This research aims to study and develop online submission for medical device through the internet and follow the international standard. The tool for collecting data is in-depth interview and questionnaires to reveal the problem in the real situation and user’s requirement to develop online submission of import certificate for medical device. The target groups of this research are private and public sectors through the supply chain. We found that the research we propose can drive the change the operation through the chain efficiently and tend to implement the prototype from this research in the future.
According to the research, the prototype is developed following the ASEAN standard, CSDT: Common Submission Dossier Template, which is going to force to be used in the future. The researchers expect that this research can drive private sector can change and accept the information system to implement in the operation for decrease resources and implement data standard which more stable the storage data.


ST segment elevation myocardial infarction (STEMI) is a major cause of death. Recent evidences
showed that primary percutaneous coronary intervention (PPCI) can reduce mortality rate. However, in a
situation where PPCI is unavailable, a facilitated percutaneous coronary intervention (FPCI) using fibrinolytic drug before patient referral could be an important life-saving solution. Since FPCI may increase the
risk of major bleeding and incur more expenditure, the information on cost-effectiveness of FPCI is useful
for policy makers.
A Markov model was used to compare the lifetime cost and quality-adjusted life years (QALYs)
accrued to patients receiving FPCI before referral and PPCI at referral center from societal and health
system perspectives. All analyses were performed using Microsoft Excel. Input data were retrieved from
literatures and electronic databases.
We found that FPCI program at community hospital is a dominant alternative given its lower cost
and higher effectiveness than PPCI at referral center. This means it is a cost-effective policy option.
Therefore, community hospitals with the capacity to provide FPCI service for STEMI patients should
be supported to offer such service for better access to the patients with higher overall quality of life and
lower costs to the systems. We suggest that policy makers in the Ministry of Public Health and the hospital
administrators should consider these findings and provide support to make FPCI available in community
hospitals with existing capacity. Capacity strengthening particularly in terms of manpower, and budget
should be provided especially in the areas where there is still shortage of supply.


The aim of this research and development study was to develop model of lifestyle intervention for
preventing type 2 diabetes mellitus (DM) among the high-risk population. The Diabetes Prevention Program
(DPP) was designed to modify the lifestyle through seven meetings (in 16 weeks) organized by the
researcher team and the public health nurses of the Sub-district Health Promoting Hospitals. The education
and the empowerment program consisted of healthy diet, physical activity, stress management, DM
risk assessment, and goal setting of health behaviors. The participants were selected from the diabetes high-risk group in the local community, Kudjub district, Udonthani province, Thailand. The intervention
participants were encouraged to match a buddy for coaching each other for 16 weeks of the applied DPP.
Quasi-experimental study was used to evaluate the effectiveness of the model. The outcome measures
were the body mass index (BMI), waist circumference (WC), fasting blood sugar (FBS), health behaviors,
and the satisfaction of the applied DPP. Sixty participants that consisted of 30 intervention participants
and 30 controls were included. After 16 weeks of the intervention, the adjusted mean difference of the FBS
(90.1 mg/dl for the intervention group vs 95.3 mg/dl for the controls) and the BMI (25.7 kg/m2 vs 29.1
kg/m2) were not statistically significant between the two groups. The WC was significantly decreased
among the intervention group compared to the controls (mean difference = 5.9 cm; 95% CI = 2.4-9.4).
Health behaviors (mean difference = 3.6 score; 95% CI = 0.3-6.9 ) and the knowledge (mean difference = 2.0
score; 95% CI = 0.6-3.4) were significantly increased among the intervention group compared to the controls.
Collectively, 96.7% of the intervention group was satisfied with the applied DPP at the high to the
highest levels. The lifestyle program indicated significant improvement of the WC and the health behaviors
and could contribute to prevent the type 2 DM in the local community.


Bacteremia is a serious infection associated with high mortality rate. The diagnosis of bacteremia
depended on blood cultures. Published guidelines do not clearly state when blood cultures should be
obtained. The objectives of this study are to validate two clinical predictor rules: systematic inflammatory
response syndrome (SIRS) criteria and clinical prediction rule of Shapiro et al. for patients who were
suspicious of bacteremia. This study was retrospective cohort study, collected data from patients who
were suspicious of bacteremia in emergency department of Warinchamrab Hospital, Ubon Ratchathani. There were 457 patients met inclusion criteria, 65 patients (14%) whose blood cultures results were positive
for true pathogens. When applied SIRS criteria, the sensitivity and specificity were 83% and 31%
respectively. Positive likelihood ratio and negative likelihood ratio were 1.21 (95% confidence interval
1.06-1.38) and 0.54 (95% CI 0.31-0.93) respectively while applying clinical prediction rule of Shapiro et al.,
the sensitivity and specificity were 91% and 40%, respectively. Positive likelihood ratio and negative likelihood
ratio were 1.52 (95% CI 1.36-1.70) and 0.23 (95% CI 0.10-0.49), respectively. In conclusion clinical
prediction rule of Shapiro et al. is more accurate in predicting patients suspicious of bacteremia. Application
of this tool in clinical practice may reduce costs and improve quality of treatment.


The purpose of this study was to examine changes of body mass index (BMI) among elderly in the
Royal Denture Bestowed Project (RDBP). The study design was a retrospective cohort study. BMI was
carried out of 436 subjects, from 6 months to 2 years after denture services from medical record. Multiple
linear regression was analyzed the relationship between denture use and BMI adjusted for gender, age,
income level and baseline of BMI.
The results showed that the denture use significantly increased BMI with positive coefficient regression
and the BMI baseline decreased with negative coefficient regression of elderly in the RDBP (P < 0.05).
The conclusion of the elderly with loss of tooth was replaced with denture for food chewing effected
increase BMI


This study aimed to determine the total direct cost and the itemized unit cost of dental services of
Thatum Hospital in 2014 fiscal year. The total direct cost was summed of labor cost which paid from
dental personnel’s remuneration and welfare, material expenditure, and depreciation costs of durable
dental equipment. Costs were allocated by dental service time and amount of dental services. The study
revealed that the ratio of labor cost : material cost : capital cost was 71.79 : 20.03 : 8.19. The first and second
highest unit costs were prosthetics and endodontics. Sealant had lowest unit cost (86.76 baht/tooth). Comparing
to the 2006 fee schedule of the Comptroller General Department (CGD), most dental services operated
at Thatum Hospital had a lower unit cost. In prosthetics, unit costs were higher, except temporary
plate 1-5 teeth was lower than the CGD’s fee.


