long-term disability of emergency patients could be reduced with prehospital
emergency medical service (EMS) utilization. Current reports indicated that emergency medical
services were used only 3.1 percent of cases in Thailand. This reflected that a review of causes related to
the use of pre-hospital EMS was urgently required. This research was then conducted to promote the EMS
utilization. After the review, 38 articles were found related to the topic, and the contents of 31 articles were
relatively relevant and credible with evidence-based data after verifying with rigorous methodology. Then all of the 31 articles were utilized in the process of content analysis. The findings indicated that
EMS utilization via 1669 hotline and others were related with various factors including population, socioeconomic
of the service users or relatives such as gender, age, education, marital status, income, and
vehicle ownership.
The important factors included attitude towards EMS, EMS past experience, social support, perception
on obstacles in using EMS, access to information, knowledge on urgent symptoms of EMS use, and
self-confidence on using pre-hospital EMS system. These findings may be used to develop further
research for promoting appropriate EMS utilization in Thailand.


This study focuses on four parts of health promotion and disease prevention budget under the Universal
Health Coverage, including budget for solving specific health problems in the area or provinces,
benefit packages, community health promotion and budget for promoting, monitoring and evaluating the program. Therefore, the objectives of the study are to evaluate the allocation in terms of sufficiency
and budget implementation, as well as monitoring and evaluating process in healthcare facilities during
2014-2015. Two provincial case studies were selected and retrospective method was employed by reviewing
related primary and secondary data. In-depth interviews of healthcare executives and focus group
discussions with healthcare practitioners were conducted. The results showed a number of challenges
due to the dynamic budget allocation that could lead to difficulties in budget management. Also, it was
unable to explain whether budget in each area was sufficient due to no separated budget for P&P. Furthermore,
lay people might not be aware that they were entitled to receive personal benefits from the Health
Promotion and Disease Prevention Fund. Most healthcare facilities did not portray evidence-based manner
to carry out and create activities regarding monitoring and evaluation program effectiveness. Therefore,
the National Health Security Office should estimate the budget to meet the requirement and strengthen
public relations to increase service utilization, and also set up mechanisms to verify accuracy of data in
order to plan the service provision. For health facilities, the P&P budget should be explicitly separated
and evidence-based academic should be used to support the implementation.


Thailand has a large number of the migrant laborers working both legally and illegally. In 2014 the
government set a strong policy to officially register migrant workers for providing health insurance. This
research aims to analyze the costs of medical care and health services of the registered migrant workers at
Khao Chakan District, Sa Kaeo Province. This was a descriptive study using secondary data from the
accounting and finance on HOSxP database of the hospital and JHCIS database of Subdistrict Health
Promoting Hospitals in fiscal 2014 and 2015.
The results showed that there were 54 registered migrant workers receiving 90 health care services visits in the fiscal year 2014. In 2015, the number of registered migrant workers increased to 983 people
receiving 596 health care services. The total cost of outpatient in fiscal 2014 and 2015 was 22,588 baht and
145,482.92 baht. The average cost per visit was 250.98 ± 352.18 and 244.10 ± 301.82 baht. The average cost
per registered person was 418.30 baht and 148.00 baht respectively. The percentages of people who turned up for services to the total registered workers were 38.9% and 25.5% respectively. The total revenue of the outpatient from health insurance card for migrant workers in fiscal 2015 was 642.40 baht per person per year.


Projection of pharmacist workforce is essential information for planning and allocating pharmacist
workforce. Hospital pharmacists accounted for the highest proportion of the pharmacist workforce in
Thailand. This study was aimed to project hospital pharmacist workforce for the next 20 years (2015-2035)
by using needs assessment models. The projection of hospital pharmacist based on two techniques: time
series and regression analysis by using 3 factors: male and female ratio, elderly age greater than 60 year
old ratio and gross provincial product (GPP). According to time series forecasting and regression analysis,
the maximum extent of FTE requirement for hospital pharmacist in 2035 based on sensitivity analysis was
123,405 (87,227-159,584) and 111,454 (79,543-143,365), respectively. While the minimum number of FTE
requirement was 69,723 and 50,502, respectively. This study showed that the shortage of hospital pharmacist
is an issue of concern that requires an effective planning to secure the future of hospital pharmacist
workforce. However, other factors might affect the results of this study such as continuing pharmaceutical
education (CPE), new technology etc.


Roles of community pharmacy are changing to extend cooperating services with the National Health
Security Office (NHSO). Its change could be a strategic policy to support patient service continuity. Objectives
of this study were to evaluate the readiness and decision of community pharmacy preceptors to coservice
with the NHSO, and to investigate factors affecting the co-service decision. Samples were 408
community pharmacies that provided experiential education to pharmacy students of 17 pharmacy faculties
across the country. This was a cross-sectional survey study design. A self-developed questionnaire
was administered during May-August, 2014. The survey questionnaire was validated by six experts, and
the reliability was tested with Cronbach’s alpha > 0.7. The survey response rate was 46.1% (n = 188).
Almost half (49.4%) of respondents were owners and practitioners as community pharmacists. Three highest
services provided in community pharmacy preceptors were 1) medication therapy management (MTM)
for individual patients (64.5%), 2) diseases screening and monitoring (60.1%), and 3) smoking cessation
counseling (58.0%). The two criteria that community pharmacy preceptors gave scores lower than 50% of
minimum requirements were: 1) accessing to data of health service units in the area, and 2) capacity of
prescription evaluation and patient referral system. Regarding the readiness of NHSO co-services participation,
the community pharmacy preceptors gave high scores on both quality and willingness to participate.
Significantly positive relationships with a decision to participate were found in service system (B =
0.248, p<0.05) and management towards customer’s need (B=0.214, p<0.05). All community pharmacy
preceptors for Year-6 Pharm.D. students should be supported to be in the accreditation program. This will
strengthen the readiness to co-service with the NSHO and be one quality assurance for pharmacy education
in experiential practices.