The purposes of this study were: 1) to study organizational effectiveness, transformational leadership,
and good governance of district health office, 2) to study relationships among transformational
leadership, good governance, and DHO’s effectiveness, and 3) to study impacts of transformational
leadership and good governance on DHO’s effectiveness. This study was a descriptive research by using surveys. The units of analysis were chief district health officers, administrative personnel, academic
personnel, and directors of subdistrict health promoting hospitals from all 54 DHOs in Health Region 3
for a total of 270 samples. The research instrument was a 5-point rating scale questionnaire. The content
reliability was 0.982. The analysis for frequency, average, standard deviation, and one-sample t-test was
done on SPSS for Windows, and the analysis for validity was done on LISREL 8.8.
The results were: 1) The levels of organizational effectiveness, transformational leadership, and
good governance were between 3.72 and 4.21 which were higher than 3.5 in 5-point rating scale (p < 0.01).
2) Organizational effectiveness, transformational leadership, and good governance had high pairwise
correlation coefficients between 0.745 and 0.819 (p < 0.01). 3) Transformational leadership and good
governance together influenced the effectiveness by 70.90 percent of variance (p < 0.01).
Suggestions from this research: To improve DHO’s effectiveness, one should emphasize on the
leadership development for CDHOs so that they have transformational leadership and good governance.
Moreover, Ministry of Public Health should develop a policy guidance for assessing transformational
leadership and good governance in a selection process for the position.


This descriptive study aimed to know the situation and pattern of dental health care utilization in
Thai working-age population related to health insurance coverage. Data of population aged 15-59 years
were selected from the Health and Welfare Surveys 2009-2013. Descriptive statistics were used in terms of
percentage and rate. Results showed that in 2013 dental health care utilization rate was very low despite
all of population had health insurance coverage. Population in Universal Coverage Scheme always had
lowest utilization rate. Female, urbanites and graduated adults were high utilization rate groups while
people in the central and north-eastern regions were low utilization rate groups. Self-employed, family
business and private employees always had low utilization rates too. Most utilization was for basic dental
care in the one to one ratio of public and private health care services. Private dental clinics were the most popular. The utilization with insurance cover ranged between 57.1%-70.0% of each health insurance scheme.
Main reasons of service utilization without using their insurance cover were “long waiting”, “limited
service time” and “limited insurance benefit”. Unmet rates were 1.0% in 2011 and 1.1% in 2013. Main
unmet reasons were “time constraint”, “unable to pay for service”, “long waiting” and “others such as
fear”. The results from this study suggest that the dental health care service be developed to match needs
of the working-age populations. The regulation system for private dental clinic should be standardized.
Competency of dental staff on each service level should be reviewed and updated. Other dental health
aspects should be researched as well.


The purpose of this descriptive study was to analyze unit cost of dental services by service group
which were promotive, preventive and curative services of Rajanukul Institute. This study was retrospective,
collecting data from dental service quantity, material disbursement, dental personnel’s remuneration
and welfare, lists of durable dental equipment and building-construction in fiscal year 2014. The data was
analyzed by using descriptive statistics. The unit cost of dental services was 554.22 baht per visit which
the labour, material and capital costs of 79.41%, 14.94% and 5.65%, respectively. The costs of promotive,
preventive and curative services were 189.61, 613.34, 657.58 baht per visit. The proportion of cost of promotive,
preventive and curative services was 1.00 : 3.23 : 3.46. Oral health promotion was the lowest cost
service group and necessary for children, especially children with developmental and intellectual disabilities.
Educating parents how to care children’s oral health effectively would reduce oral diseases and
high cost curative service.


Objectives: To examine the prevalence and geographic distribution of unsafe products using risk
and possibility assessments of problem-solving using prioritizing unsafe products at provincial level in 2014. Methods: A cross-sectional descriptive study was undertaken to rank the top 5 unsafe products
using risk and possibility assessments of problem-solving principles under Unsafe Product Issue
Prioritization Project in 4 Regions (60 provinces), during January to August 2014. The data were collected
by a health consumer protection pharmacist in each provincial public health office. Descriptive statistics
for the analysis, prevalence and geographic distribution of the unsafe products were employed. Results:
Thirty-one unsafe products were found. As for the prevalence of the top 5 unsafe products assessed at
national level, they were agricultural chemical residues in fruits, vegetables and salted fish, hazardous
chemicals in cosmetics, repeatedly-fried oil, steroids adulterated in health products and drug sole in the
community, and formalin contaminated food. Based on geographical conditions and public health services,
it was found that the prevalence of the most unsafe products in 4 regions was similar to that of the
national level. However, there were some slight differences in certain regions. Besides, it revealed that the
top 5 unsafe products at national level were distributed geographically in each province. Conclusions:
There were some similarities and differences among the conditions of unsafe products in different areas.
The differences could be due to the different factors in the areas such as consumer behavior, geographical
conditions affecting the distributions of goods, etc. These factors affected the selection of unsafe products,
as well as the risk and possibility assessments. Therefore, any relevant organizations should set appropriate
policies, measures or plans to solve such problems in all aspects.


This study is a descriptive study to develop the information systems research
health care systems in the nation's hospitals, Thai standards by storing data in research agencies / organizations and educational institutions since the year 2002-2012. Total 4371 researches. The data was collected during March to August 2013. The enterprise has a number of 194 story was 12.82 percent and from educational institutions of 4177 story was 3.34 percent. Researches have passed the criteria the most on 2007 was 12.06 percent. Mahidol University research through the qualifying criteria was 10.71 percent. Trends in health care systems research in the hospital. Recognize the anniversary of the studies found that the dimensions of health care are the most in a year since 2007 was 12.06 percent dimensions of health are the most in a year since 2006 was 11.28 percent dimensions the location with the most in a year since 2007 was 14.62 percent dimensions according to the level of management systems with the most in a year since 2004 was 11.69 percent dimensions dimensions based on the value chain of the health system are the most in a year since 2004 was 12.83 percent and the dimensions of health care are the most in a year since 2007 was 15.56 percent. Research overviews of each dimension by organization and institutions. The research was found to be compatible with the dimensions. There is a lot of research, as each organization and Council of education that have been carefully selected according to the criteria. In this study, the researchers conducted health care systems in the country's overall Thai hospital. On the basis of all education data is recorded in a computer program that can be added to the trace. So that is gathered. There are to be useful.
There should be a study of health service systems research collection in the community of the country, Thai within 10 years, and the study of storage systems research on public health service system. Basis both in the hospital and the community as a database for educational and research use to advantage.


Background: Patient referral to tertiary hospitals is currently problematic and faces many obstacles. At large state hospitals and teaching hospitals, consistently high inpatient occupancy rates limit the ability of the hospitals to admit new patients, including referral patients. Since the issues with high inpatient occupancy rates partially stem from patients not being ready to leave hospital care at the time of discharge and prolonging hospital stay, it is important to understand the reasons why this happens.
Methodology: The study focused on cases of difficult discharges at a large tertiary hospital by analyzing the situation around the discharges and other relevant factors on the part of the hospital, the patients, their families and societal attitudes. It is divided into four parts, each with different methodologies designed to give a comprehensive view of the issues from various stakeholders: 1) compilation of consensus opinions of medical experts, 2) a survey of difficult discharges, 3) in-depth interviews, and 4) a knowledge exchange workshop.
Results:
Part 1: The first part of the study looked at the opinions of medical personnel towards difficult discharge cases. A multidisciplinary panel viewed the issue from two perspectives, patients with prolonged length of hospital stays and those with difficult discharges. The main difference between the two was that difficult discharge cases resulted in feelings of anxiety for the patients and other involved. The panel classified the main factors affecting difficult discharges into six categories: medical, patient, family, social, organization and health care system.
Part 2: The second part of the study looks at the magnitude of the problem at one teaching hospital in the Bangkok metropolitan area. A survey found that difficult discharges occur in about 10% of all cases, with the majority of patients being over 65 years of age and required some form of assisted living. Most were general medicine patients with cancer or circulatory system disorders and are part of a healthcare program where hospitalization costs can be reimbursed. About 50% of the difficult discharge cases still had active medical conditions, while 70% no longer needed to be treated at a tertiary hospital. The factors contributed to anxiety for medical staff in dealing with these cases include the patient’s inability to care for themselves independently, and the fact that their families are not ready to care for the patient at home. For patients and their families, their concerns stem of a lack of confidence in their ability to care for the patient at home.
Part 3: The third part of the study focuses on the perspective of the patients, their families and society at large towards hospital stays and discharges. It was found that Thai society in general places high expectations on hospitals, with many holding the view that hospitals are able to treat and cure all ailments and is their primary healthcare provider. Subsequently, when faced with situations where medical conditions are not curable, patients and their families are not able to cope with the bad news. At the time of discharge, patients tend to disagree with the recommendations of the medical staff because of their dependency on hospital care. In addition, the Thai public lacks knowledge about palliative care and there is a general shortage facilities for alternative care such as nursing homes, hospices and chronic care facilities.
Part 4: The last part of the study was a knowledge exchange workshop on the issue of difficult discharges and potential solutions for tertiary hospitals in the Bangkok metropolitan area. The workshop was conducted with representatives from the hospitals and from the staff of 12 health districts under the Ministry of Public Health. Some of the major findings from the workshop was that: 1) the participation of family members in the patient’s treatment plan helped to make the discharge process easier, 2) hospital systems working in close cooperation in each health district resulted in a more efficient discharge and referral process and 3) for Bangkok, a major problem was the lack of secondary care institutions that were acceptable for patients and their families and the family not being ready to care for the patients at home.
Conclusion: The issue with difficult discharges from tertiary hospitals is widespread throughout large hospitals in Thailand. Many complex and overlapping factors contribute to the issue, including medical, patient, family, social and larger health care system factors. The solution to the problem needs coordinated steps that tackle all facets of the problem and requires further study to develop discharge protocols that can be practically applied by each hospital.


Ambulatory Care Sensitive Conditions (ACSC) are disease groups or medical conditions
that, if patients are effectively taken care of in the ambulatory setting, hospital admissions can
be avoided or preventable. This study aimed to assess performances of primary-care provision
in the Bangkok area using 13 ACSCs set by Agency for Health Research and Quality (AHRQ),
USA. The analyses were conducted by using inpatient-service reimbursement databases from
2007 to 2014 of the Universal Coverage Scheme (UC), the Civil Servants Medical Benefit
Scheme (CSMBS) and the Social Security Scheme (SSS).
The study findings indicated that it was very likely to use ACSC statistics to assess
primary-care performances in the Bangkok area. Based on the year 2011 data which was the
most complete for all population groups, the Top 3 ACSCs were urinary tract infection,
congestive heart failure and adult asthma, respectively. The other close-call groups included
hypertension and angina without procedure. Surprisingly, the hospital admissions caused by
short-term and long-term complications of diabetes mellitus were not as high as expected.
ACSCs’ Inpatient services in the Bangkok area, particularly for the UC population, were
mainly for patients from Bangkok itself rather than those from vicinity provinces or other
provinces. It was worth noted that the amount and proportion of the hospital admissions in most
of the ACSCs were highest among patients registered with private providers (e.g. private
hospitals), followed by those registered under Bangkok Metropolitan’s provider network. It was
also found that the CSMBS patients tended to be in older than UC and SSS patients in almost all
ACSCs. They were also more likely to get admitted with Hypertension and COPD, compared to
the latter two groups.
Nevertheless, ACSC might not be applicable without restriction. There were problems
with the databases as they were from different responsible agencies with differing working
processes and data-processing capabilities. Quality of the databases varied somewhat.
Moreover, data analyses were affected by the fact that the three health schemes were designed
differently in terms of beneficiary registration.
In sum, primary-care services in the Bangkok area needed improvement. The most
significant ACSC target would be around heart and vascular diseases, along with the development of ACSC measures and quality of the databases such that they could be applied
in monitoring access to and quality of primary care.