This study was an exploratory survey, divided in two phases. The first phase explored the
multidisciplinary team’s expectation on pharmacists’ role and characteristic during palliative care, by
purposively selecting two palliative care teams for interviews and content analysis. The second phase
surveyed pharmacist’s perspective on palliative care to pharmacists who worked in tertiary hospitals, as
against the roles and characteristics obtained from the first phase. Self-administered questionnaires were
distributed to 858 pharmacists using stratified random sampling technique. The data was analyzed with
software by using descriptive statistics. From the interview data, it was found that the main role of pharmacist
to the team was general pharmaceutical care and pain management and the important characteristics
the team needed from the pharmacist were good working attitude and the team work. The data from
questionnaires showed that the ability of pharmacist in palliative care, according to the team’s expectation
was assessed at high level. When considering the individual care, the pharmacists thought they had
very high level of caring ability in physical, and then in the field of social care. For the mental and spiritual
fields they thought they had the ability at moderate level. By the role in team, the pharmacists thought
that they had pharmaceutical care ability at the highest level. Next lower levels were the using of specific
medicine and palliative care and the lowest level was the mental and spiritual care.


At the present age, health of migrants is an issue on a spotlight in
many countries. This is due to a rapid economic growth and a swift
change in communication and transportation technology around the
globe. Thailand also has a huge demand on migrant labour, and the
recent governments always paid much attention on this matter. In 2004,
the government introduced 'Health Insurance Card' for cross policy for
cross-border migrants, who were not covered by the Social Health
Insurance (SHI). The insurance was regulated by the Health Insurance
Group (HIG) under the Ministry of Public Health (MOPH), and was tied with
the nationality verification process (managed by the Ministry of Interior
(MOI)) and the registration for legitimate work permit (managed by the
Ministry of Labour (MOL)). So far, there has been very few studies
exploring the management and performance of the insurance. The
aforementioned reason thus becomes the objectives of this study.
Study objectives
The study ahas 4 main objectives: (1) to systematically review
evidence of the management of health insurance and the attitudes of
healthcare providers in healthcare practice for migrants from international
literature, (2) to explore attitudes of local healthcare providers and
migrant patients on the operation of health insurance policy for migrants
in the real setting, (3) to assess the effect of the insurance on volume of
use and out of pocket payment (OOP) of migrants, relative to the
uninsured migrants and Thai beneficiaries, and (4) to synthesise policy
recommendations for better management of the health insurance policy
for migrants in the future. Methodology
Ranong province was served as study site. The study employed
both qualitative and quantitative methods. Data collection techniques
were composed of: (1) a systematic review, (2) in-depth interviews with 24
local healthcare providers and 11 migrant patients, and (3) the
investigation of routine faciliy-based data. Thematic analysis was used for
qualitative data analysis and econometric models were used for
quantitative data analysis.
Results
The management of health insurance policy for cross-border
migrants in Thailand was quite complex. The policy was also open to all
types of migrants.
However, there has been a number of operational problems and
challenges because: (1) In theory, the process of buying the insurance
card is tightly linked with the acquisition of legitimate residence permit,
managed by the MOI, and the registration of work permit, regulated by
the MOL. In fact, the enforcement of such regulation is ineffective. A large
number of migrants were not registered for the work permit. In addition,
the registration policies (by the three ministries) were inconsistent and
frequently changed over time, (2) The policy does not fir the local
context of Ranong province since the province has a long border
connecting to Myanmar, which renders the cross-border control difficult.
Many migrants enter the country for various purposes rather than seeking
for jobs. Thus, some migrants relied on "brokers" to make them accessible
to the registration process (in order to acquire the work permit and then
be eligible to buy the insurance card), (3) The MOPH does not have
sufficient institutional capacity in regulating, and monitoring the
performance of each facility in implementing the insurance scheme. This problem is intermingled with inadequate communication between the
MOPH and the local authorities, (4) Many healthcare providers viewed
that the insurance is always running deficit. This is because the healthy
migrants are not willing to buy the card, and the pooling size is too small
(the card revenue is collected at each individual facility). Accordingly,
some health facilities adapt the policy by various means, such as allowing
only healthy migrants to buy the card, andimposing a lag time between
the starting valid day and the time of buying the card, (5) One of adaptive
measures of health facility is hiring migrants to work as 'migrant health
workers (MHW)', serving as bridging personnel between migrants in nearby
communities and the local providers. However, the sustainability of this
measure is questionable due to the limitation of law on the work of
migrants, which still disallows official authorities to hire migrants as official
employees. Many healthcare providers hence finds a way out by hiring
migrants as their house maids, but in fact these migrant employees are
still working as MHWs.
The quantitative analysis shows that the utilisation rate of
migrants was about 3-4 folds was low as the Thai beneficiaries, covered
by the Universal Coverage (UC) scheme. The absolute effect of having the
card (after adjusting all covariates) did not significantly increase the
volume of use of the patients, who ever visited a facility. The key factor
of increasing the use is clinical factor that is a patient's disease status per
se. Moreover, the card was proved to reduce the OOP of migrants at
point of care by 157-756 Baht per outpatient visit and 2,706 Baht per
inpatient visit.


Measuring of blood sugar and glycated hemoglobin (HbA1c) levels is a standard protocol for screening and monitoring of diabetes mellitus progression. However, blood sugar level is depending on food uptake before taking the measurement and HbA1c life cycle is somehow too tong to be monitored in severe cases. In addition, in condition effecting red blood cell structure or hemoglobin production (hemolytic anemia, thalassemia and thalassemia carrier (40-50%)), HbA1c level is not unrealizable. Therefore, measurementof glycated albumin, which is intermediated indicator outside red blood cell, could improve the way to control diabetes progression and treatment in all populations. The research program “Albumin glycation for diabetes mellitus monitoring” is focusing on development of aptasensor platform for detection of glycated albumin. Three platforms have been developed, which are graphene oxide-aptamer, electrochemical and nanopore sensors. In summary, we successfully developed graphene oxide aptamer and electrochemical platform to detect albumin, glycated albumin and percentage of glycated albumin in clinical samples. Both sensitivity and specificity of our graphene oxide-aptamer platform are higher than those of the commercial available (ELISA). Therefore, our platform has a potential for technology transfer and commercialization.


Introduction The incidence of dementia in elderly population, aged 60 year or older, has been rapidly increasing. Dementia causes significant negative impacts on quality of lives, both in patients and families, constituting a huge socioeconomic burden and drawback in country’s development. Current diagnostic approach based on clinical symptoms and signs may not sufficient. Thus, early detection of amyloid deposition in the brain may play important role in accurate diagnosis, identifying patients at risk, planning for patient management and also leading to development the drug or procedure aimed for therapy or prevention of dementia.
Objectives To evaluate the use of F-18 amyloid PET scan in assessing brain amyloid deposition in Alzheimer’s disease, mild cognitive impairment and normal aging and the correlation between brain amyloid deposition in PET scan and results from neuropsychological test, MRI brain and F-18 FDG PET scan. We also aimed to evaluate the correlation between amyloid PET scan results and changes in neuropsychological test, MRI brain and F-18 FDG PET scan results.
Methods 1) Synthesis of F-18 flobetapir PET tracer 2) Initial clinical study in 43 eligible subjects including 22 normal elderly controls (HC), 12 MCI patients and 9 AD patients according to clinical diagnosis. All subjects were assessed by 1) clinical signs and symptoms and neuropsychological test, brain MRI, F-18 FDG PET and F-18 flobetapir PET scan of the brain within 6-week period. The images were then analyzed using visual and quantitative analyses.
Results The semi-automated synthesized F-18 flobetapir demonstrated equivalent characteristics to those of reported original compound; radiochemical  yield of approximately 20%, pH of 6, half-life of 115.66 minutes, radiochemical purity  > 95%, sterility and pyrogenicity were equivalent to drug for injection standard. Each synthesis could serve approximately 3 patients. Preliminary results of the clinical study in 17 of 43 eligible volunteers who had completed study protocol and test analysis found that F-18 flobetapir results in most of volunteers (n = 16 (94.12%) corresponded to the clinical diagnosis and neuropsychological test results, while MRI (Schelten’s rating scale) and F-18 FDG PET scan results corresponded with clinical diagnosis and neuropsychological test in 13 (76.47%) and 15 (88.24%) volunteers, respectively. The correlation of results between F-18 flobetapir and other tests showed that F-18 flobetapir tended to correlate with neuropsychological test in 16 (94.12%), MRI in 12 (70.59%) and F-18 FDG in 16 (94.12%) volunteers. So far, there was no detectable adverse effect in any subject.
Conclusion Our preliminary results found a very high correlation between amyloid PET scan using F-18 flobetapir and clinical diagnosis and neuropsychological test results, which was higher than in F-18 FDG PET and anatomical abnormality detected by MRI, respectively. However, correlation between amyloid PET scan results and changes in neuropsychological test, MRI brain and F-18 FDG PET scan results are still needed to be followed.