Bangkok is a metropolis, administratively governed by a special form of local administration organization which has been established to take care of the entire area of the city under the supervision of the Minister of Interior, according to Bangkok Metropolitan Administration Act B.E. 2528 (1985). The existing Bangkok’s structural contexts and distribution of health resources as well as health service systems differ from other provinces of Thailand, especially in that private health facilities are outnumbering the government ones in all levels of care, whether primary, secondary or tertiary. There are many high potential private hospitals distributed around the various khets (districts) of Bangkok, but only a few choose to offer their services for any of the three government health coverage schemes, i.e. Universal Coverage (UC), Social Security (SS) and Civil Servants Medical Benefits (CS). In contrast, the total number of high potential government hospitals affiliated with either the Bangkok Metropolitan Administration (BMA) or the Ministry of Public Health (MoPH) is small with no linkage to the overall area-based integrated health service system networks and referral systems. This may result in the general public being unable to access emergency services easily and conveniently, unlike in the other regions/areas.
Acute Coronary Syndrome (ACS) is an important cause of sudden death or disability, if the patient fails to get proper reopening of the clogged vessels in time. Recently it was found that people living in Bangkok (or the 13th Health Zone of MoPH) have higher prevalence of risk factors to coronary heart diseases (i.e. overweight and obesity, Diabetes Mellitus, hypertension, and dyslipidemia), when compared to people living in other zones of the country1.
The MoPH, through Department of Medical Services, was assigned to jointly develop a service plan on heart diseases with hospitals affiliated with the BMA and other government units as well as private hospitals. This is to build a network of health service systems and heart disease patient referral systems within Bangkok area, which is effective with standard quality. However, there is still a lack in basic information on general situation and issues of medical service delivery specific for heart disease patients in the government and private hospitals within Bangkok. So the Health Insurance System Research Office (HISRO) has conducted a situational analysis on medical service delivery of government and private hospitals in Bangkok for heart diseases. This is to provide initial information for the working group concerned in the development of a service plan for heart diseases in this area. This study was aimed at analyzing the situation and issues involved in medical service delivery related to heart diseases in the government and private hospitals by focusing on acute ST elevation myocardial infarction (STEMI) in many aspects, i.e. health resources distribution, service quality and potential, pattern and structure of the organization, service system management process within and outside the hospital, and linkage or collaboration among private and government hospitals. This was to identify priority issues that should be improved and developed. The research used mixed method i.e. paper reviews, quantitative data analysis, additional survey for additional data, in-depth interviews and brainstorming sessions with experts on heart and vessel diseases.
It was found that
(1) A total of 56 government and private hospitals in Bangkok responded to the survey. Twenty nine (51.8%) have STEMI Fast Track service in place, while only 15 (26.8%) have Coronary Care Unit (CCU). However, most private hospitals which are well-equipped and having high potential in providing primary percutaneous coronary intervention (Primary PCI), i.e. having proper organizational structure and medical team, are not within the service network for government health coverage schemes.
(2) The prevalence of STEMI per 100,000 population among participants of the three government health coverage schemes, i.e. UC, SS and CS, within Bangkok showed an increasing trend when compared to other zones nationwide (i.e. among Health Zone 1-13), especially among elderly aged over 60 years. Moreover, collectively only 40% of the patients in the three government health coverage schemes have received reperfusion service, which is less than the average level of the country. Patients of UC and SS schemes could access health service networks and referral systems which are linked with private hospitals, but patients of the CS scheme still have no such systems.
(3) Discrepancy in methods and rates of payment among the existing government health coverage schemes is an important obstacle affecting the development of health service networks for heart disease patients in Bangkok where the contexts of health service system differ from other areas, especially among emergency heart patients who are in need of medical services that are convenient, timely and of standard quality to save lives and prevent disabilities.Suggestions on the service plan for heart diseases in Bangkok are as follows:
(1) There is a need to establish health service networks and referral systems for patients of heart diseases based on collaboration among government and private hospitals in each sub-zonal area. This is to ensure that every patient under every scheme can access the needed primary PCI under emergency conditions within the suggested timeframe according to technical guidelines, with support of effective information systems.
(2) Amendments on criteria, conditions, methods and rates of payment should be made to be identical or to achieve harmonization among the three government health coverage schemes. Patients of CS scheme should also be able to access the needed medical services at capable private hospitals in case of emergency.
(3) Data collection and information systems on medical and health services for heart diseases, which are integrative in nature, need to be developed. Those systems should cover government and private health facilities for continuous situation analysis, planning, and monitoring and evaluation.


The objectives of the study of Social Care System for Elderly are to study and
synthesize meaning, area and format including mechanism of social care for dependent
elderly in abroad to present guidelines for integrating health care and social care system for
dependent elderly in Thailand. This study is documentary research which data are collected
from textbooks, research reports, academic journals, theses and related electronic data about
social care in Thailand and other countries such as United Kingdom, United States, Canada,
Australia and Japan. Due to those countries have good role models for elderly welfare that
could be applied and presented integrating of health and social care for Thailand. The findings
are as follows;
Social care is the system designed to help, protect and educate elderly who face
physical and psychological problems. It would help elderly to self-support in daily life or help
them to better develop their potentials. The formats of social care service are family, social
and also institutional levels. In addition, social care mechanism setting must start from
government agencies as the center to set policies, resources, administrative formats, service
formats, budgets including responsibility transition to local authorities and create formal and
informal social care networks for always and thoroughly driving care to elderly and families to
create good quality of life to elderly. The important mechanism to push dependent elderly to
effective service is to consider elderly qualifications and set channels to access social care
services as the following steps: 1) Examining elderly rights 2) Evaluating elderly for considering
care activities 3) Paying care expenses 4) Getting services according care activities.
The recommendations for developing social care system for elderly divide into 5
aspects: 1) Creating basic concept, importance and readiness of social care 2) Seeking ways for
developing suitable social care service for elderly 3) Planning to produce and develop human
resources who expertise in caring elderly with quality 4) Setting administrative approach for
driving elderly implementation 5) Setting and integrating funds for health and social care.


This paper aims to review and describe method to determine outlier trim point for outlier cases in
diagnosis related group. This review demonstrates concept and experiences in each country. The outliers
cases divided into 2 categories: length of stay (LOS) outlier and cost outlier. Outlier trim point methods for
LOS were 4 methods: inter-quartile range (IQR) method, 10th - 95th percentile method, L3H3 method and
geometric mean method. The literature review will be information for decision in formula of outlier trim
point in Thailand. Since the trimming of outlier cases will effect for relative weights that used for payment
to hospitals.


Background: Increasing trend of traditional and alternative medicine use has been documented
worldwide. In many developing countries, the majority of the population continues to use traditional
medicine to meet its primary health care needs. In Thailand, the Thai traditional medicine service using is
a fundamental right for all Thais according to the constitution as well as Universal Health Care Coverage
program. However, none of the study has been conducted to survey for Thai traditional and alternative
medicine (TT & AM) services together. This study therefore aimed to survey the data of TT & AM services
as well as to study the factors influencing utilization of TT & AM services in the outpatient department of
the hospitals under Ministry of Public Health. Method: The data of TT & AM services were collected
from October 2013 to March 2014. 456 data collecting forms were distributed through representatives of
Thai Traditional services in 76 Provincial Health Offices under Ministry of Public Health. The factors
influencing the utilization of TT & AM services at the outpatient department were analyzed with multiple
linear regressions. Results: 266 out of 456 data collecting forms were filled and sent back. The response
rate was 58.33%. Only 231 hospital responses (86.84%) could be analyzed. 186 hospitals (80.52%) provided
only Thai traditional medicine services while 45 hospitals (19.48%) provided Thai traditional medicine
services together with alternative medicine service. 10.93% of the total outpatient department (OPD) visits
was the utilization of TT & AM services. Factors influencing outpatient department utilization of TT &
AM services were the number of staffs (p-value < 0.001), clinical competency for inpatient services
(p-value = 0.002), the number of staff receiving wage at least 15,000 Baht per month (p-value = 0.017),
being a study/visiting site for education (p-value = 0.011), continuing year of services (p-value = 0.004)
and herbal consumption value (p-value < 0.001). Recommendations: To strengthen the support of TT &
AM service, the relevant agency should develop more suitable workforce in service units and pay them
appropriate salary. In addition, the practitioners need to be developed in their clinical competency and
academic networking with universities is also crucial for implementation.


The use of legal process to protect and prevent the Thai youth from easily accessing to tobacco is one
of the important missions at the national level. In the past, some facts indicate failure. This article aims to
review the weakness and to present proposals for reform the laws for restriction of access to tobacco
among youth in Thailand. Using the literature review of research and article related to both domestic and
foreign that published or produced since 1990 to 2015 in databases, Cochrane Tobacco Addiction Group,
PubMed, Thailist and google.This study found that Thailand needed to reform limiting youth access to tobacco laws on two
issues. First) the content of the law is not up to date with the new marketing strategy of the tobacco
companies and sale behavior of tobacco retailer, and second) the law enforcement is ineffective. Two
reforms related to tobacco laws are proposed. First, amendments of 2 Acts: 1.1) The Tobacco Production
Control Act B.E. 2535: (1) changing the definition of the term “advertisement” and issuing additional laws
on prohibiting all types of indirect advertisement of tobacco, (2) prohibiting sales of individual cigarette
or in small packages, (3) demanding plain packaging practice of tobacco product, and (4) identifying
provincial authority to control tobacco at provincial level. 1.2) The Tobacco Act B.E. 2509: to limit the
number and location of the tobacco retailers in the community and near schools. Second, strengthen law
enforcement: 2.1) developing the database of tobacco retailers, 2.2) developing the measures that enforce
law more effectively, and 2.3) developing the community participation in solving the problem of easy
access to tobacco among the youth.


This study aimed to quantify the cost of institutional long-term care at Thammapakorn Social Welfare
Development Center for Older Persons in Chiang Mai Province in 2014. The population of the study
was all 104 older persons who lived at the center. The sample comprised 24 older persons with at least moderate dependence level as measured by activity of daily living or ADL scale (N = 24). Activity-based
costing was used. Cost allocation was based on long-term care needs of each older person in the sample,
documented through activity logs and records of resource utilization pertaining to each activity within 72
consecutive hours. Two sets of costs were estimated, depending on assumptions related to depreciation
expenses of the following cost items: buildings, vehicles and equipment. It was found that, based on the
first set of assumptions, the average costs of institutional long-term care for older persons with total ADL
dependence (N = 19), with severe ADL dependence (N = 4) and with moderate ADL dependence (N = 1)
were 461.39, 456.91 and 445.20 baht per person per day respectively. Based on the second set of assumptions,
the average costs of institutional long-term care for older persons with total ADL dependence, with
severe ADL dependence and with moderate ADL dependence were 449.89, 445.42 and 433.71 baht per
person per day respectively. Approximately 17% of the estimated costs came from cash and non-cash
donations. The results reflected the fact that the budget received from the government, without monetary
and non-monetary support from other sources, would be insufficient for the level of long-term care being
provided at the center.


Alcohol-drinking is one of the most important public health problems related to an increase risk of
suicidal behaviors. The objectives of this cross-sectional analytical study were to determine the prevalence
and factors associated with suicidal ideation and suicide attempt in mental and behavioral disorder
due to use of alcohol. Subjects were 303 patients diagnosed with ICD-10 code F10.xx and admitted in
Suanprung Psychiatric Hospital during 1 October 2012 to 30 September 2013. Data of various factors were
collected from medical records. Results of the study revealed that prevalence of suicidal ideation and
suicide attempt were 22.4% and 5.0%, respectively. Factors significantly associated with suicidal ideation were having psychological comorbidities (adjusted OR = 2.58 95% CI; 1.14-5.85, p-value = 0.023), previous
suicidal ideation and previous suicide attempt (adjusted OR = 3.00 95% CI; 1.40-6.40, p-value = 0.004 and
4.27 95% CI; 2.31-8.94, p-value < 0.001, respectively), numbers of problems or life-events, more than 3 and
2 life events (adjusted OR = 4.36 95% CI; 1.53-12.41, p-value = 0.006 and 3.22 95% CI; 1.08-9.57, p-value =
0.036, respectively), and patients who drank 40 degree-rice clear liquor (adjusted OR = 3.10 95% CI; 1.33-
7.20, p-value = 0.009). Regarding factors related to suicide attempt, it is found that previous suicide attempts
and psychological comorbidities were statistically significant associated with suicide attempts
(adjusted OR = 4.36 95% CI; 1.53-12.41, p-value = 0.006 and 3.22 95% CI; 1.08-9.57, p-value = 0.036, respectively).
In conclusion, close monitoring should be emphasized in patients who had problem associate
with alcohol drinking and had previous suicidal ideation or previous suicide attempt(s), particularly in
those with psychological comorbidity and had more than 2 life-events.


Birth asphyxia and low birth weight were important causes of mental retardation, delayed development,
learning disabilities and cerebral palsy. This retrospective research was aimed to study the outcome
of Thai Child Development Integration Project in Sungmen Hospital. The subjects studied were 51
patients who attended the Well Child Clinic from October 1, 2013 to September 30, 2015. Developmental
Assessment for Intervention Manual [DAIM] was used to evaluate child development. The majority of
patients were low birth weight (86.3%) and were female (64.7%). Most of the low birth weight (72.7%)
were intrauterine growth restriction. The influencing factors of birth asphyxia were from delivery and
abnormal delivery (57.1%). Most mothers had secondary education (37.2%). Primary caregivers were
parents/grandparents (51%). Infants fewer than six months of age were predominant breastfeeding (62.1%).
The majority of patients had normal child development (78.3% - 97.8%). The growth, weight for age,
height for age and weight for height were normal in range. Neurodevelopmental assessment at 1, 4 and 12
months of age were normal. Anemic patients (hematocrit less than 33%) at 6 months of age were 22.6%.
Iron supplement statistically improved anemic condition (P = 0.012). The Thai Child Development Integration
Project could be established in a community hospital by training DAIM skill and be most effective
for birth asphyxia and low birth weight.


This study was an analysis of the situations and trends in the Thai Traditional Medicine (TTM)
services in Thailand, especially the illnesses and treatments with TTM, based on the data derived from the
2009, 2011, 2013 Health and Welfare surveys, conducted by the National Statistical Office, which interviewed
a sample of 28,000 households across the country each year. The trends in such services were
compared with those derived from other data sources during the same period.
The results showed that most Thai patients attended state health-care facilities, whereas a small
proportion of them sought medical care from Thai folk/traditional healers or masseurs at less than 2% of
all patients. Among all patients, the 25-59 age group sought TTM services, about the same proportions
ranging from 50.0% to 60.3% in 2009, 2011, 2013. Regarding their illnesses, the second most common
illness was chronic back and muscle pain, but their use rates were highest at 27.3%, 33.4%, and 31.1%,
respectively.
In conclusion, only a small proportion of the Thai population use TTM including herbal remedies,
but with a rising trend. Thai massage therapy is most popular in working-age people. Thus, such service
should be further developed and promoted through the integration with the use of herbal remedies and
other TTM services.