Cannabis is traditional plant that contains psychoactive substances. In the past, there were reports suggesting the utilisation of cannabis for various purposes, for instance, recreation, medicine, and textile. However, many countries, including Thailand, probihited the use of cannabis, and included it in the narcotic or addictive substabce list. So far, there have been a number of reports suggesting harmful effects of cannabis on health, especially, deleterious effects on brain function and increasing risk of the use of other substances.
	Between 2015 and 2016, there were massive campaigns from both public and private agencies urging an amendment of the 1979 Narcotics Act in the way that withdraws cannabis from the narcotic drug list. This campaign is related to not only medicalisation, but also legalisation of cannabis. This report therefore sought to review the current situation regarding the use of cannabis for medical purposes in various aspects, such as benefits, caveats, as well as international experience in cannabis legalisation and challenges in the Thai healthcare system. It is hoped that results from this study will serve as grounds for future research, and can be useful to later policy decision. The main data collection technique is literature review on electronic databases, especially, Medline.
	The findings show that most research on cannabis was confined in laboratory or animal studies. Though there were some clinical trials on humans, the majority of them still had limited number of participants, and compared clinical effects of cannabis with placebo. Regarding international experiences, the scope of cannabis medicalisation varies substantially; from extracting some substances in cannabis or using cannabis-like derivatives to produce second- or third-line drugs for treating patients with certain diseases, using herbal cannabis (by oral route or smoking) under supervision of physicians, to using cannabis in recreational activities. Some countries implemented decriminalisation measures. The openness of cannabis policies in many countries has some similar features, namely, (1) cannabis related laws were gradually amended over time rather than having a radical change, and (2) there were several measures implemented in parallel with the cannabis legalisation/medicalisation in order to prevent the use of cannabis in the way that deviates from original policy intentions.
	Note that this review found that most information was retrieved from international literature. This observation reflected gaps in knowledge regarding medical use of cannabis in Thailand. Thus it is imperative to support domestic research on cannais in various angles, such as how to improve species of cannabis for better botanical use, how to extract medical substance from cannabis, and how to promote pharmacological studies on the effectiveness and efficacy of cannabis for treating certain diseases. This point should include research questions outside health service system arena, such as social science research and law studies. Some broader research questions should be taken into account, such as public opinions towards cannabis and the readiness and aprropriateness of existing laws in controlling cannabis. If the Thai government aims to implement policies vis-à-vis the utilisation of cannabis, it is imperative to distinguish medicalisation issue from legalisation issue while communicating with the wider publi. Moreover, the government should assess its capacity in regulating the use of cannabis before introducing cannabis-medicalisation/legalisation policies and the potential cost of treating patients with substance abuse.


Thailand has put much effort in registering undocumented/illegal migrants/aliens and protecting health of non-Thai populations for years. One of the most distinct policies in protecting health of the non-Thais is the establishment of public insurance schemes, for instance, 'Health Insurance for People with Citizenship Problems' (HI-PCP) and 'Health Insurance Card Scheme for cross-border migrants' (HICS). However, in practice, there are always people failing to be enrolled in the insurance schemes due to various reasons, such as poor law enforcement and fear of being exposedby state officials amongst undocumented migrants/aliens. These uninsured migrants/aliens often visited state-run health facilities when they experienced severe illnesses. Some cannot afford the treatment cost. Accordingly, the visited facilities inevitably shoulder this unpaid debt instead. This research therefore sought to explore the reimbursement system for subsidising treatment cost for uninsured migrants/aliens with critical illnesses in Thailand. Mixed-methods design was employed. The study comprised three objectives. The first objective aimed to review literature regarding international experience in managing care for undocumented migrants/aliens. The second objective used qualitative approach (in-depth interviews and focus group discussion) to investigate perspectives of healthcare staff in establishing the reimbursement system of recouping cost of treating uninsured migrants/aliens. The third objective employed quantitative method to estimate budget impact for the whole country in case that the Thai government implements such a system.  The review in the first objective found that level of care for undocumented migrants/aliens from international experience could be classified into four levels: level 1—insurance for fully legalised migrants, level 2—insurance for illegal or undocumented migrants who passed the registration process arranged by the state, level 3—reimbursementscheme of specific diseases, and level 4—contingency/special fund. Compared to the Thai context, the Social Security Scheme might be regarded as level 1, the HICS as level 2, disease control programmes by the Department of Disease Control as level 3, and the contingency fund by the National Health Security Office as level 4. However, level-3 and level-4 care programmes were normally managed on ad hoc basis and have not been incorporated into the main insurance schemes. In terms of providers' views, most interviewees opined that the proposed reimbursement system is useful to health facilities. Some interviewees suggested that the system should cover not only the cost of treatment, but also health promotion and disease prevention activities. The proposed system should be set up in parallel with the improvement of the HICS administrative performance. Nonetheless, there were some concerns raised by the interviewees. Firstly, if this policy is clearly announced as though it is rights for undocumented/illegal migrants, this might indirectly encourage existing migrants to avoid the purchase of health insurance card. Secondly, this policy did not tackle the deep rooted problems regarding undocumented/illegal migrants. The bottom line was that migrant policies in Thailand at the status quo could not effectively prevent illegal border crossings. Lastly, the source of funding has not been explored. Should the reimbursement system reply on additional earmarked central budget, one might argue that such a proposal is taking advantage of Thai tax-payers. If this budget is drawn from the HICS, there might be less political constraint. Another option that is worth considering is using non-health budget, such as extracting part of the visa fee for tourists. Concerning quantitative analysis, the estimated budget is approximately 149 to 891 million Baht, depending on the scope of services and nationalities of the users (whether the reimbursement system should cover Cambodian, Laotian, and Burmese migrants only, or cover all ethnic groups). This study experienced some limitations. Firstly, it is difficult to ensure correctness of utilization data as they are routine hospital-based records. Secondly,  many figures used in the analysis might be out of date and based on several assumptions. Thirdly, service users (patients) were not included in the in-depth interviews. Lastly, this research has not explored sources of funding in detail. Key policy recommendation is the Thai government should set aside some budget for recouping cost of the treatment for uninsured migrants/aliens at public health facilities for around 149 to 891 million Baht. The size of budget depends on the openness of policy for migrants. The government might start from migrants from Cambodia, Lao PDR, and Myanmar first, then gradually expand to other non-Thai populations. The reimbursement system should be introduced in tandem with the improvement of the HICS administrative performance.