The Pharmacy Council of Thailand has set a system of accrediting pharmacies
on standard professional practices. Pharmacists in accredited pharmacies are capable of providing professional services to people under the universal health coverage scheme (UCS). Community pharmacies
in Thailand are, at present, not included in the UCS. Consumers’ opinions on integrating pharmacy
services to the UCS are useful for the model design in the future and are the objectives of this study.
Methodology: This study was composed of 2 parts. In part 1, two percents of clients from accredited
pharmacies in Khon Kaen province were conveniently sampled to answer 4 levels of agreement questionnaires
regarding a proposal if accredited pharmacies were incorporated in the UCS. Opinions to overall
and each proposed activity were analysed into percentages, Chi square test and multiple logistic regression.
In part 2, in-depth interview was conducted in another 36 clients regarding scope of pharmacy services,
advantages-disadvantages, and service charge, if accredited pharmacies were incorporated in the
UCS. Data were analysed by content analysis. Results: From 298 analysable questionnaires, more than
80% of the respondents replied that they agreed and would come for the services in 7 out of 11 proposed
activities. Agreement and intention to come for the services of the rest activities were: 78% for pharmacist
monitoring drug treatment in chronic patients, 69% for patient registering with accredited pharmacies,
62% for pharmacist recording patients’ profiles, and 44% for pharmacist doing home visit. In-depth interview
revealed that the consumers expected to receive quick and convenient pharmacy services which
were real problems of the existing system. They also mentioned about the extended roles of community
pharmacies. Discussion: Clients’ opinions were in accordance with the opinions from the high rank administrators
and from the experts in previous studies about incorporating accredited pharmacies into the
UCS. However, the proposed pharmacy activities needed to be justified to the consumers’ requirements
and in accordance with the existing system.


Thailand has experience of health care reform for a decade. Therefore health care services require more new health workers with more capabilities and competencies according to the changes in the system. Praboromarajchanok Institute for Health Workforce Development (PIHWD) is a government organization and responsible for production and development of health workforce to serve the needs of the Ministry of Public Health (MoPH). This qualitative research was designed to study health workforce needs, the desirable competencies of the graduates and distribution of health workforce who graduated from Sirindhorn College of Public Health under PIHWD, MoPH including Bachelor degree in Community Public Health, Community Dental Public Health and a high class certificate of Pharmacy Technician. Data were collected by in-depth interviews and focus groups discussion between June and October 2558. The purposive sampling was applied and 8 provincials were determined by using geographic information system (GIS) distribution of health workforce. The samples consisted of executive’s administrator from Ministry of Public Health, PIHWD and Provincial, District and Sub-district of Public Health Offices. They were also chiefs of Local Authority, supervisors and co-workers of the graduates and local people. Content analysis was applied using transcriptions from audio recordings and memory information. Data summary were then classified and interpreted for research conclusion. The study showed that most executives have commented that three professionals’ health workers are still shortage consideration by using GIS and the hourly rate equivalent employees (FTE). The distribution of health workforce of these programs is disproportion mainly in the central region where is densely than in the Northeast. In addition, the retention rate in position was decreased because of the lack of motivation at work. Producing health workforce of the 3 programs should come from Sirindhorn College of Public Health under PIHWD because of the expertise of the staffs and they provide specific training programs that serve community needs, especially bachelor of community dental public health and a high class certificate of pharmacy technician. These are the only programs that have been produced in Thailand. The desirable performances of the health workers are not only
their specific health professionals. They should have a new set of the 2 1 st century
skills including learning, literacy and life skill such as abilities of leadership,
Knowledge Management, conducting research, plan strategic, information technology
and necessary languages. The results indicated that the production of health
workforce is still the needs in order to serve the changes of health care system.
Stake holders who are involved should consider various factors that come into effect
on the production of health workforce. Thus, a mechanism for driving the
development of research on the health professionals from three programs should
continue and systematic develop in order to force the policy into practice, literally.


Development of an integrated data visualization system for health examination survey data on
the internet is an extension of data presentation and utilization of the 4th national health examination
survey during 2008-2009 by increasing the variety of variables used in the system for responding to
wider demand of users and providing more accessibility of data via the internet.
Steps of development started with the study of variables collected in the survey for adults aged
>= 15 years and children aged 1-14 years followed by selecting and grouping of variables for
preparing dataset used in the next steps. Design of data presentation and visualization composed of 3
models. The first model is the presentation of outcome measures including proportion, multinomial
proportion and mean divided by 1-2 categorical variables which can be either characteristic or
outcome data. The second model is the presentation of correlation pattern at individual level between
a pair of continuous variables which can be either characteristic or outcome data and can be filtered
by one categorical variable and disaggregated by another categorical variable. The third model is the
presentation of distribution pattern of samples divided by 1-2 categorical variables which can be either
characteristic or outcome data. The number of outcome measures for the first model is 103 in 21
groups for adult and 30 in 10 groups for children. The number of categorical variables for all models is
106 in 27 groups for adult and 63 in 19 groups for children. The number of continuous variables for the
second model is 35 in 12 groups for adult and 23 in 8 groups for children. The next step was data
processing for each data presentation model. This process provided summary data or corresponding
data for each model. Finally, the data visualization on the internet was designed and developed using
appropriated data visualization tools. Users can select the variables to generate the graphical
presentation as demanded and can export graph to image file and excel table for further usage.
The result of development of data presentation and visualization for the 4th national health
examination survey data showed the possibility to extend to the 5th national health examination data
with one more model for comparing the 4th survey data with the 5thsurvey data to show the changing
trend overtime. Moreover, from the variety of outcome measures and variables selected in the system,
this system can provide various objectives of data utilization including targeting population and area
target, monitoring disparity of health and health care among population, exploring relationship among
risks and between risks and outcomes, and building new research question and hypothesis.


There are a lot of stories in this world
the stories of “distress” and “happiness”:
smile, tear, laugh, tackle, misunderstanding,
uncomfortable, angry, fun, hate, fearful,
disappointed, tying, uncompromising, pround.
There have “fulfilled” a “tastes” life.
if we use our heart to feel the meaning of difference,
create the understanding, delete the judgement,
“autism” is the another perspective of difference,
waiting for the space of understanding and sharing
between us--fellow human beings.
using heart to learn the meaning of differences
and understand each other:
new friends, new thoughts, new lifestyles
from the difference angles.
Let them get inside our space
which is not only or individedly “me” or “them”
but literally our “space” that all of us can live together with equalily.


Hypertension (HT) is among the most prevalent chronic diseases in Thailand which leads to a considerable amount of healthcare expenditure. Owing to its high costs, concerns about efficiency of HT treatments have been raised, especially in the context of the Thai healthcare system where 3 main health insurances are publicly available: Civil Servants’ Medical Benefit Scheme (CSMBS); Social Security Scheme (SSS); and Universal Coverage (UC). Previous research has revealed the costs and health outcomes of HT treatment; however, little is known about the comparative cost efficiency of treatment across health insurances. The purposes of this study are two-fold: 1) to perform the cost-outcome analysis of HT treatment in uncomplicated HT patients across health insurances; and 2) to explore factors associated with the rising costs of HT treatment.  Data of uncomplicated HT patients who were treated at the out-patient (OP) department at Suratthani Central Hospital in 2014 were retrieved from electronic medical records. Direct medical costs of HT treatment were estimated from resources used in the OP care of HT, including the unit cost of an OP visit, and also the costs of laboratory tests, anti-hypertensive medications (essential drugs (ED) and non-essential drugs (NED)), and other HT-related treatments. The costs of HT treatment were approximated from 4 different perspectives: societal, patients’, healthcare payers’, and providers’, with base year 2014. A treatment outcome was a patient having well-controlled blood pressure (BP), defined as having systolic BP<140 mmHg and diastolic BP<90 mmHg. Chi-square and ANOVA were used in the statistical analysis, with a significance level of 0.05. Multiple linear regression analysis was employed to assess the attributes associated with the costs of HT. To evaluate the elements affecting the use of NED, multiple logistic regression analysis was applied.  A total of 4,353 patients were identified: 2,247 entitled to UC, 149 to SSS, and 1,957 to CSMBS. Statistics indicated that the proportions of patients with well-controlled BP were not significantly different across health insurances. From all perspectives, the costs of HT treatment were much higher in CSMBS beneficiaries, compared with those in the other insurance schemes. Comparing the 3 health insurances, the CERs of HT treatment are highest in CSMBS beneficiaries. Results demonstrated that the increased costs of treatment are associated with the use of NED, and that the likelihood of using NED increases in patients with CSMBS insurance in relation to those with UC and SSS.  Inefficiency of HT treatment appears in CSMBS beneficiaries. The higher costs of HT treatment are attributed, in part, to the use of NED. While no such clear evidence reveals advantages of NED to reduce blood pressure over ED, NED are relatively much more expensive than ED. As physicians are responsible for the choice of medical treatment in hypertensive patients, a hypothesis proposed in this study to explain physicians’ selection criteria for the use of NED, is the awareness of cost burden. That is, physicians tend to avoid the use of NED when the burden of the additional costs is either the patients’ or the hospitals’, as is the case with the UC and SSS beneficiaries, respectively. In contrast, the use of NED increases when the public insurance bears the incurred costs from NED prescription, as seen in CSMBS cases.  Future research, testing this hypothesis using a qualitative study, is recommended. Furthermore, as a reimbursement mechanism could be the key to reducing the overuse of NED, future research should explore the impact of a change in the reimbursement system, from fee-for-service to capitation, on the drug costs for CSMBS patients.


Modern gold mining is of great concern on environmental and human health impacts. Based on
literature review, this article presented information on gold mining process and its related environmental
and health effects. It was found that modern gold mining mostly employs open-pit technique and uses a
huge area to explore a tiny amount of gold concentrate. Mining often generates enough dust, noise, and
vibration to affect nearby residents. Modern gold extraction process employs a large amount of cyanide, a
highly toxic compound to living organism and human. Ore exploration might also release coexisting
heavy metal, such as arsenic, lead, manganese and mercury. Moreover, a large gold mining might involve
communicable diseases and the change of social, economic and community lifestyle. Government should
support a study on a health impact on every project of modern gold mining.


This participatory action research was undertaken to determine the process used to develop
the Health Information System for Project and Budget Management (HIS4PM) and to evaluate its
effectiveness. The HIS4PM was developed to support work related to the missions of the health
care organizations in the seven provinces in Southern Thailand under the 12th Regional Health
Service Center, also known as Health Service Area 12 (HSA 12). A sample of 84 HIS4PM users, 12
from each of the 7 provinces, was purposively selected into the study. Three representatives from
four different health care organizations in each province, namely the hospitals and the sub-district
health promoting hospitals, the provincial and the district public health centers, were chosen
to participate. The administrators of the hospital/healthcare center, the project planning staff,
and the budget department staff for each organization were specifically recruited. Qualitative
and quantitative data were gathered by using in-depth interviews, documentary studies and analyzing
the current health information system; assessing the HIS4PM development using questionnaire.
Results: The study found that the main concept employed to guide the development of the
HIS4PM web-based application was a relational database based on a Rapid Prototyping Design
Model (RPDM) in order to allow any involved users to be able to access the single entry system
and update their real time data information. There were three main steps used to develop the
HIS4PM including: 1) reviewing the current health information system and assessing what developments
were needed to improve the system; 2) determining the possibility of determining and
assessing risks during the HIS4PM system development process and to plan-out the project to
ensure that all aspects of performing work related to the project planning and budget monitoring
missions could be performed and were addressed; and 3) completing the development process
using the 6-phase rapid prototyping design model. These 6 phases included: 3.1) assessing the
needs and analyzing the content to gather the vital information regarding what needed to be
included in the new software program using the rapid prototype manual along with in-depth interviews; 3.2) setting objectives for the software design and development using the data flow diagram
and object-oriented design techniques; 3.3) constructing a prototype; 3.4) performing a trial run evaluation
of the prototype HIS4PM system for approximately two months (February-March 2015) to evaluate
the program and obtain feedback and suggestions for improving the system, as well as the preliminary
users’ level of satisfaction; 3.5) installation and maintenance of the completed system; and 3.6) evaluation
the new HIS4PM software program using the questionnaires during March-April 2015.
In terms of its effectiveness, the study discovered that the newly developed HIS4PM could help
support the project planning and budget monitoring by the public health organizations in HSA 12. The
HIS4PM was practical and facilitated performing work at all levels ranging from the level of regional
health administrators to the working users at operating units. Moreover, the newly developed HIS4PM
not only helps reduce the duplication of data records and allows all users to update data in real time from
their operational sites, but it is also able to link data from all operating sites together. Therefore, it can be
accessed rapidly, meets the users’ needs, helps facilitate working from different operating sites, and helps
promote an effective, focused work atmosphere.
HIS4PM user satisfaction was assessed using the questionnaires and found that the majority of the
users were highly satisfied with all aspects of the new HIS4PM, including the policy to provide the HIS4PM
program to every public health organization, the policy’s implementation strategy, as well as the applicability,
the completeness and the appropriateness of the HIS4PM program.
Recommendations: 1) When the HIS4PM is considered for use in other regions, it is important to
take into account the drive behind the administrators’ policy management, 2) the HIS4PM national development
process should take into account the interests and needs of the local areas’ main operating unit,
and 3) when the HIS4PM is considered for nationwide use, it still has to be subjected to the operational
standard framework of the information system.