Objectives: To 1) examine the prevalence of common and high-burden mental illnesses in the community, including depressive disorders, psychotic symptoms and alcohol and substance use disorders; 2) investigate social factors associated with mental disorders; and 3) describe what proportions of mentally ill individuals had limited or no access to services and associated barriers. Methods: Mixed method, including cross-sectional community survey and qualitative designs, was employed. The cross-sectional survey sampled without replacement residents aged 18 or over living in households within the Municipalities of Kukot and Lumsamkaew of Prathumthni Province. Face-to-face interviews were conducted by trained interviewers using the World Mental Health – Composite International Diagnostic Interview version 3.0 (WMH-CIDI 3.0) – Thai version, divided into 2 parts. The first part elicited diagnoses based on DSM-IV criteria. The second consisted of questions on sociodemographic background, history of service use, health coverage and earnings. The qualitative component consisted of in-depth interviews with mental health professionals about barriers to care and proposed solutions. Results: A total of 5,698 households in the selected municipalities were approached. The response rate was 69.1% (N=3,940). There were 3,877 interviews completed for analysis. Psychological distress had a one-year prevalence of 6.5%, psychotic symptoms 0.8%, alcohol use disorders 0.9% and substance use disorders 0.3%. Socio-economic status (measured by the Household Asset Index) was not associated with mental illness. Only 4.1% of those who reported having had mental illness in the past year had sought advice or treatment in the same period. Having mental problems in the past year was significantly associated with reduced or no earnings. A history of mental illness, with no current or recent active symptoms, was not significantly associated with reduced or no earnings.  Conclusions: The prevalence rates of mental illnesses in Prathumthani Province were similar to those reported in the recent mental health survey in Bangkok. The figures were also comparable to those reported in many East Asian countries, but relatively low compared with those found in Western countries. Reducing treatment gap in mental health care is likely to substantially ease economic burden because, if well-treated, mentally ill people can get back to work and earn incomes. Certain measures such as improving mental health literacy and developing alternative care models may help narrow the gap in accessing mental health care.


สถาบันวิจัยระบบสาธารณสุข


Alcohol consumption is an important problem of Thailand which law and social measures for
reducing alcohol consumption have been provided. The purpose of this research was to develop
community participation model to reduce alcohol consumption behavior and study the effects of this
model. It was a research and development study, included 3 phases: the first phase was reviewing
documents and studying community context, the second phase was developing community participation
model and the final phase was studying the effects of the community participation model in reducing
alcohol consumption behavior. The sample size of 30 persons consisted of community leaders and
relevant persons. They were one village headman, one subdistrict headman, seven health volunteers,
one teacher, two health officers, five members of elderly club, one social development volunteer,
four members of Stopdrink network and eight young leaders, divided into two groups by simple random
sampling. Data were collected from in-depth interview and focus group discussion and analyzed
by content analysis.
The results showed that more than 80% of the sample had extensively participated in the process
of model development, that is, they participated in every step of health promotion activity. The
results of the model included social measures by the community, such as surveying drinking people in
community, the community leaders acted as role models to reduce alcohol consumption, asking for
alcohol free zone in the religious ceremony and the festival. The social measures highly empowered
the community and the network. The relevant agencies participated in the health promotion activities.
The people’s alcohol consumption behavior reduced, evaluated from sales in the community.
Temples, schools, and public offices were alcohol free zones. The people knew more about toxicity
of alcohol and they created innovation of reducing alcohol consumption behavior in the community
such as “Love friends, suggest friends” and “New people with strong heart” projects.
It could be concluded that the development of community participation model could reduce
alcohol consumption behavior.


Health benefit under the Universal Coverage Scheme (UCS) in Thailand is a comprehensive
health package, with a few services on the negative list; for example, organ transplantation including
liver transplantation in children with biliary atresia.
Since 2011, liver transplantation in children with biliary atresia has been approved for UCS’s
health benefit package. All key actors involved in the health policy process of this new approval
including beneficiaries, health care providers, professional, and academics. This decision making is
an example of evidence-informed health policy explicitly including health need analysis, cost-utility
analysis, long term budget projection, and readiness of service delivery system.
As providing access to effective health care services when needed and protecting household
from catastrophic illness expenditure are key functions of public health insurance and UCS. This article
illustrated the health policy process of including the rare disease with high cost care (a case of
liver transplantation in children) into the health benefit package under UCS considering the threshold
for affordable and worth investment. Besides, critical success factors for the process of evidence-informed
health policy and enabling factors for moving health policy into implementation were discussed
in this paper.


Background: Prisoners are socially vulnerable population and have high risk for tuberculosis
(TB) and human immunodeficiency virus (HIV). This study was conducted to explore whether the TB
notification rate, patient characteristics, access to HIV care and TB treatment outcome of prisoners
differ from general TB patients in Chiang Rai province. Design/Methods: A retrospective analysis of two existing TB related electronic databases included TB registry (N=2,472, 11% were prisoners)
and drug-resistance surveillance TB database (smear positive=2,193, 6.6% were prisoners). The study
populations were patients aged over 18 years, living in Mueang District, Chiang Rai, and registered in
TB registry during 2007 to 2014. We analyzed data by classifying into prisoner and general TB patient
groups. Percentage proportions of each variable were compared using chi-Square test and p-value
for the difference between two proportions. Results: The TB notification rate of prisoners was 3.2
times higher than general population. Prisoner group was significantly younger (mean age = 36.5 vs
45 yrs), had higher proportion of male, smear positive, and higher rate of HIV co-infection (TB/HIV)
than general TB patients (p<0.05). The treatment outcomes of smear-positive in two groups were not
different. However, treatment outcomes of all types of TB in prisoners were better than general TB
population, i.e. higher success rate with lower rate for loss to follow-up (p=0.030). Prisoners with TB/
HIV significantly had less access to antiretroviral drugs (ARV) (p<0.001) but access to cotrimoxazole
was not different. Both groups had high proportions of regular alcohol drinking. Prisoners significantly
had higher proportions of smoking and drug use than general TB patients but lower proportions of
diabetes mellitus or hypertension. Almost 11% of general TB patients were previously incarcerated.
Conclusions: Although prisoners had higher notification rate for TB and higher HIV co-infection than
general TB patients, treatment outcomes were better. To enhance health equality, access to ARV
among prisoners with TB/HIV should be ensured.


Health personnel (HP) have higher risk of tuberculosis (TB) infection during working than people in
the community. This research aims to determine TB situation among HP working in hospitals under the
Ministry of Public Health, Tak Province, fiscal year 2008 - 2016. During the study period, of an average
of 2,956 HP per year, 46 were registered for TB treatment, giving a rate of 15.6/1,000 HP. About 69.6%
of them were female and the mean age was 33.6 years old. About 71.7% were personnel responsible
mainly for patients’ management. Of all 46 TB cases, 69.5% had pulmonary TB. Overall, physicians
had the highest TB rate (38.5/1,000), followed by pharmacists/pharmacy technicians (35.1/1,000) and
nurses (17.6/1,000). Hospital personnel working in 5 districts (along Thailand-Myanmar border) of the western region of the province had a higher TB rate of all types (17.7/1,000), hospital personnel
working in the western region had a higher TB rate of pulmonary TB (13.0/1,000) than those working
in the eastern region (6.7/1,000). It is crucial to carry out early TB detection and treatment with high
successful rates among people in the communities to reduce TB spread, particularly in the western
region of Tak Province. In addition, good TB infection control should be continuously maintained in
the hospitals.


The ultimate aim of Universal Health Coverage (UHC) is 1) to ensure that all Thai citizens have
access to essential health services when needed without financial barriers, 2) to improve equity in
utilization of health services and 3) to protect households from financial catastrophe and impoverishment
due to medical bills. Thailand has achieved UHC since 2001. However, some are still uninsured
and may face difficulties when they need health services. Objective: This study aims to estimate the
number of Thai population who were at risk of potentially falling into a vicious cycle of “low education,
poverty and illness”, and identify who they are, where they live and whether they suffer from
medical bill? Method: Data from the Health and Welfare Survey 2015 conducted by the National
Statistical Office were utilized. The studied variables included socioeconomic, healthcare utilization
of both inpatient and outpatient services, and the out of pocket payments. Result: There were about
2.4 million Thai populations identified as having lowest economic household status, educated up
to primary school and had no jobs or being economically inactive. Among these vulnerable people,
59,779 had no health insurance. For this subset of population, 86 percent were female, their average
age was 38 years and most of them lived in municipal or urban area, Bangkok or in the central
region. When they were ill, the majority (62 percent) chose self-medication or sought traditional care
or herbal medicines. For hospitalized illness, all (100 percent) admitted to public hospitals, and paid
for medical bills by themselves (i.e., out of pocket) with a higher amount than those insured (Median:
9,999 Baht vs 700 Baht, respectively). Summary: Proactive and passive policies with collaboration
among ministries, especially the Ministry of Public Health, the Ministry of Labour and the National
Health Security Office would mitigate vulnerability of these risk groups and gradually reduce, then
eliminate the vicious cycle.


Since 2002, Thailand has achieved Universal Health Coverage (UHC) under the three main
public health insurance schemes. UHC enabled Thai population to access essential healthcare services
regardless of income. Patient would not be worried about negative financial impacts from medical
bills to their household however the unmet health need can be found. Therefore, there is a study
on unmet health need conducted in order to monitor UHC on another aspect and to demonstrate
whether or not Thailand has patients who cannot access health service when needed, if yes, how
many; who are they and why? The objective of this study is to analyze prevalence of unmet health
need, to describe profile of patients with unmet health need and to identify factors and reasons for
unmet health need. Descriptive statistics and logit model were applied for analysis of Health and
Welfare Survey (HWS) in 2015 with 55,920 sampled households representing Thai populations.
Prevalence of unmet health need for outpatient, inpatient and dental service were 1.50 percent,
0.14 percent and 0.99 percent of all population, respectively. Main factors of being unmet health
need were age, especially elderly; uninsured people; and the poorest household economic group.
In addition, people living in Bangkok had more unmet health need for outpatient services than other
regions. The main reasons of unmet health need were inadequate time of patient for seeking care,
too long queue at health facilities, and too far to travel to health facilities.
Ministry of Public Health, National Health Security Office and other relevant agencies should
collectively work together for a policy and strategy to reduce unmet health need of Thai population,
especially for elderly. Primary health care service delivery system should be strengthened to cover
all urban areas in particular in Bangkok. “Close to client health services” should be developed for
improving access to health services.


This study used health and welfare survey 2015, national household survey, to explore pattern
of dental service utilization including use of health insurance, and expenditure among Thai population
in order to improve national policies related to dental services. The results showed that (1) 8.1
percent of Thai population received dental services in the past 12 months. More than 80% of dental
services were dental treatment. Thus, dental health policies should focus more on dental prevention
and promotion. (2) Main reasons of unmet need were no time to get the services and long waiting
time. So, the dental health service providers should be expanded. (3) Different access to dental services
associated with different health insurance schemes. The dental services should be harmonized
among health insurance schemes in particular payment methods, and benefit package and points of
service. Also, criteria, quality control, scope of services and payment mechanism should be considered.


Advancement of Universal Health Coverage in Thailand since 2002 increased access to both
outpatient (OP) and inpatient (IP) services. This study aimed to analyze the utilizations of government
health insurance schemes and also the factors affecting access to outpatient and inpatient services in
2015. Based on the 2015 Health and Welfare Survey data, descriptive and logit model was performed
to analyze individual utilization of outpatient and inpatient and the factors determining the heath care
utilization.
Results demonstrated that universal health coverage scheme covered the majority of Thai
population. However, the general characteristic, employment and economic status of beneficiaries
differed across different schemes. The illness rate for ambulatory care was 3.1 episodes per capita per
year. Over-the-counter medicines had the biggest share around 27.2 percent, while the hospitalization
was 0.06 admission per capita per year. Most of them were admitted at community hospital and
general hospital (39.6 percent and 38.7 percent respectively), while the hospitalization in private
hospital was only 11.3 percent. In addition, there are some other factors that affected the utilization
of both outpatient and inpatient services such as household characteristic, chronic diseases and the
variation of benefit package of each scheme.
Many people chose to buy drug (around one-third of total treatments). It is important to
establish safety measures through awareness on rational use of drugs and develop a mechanism to
ensure drug quality. Policy maker should strengthen primary care services such as family care team,
home health care and long-term care to reduce the utilization gap in vulnerable groups especially the
poor and elderly and reduce financial burden from medical treatment of patient with chronic disease.
Moreover, government should expand the coverage to uninsured group to increase access to health
care services without financial burden to reduce the gap among health insurance groups.


This study aimed to determine the adequate physical activity level of Thai adults, and disaggregated
by subgroups of participants. The study re-analyzed data of 108,416 Thai adults aged 18 and
above from the 2015 National Health and Welfare Survey conducted by National Statistical Office. Descriptive
and analytical statistics were defined in the analysis. The results showed that 42.4% of Thai
adults aged 18 and above met physical activity level according to the recommendation by the World
Health Organization and 33.8% had high level of physical inactivity. Most males, farmers and laborers,
and those who had no underlying diseases, reached recommended physical activity level and had
low-rate of high level of physical inactivity. On the other hand, most elderly, unemployed, and those
who had underlying diseases, did not reach recommended physical activity level and had high-rate of
high level of physical inactivity. Our findings will benefit to the national policy development to reduce
sedentary behaviors and increase physical activity especially in work and transportation domains, with
the focus on the subpopulations that did not reach the recommended physical activity level and had
high level of physical inactivity.


Health service provision in urban area is a key challenge in Thailand as there is only tertiary care
hospital and a network of health center provides curative and health prevention services. As a result,
primary care services seem to be neglected. Recently, there are interventions to upgrade health health promotion services in Mueang districts of Nakhon Ratchasima and Burirum provinces. Capitation
budget for out-patient care is now transferred to CUP instead of provincial hospital. This study aims
to explore process in setting up those autonomous CUPs as well as key success factors and remaining
challenges in these provinces to be lessons learned for other provinces.
We reviewed documents and interviewed key informants who involved in setting up autonomous
CUPs or were working in those CUPs. Results showed that main purposes of autonomous CUPs were
to reduce crowdedness of provincial hospitals and to improve quality and access of health services
at health centers. One major change after the implementation was the increased numbers of staff
especially those of medical doctors and supporting staff. Key success factors are consistent with
policy direction at provincial and district levels as well as availability of retired medical doctors who
were key human resources. The remaining challenges were to increase active role of District Health
Coordinating Committee, integrate district health system principle and appoint responsible persons to
coordinate health service system within the district.


A cross-sectional survey research aimed to compare the humanitarian behaviors between patients’
and providers’perspectives. The samples were out- and in-patients and staff of Queen Savang Vadhana
Memorial Hospital, The Thai Red Cross Society. The sample sizes were estimated by Krejcie & Morgan
table. Data were collected by the generated questionnaire with Likerts’ scale from 1 to 5 scores. Its
indexes of item objective congruence were 1.7-2.0 from range 0-2 scores, and its reliability was 0.95
by Cronbach’s alpha. One-way analysis of variance and independent t-test were used to compare the
humanitarian behavior scores among the three groups, and between the two groups including patients and provider. A p value less than 0.01 was defined as significant difference.
Five hundred out-patients, 630 in-patients, and 1250 staffs answered the questionnaires. The
average age of in-patients was the highest, followed by of staffs, and of out-patients (mean (SD) =
41.4 (16.1), 36.9 (10.3), 33.9 (9.6) year old (p<0.001), respectively). The humanitarian services behavior
scores among the three groups were significant different, and the scores from lowest to highest were
in-patients, out-patients, and staffs (mean (SD) = 80.8 (14.4), 82.0 (10.4), 85.3 (10.9) from 100 scores
(p<0.001), respectively).
The suggestions for quality improvement of the out-patient service were to emphasize on the
humanitarian services behaviors of the general service staffs; such as, explaining the choices of treatments,
participating in decision making, being presence and encouraging when the patients faced
suffering, providing opportunity for patients’ compliance to their religious activities.


The proportion of elderly in Thailand is 16% of population. At hospital discharge, most of elderly
patients still need helps for their daily living activities. This study aims to explore situation of hospitalization
and having carers during the recovery period at home among elderly people. Study samples
were elderly people (age ≥60 years). Data analyses were based on Health and Welfare Survey 2015
conducted by National Statistical Office (NSO). Sample weight was applied using appropriate statistics
to represent total population. The results showed that total number of hospitalized elders in the year
before was 706,183 persons (7% of all elderly people) higher than other age groups (children 3.5%,
and adult 4.5%). Overall, average length of hospital stay was 5.98 days and average number of days
needed care during recovery period at home was 13.06 days. Of all hospitalized elders, patients under
Universal Coverage (UC) scheme were the largest group, whereby those under Civil Servant Medical
Benefit (CS) scheme accounted for 17.2%. Majority of elderly patients under UC scheme were in very
poor quintile. While majority of elderly patients under CS scheme were in very rich quintile. Average
numbers of days needed care during recovery period among elderly patients in poor and very poor
quintiles were higher than those in other quintiles across all schemes. Approximately 17.7% of elderly
patients did not have caregiver during their recovery period at home and most of them were in very
poor quintile and with small household size (1-2 living persons). Although, 76% of elderly patients
were taken care by someone in their family, most of these patients were in very poor quintiles and
had small household size. The government should realize the importance of continuity of care after
hospitalization in order to provide a better living for elderly patients and their families.


Importance: Superficial surgical site infection (SSI) is common in appendectomy for complicated appendicitis. Delayed primary wound closure (DPC) is preferentially used over primary closure (PC) but its efficacy is still controversial. Objective: To compare superficial SSI rates between DPC and PC for complicated appendicitis. Design, setting, participants: A multicenter, randomized controlled trial of complicated appendicitis, involving 607 adult patients from 6 hospitals in Thailand between November 2012 to February 2016. This included cases of gangrenous appendicitis, as well as rupture. Intervention: Patients were randomized to PC (i.e., immediately wound closure after operation) or DPC (i.e., wound closure at postoperative days 3 to 5). Main outcome and measure: Superficial SSI, as defined by the Center for Disease Control criteria. Secondary outcomes included postoperative pain, length of stay, recovery time, quality of life and cost of treatment. Results: Among 303 and 304 patients in the PC and DPC groups, 5 and 4 patients were lost follow up respectively, leaving 300 and 298 patients for intention-to-treat (ITT) analysis. The superficial SSI rate was lower in the PC than DPC group (i.e., 7.3% (95% CI: 4.4, 10.3) versus 10% (6.6, 13.3)) with a risk difference (RD) of -2.7% (-7.1%, 1.9%). Protocol violations occurred in 15 patients (i.e., 9 in PC and 6 in DPC groups).  RDs for per-protocol and as-treated approaches were respectively -1.9% (-6.5%, 2.6%) and -1.1% (-5.6%, 3.4%). In addition, a counterfactual approach using instrumental-variable analysis yielded a RD of -3.6% (-8.3%, 1.1%).  Postoperative pain, length of stay, recovery times, and quality of life were not significantly different between groups with corresponding RDs of 0.3 (-2.5, 3.0), -0.1 (-0.5, 0.3), -0.2 (-0.8, 0.4), and 0.02 (-0.01, 0.04). However, costs for DPC were 2083 (1410, 2756) Baht higher than PC (~$60 USD or 56 euros). Conclusion and Relevance: Superficial SSI rates were slightly lower for PC than DPC groups, although this did not reach statistical significance. Costs were modestly but statistically significantly lower for the PC group. Trial Registration: clinicaltrial.org Identifier:  NCT01659983