Treating ischemic stroke patients with recombinant tissue plasminogen activator (rtPA) no more
than 3 hours or 180 minutes after the stroke can increase the chance of recovery or improved condition. If, however, treatment is delayed, the potential outcome may be permanent disability or death. This descriptive
study was conducted with the objective of assessing time elapsed before treatment in ischemic stroke
patients and analyzing the factors influencing the amount of time elapsed before ischemic stroke patients
receive hospital treatment. The sample group was composed of 300 ischemic stroke patients treated at
Sanphasitthiprasong Hospital in the province of Ubon Ratchathani, Thailand. Data were collected from
November 2014 to February 2015. The following three sets of instruments were employed: 1) Demographic
Data Questionnaire; 2) Ischemic Stroke Evaluation Form and 3) Time to Treatment Evaluation Form. Data
were analyzed by descriptive statistics and the correlations by using Spearman’s correlation coefficient.
According to the research findings, 229 of the 300 ischemic stroke patients (76.3%) had pre-hospital
times of more than 180 minutes. The median pre-hospital time from the occurrence of stroke to hospital
arrival was equal to 302.5 min. The amount of time elapsed from arrival in the emergency room at
Sapphasitthiprasong Hospital until receipt of treatment (in-hospital time) was equal to 107.5 min. Therefore,
the median time from the initial presenting symptoms until treatment was equal to 590 min. Furthermore,
the pre-hospital time, the distance from the site of the incident to the hospital and the in-hospital
time from arrival until receiving laboratory test results were found to be positively correlated with the
pre-hospital time from the initial presenting symptoms until receipt of treatment (rs = 0.661, 0.185, 0.235,
p < 0.01). The severity of symptoms evaluated with National Institute of Health Stroke Scale (NIHSS)
scores was found to be negatively correlated with pre-hospital time (rs = - 0.129, p < 0.05).
In summary, most ischemic stroke patients within the boundaries of Ubon Ratchathani receive delayed
treatment in which the pre-hospital time has the highest correlation with receipt of treatment and
instructing patients, people at risk for ischemic stroke and their relatives. Moreover, the development of
an emergency medical service provision system and a hospital referral system that minimizes procedures
and time in transferring ischemic stroke patients is vital to helping ischemic stroke patients receive timely
treatment.


Over the past 10 years, the Ministry of Public Health (MOPH) has transferred her seven responsibilities
and more than 30 health centres to local governments. The ministry faced both successful and failed
experiences. It was necessary for the ministry to review what should be the appropriate roles and options
for decentralization. This study was a qualitative research. It aimed at analyzing appropriate roles of the MOPH and her
sub-organizations together with the National Health Security Office (NHSO) in linking disease prevention
and health promotion in local areas and the overall system governance. Research methodology used
both literature review and brain storming as well as in-depth interview. The interviewees included 22
experts who were representatives from the MOPH, non-governmental organization, local government
and the NHSO. The gathered data was analyzed by using content analysis and the results were presented
by thematic analysis.
Results of the study showed that public health, disease prevention and health promotion were direct
responsibilities of the local government for improving the quality of life of local people and these roles
ought to be transferred to local authorities. But the prevention of serious disease epidemic should be
remained the command of the MOPH at the central level. Other ministerial sub-organizations together
with NHSO should play supportive roles of the health policies issued by the MOPH. Local government
could be an arm-length extension of the MOPH to bring policies into practice. Options for decentralization
should encourage stakeholders’ participation in disease prevention and health promotion. The area
health model became a more preferable solution because it could help align the fragmented health system
and create better networking governance.


The objective of this study is to estimate unit cost per capita of services provided at contracting unit
for primary care (CUP) network. The cost data for fiscal year 2014 were gathered from both main hospitals
and primary care units (PCUs), consisting of labour cost, material cost, and capital cost. Then, the unit cost
per capita was analysed by service types: curative, promotion and prevention, rehabilitation, and Thai
traditional and alternative medicine.
The unit cost per capita of CUPs was calculated by looking at six CUPs: two general hospitals and
four district hospitals. The results indicated that the unit cost per capita of outpatient services at the two
general hospitals were Baht 1,215 (SD=148). Adding all four service types together, the unit cost per capita
at these two general hospitals totalled Baht 1,581 (SD=184). Whereas, the average unit cost per capita of 4
district hospitals accounted for Baht 800 (SD=51). The total average cost for all services of the district
hospitals is Baht 925 (SD=60).
While, the average unit costs per capita of 10 primary care units were Baht 372, the average unit cost
of PCUs for all services is Baht 787 with the median of Baht 689. However, rehabilitation and Thai traditional
and alternative medicine services were not available in all PCUs. This is due to the fact that those
services require health professional with specific qualifications. Further studies are needed to confirm the
result of this study, which has limitation on a small number of samples.


This study was conducted to determine the prevalence of insulin non adherence and identify factors
associated with insulin non adherence among 95 patients with type 2 diabetes mellitus in Nongjik Hospital,
Pattani province from June to September 2015. Non adherence to insulin was measured by self-report
questionnaire. Frequency, percentage, mean and standard deviation were used to present the analysis
results. Logistic regression was used to identify multivariate predictors of insulin non adherence. Adjusted
odds ratios (aOR) and their 95% confidence interval (CI) were used to present the strength of association.
Prevalence of insulin non adherence was 80%. In multivariate analyses, predictors of insulin non
adherence were: age 51-60 (aOR 20.38, 95% CI 1.32, 315.71), BMI (aOR 25.11, 95% CI 1.96, 321.17), selfinsulin
administering (aOR 22.25, 95% CI 1.51, 328.2), hypoglycemia (aOR 21.0, 95% CI 1.35, 326.23), insulin
keeping (aOR 42.02, 95% CI 3.16, 558.42) and dinner management (aOR 22.6, 95% CI 2.48, 205.68).
This study has demonstrated a high prevalence of insulin non adherence in patients with type 2
diabetes. Improving insulin adherence by paying particular attention to different age groups and patients
with self-administered, insulin keeping and dinner management inappropriate could help improve adherence.


Ministry of Public Health had put many efforts to solve shortage and manage distribution of dentists
in community hospitals by initiating special allowances based on geographical locations, hardship
conditions and working hours. This study aimed to evaluate the effect of additional hardship allowance
for dentists who were working in community hospitals. The study used secondary data from two sources and compared between 2009 and 2013. The first data source was dentists in community hospitals from the
Bureau of Dental Health database between 2009 and 2013 that were used for estimating the budget for the
hardship allowance. The second dataset was derived from performance and productivity of dental
workforce from Department of Health Service Support between 2009 and 2013.
The results revealed that the number of dentists in community hospitals was 2,638 in 2013, compared
to 1,859 in 2009, or a 41.9% increase. Additionally, the budget of hardship allowance increased
28.1%, or by 168.6 million Baht; from 599.82 million Baht in 2009 to 768.4 million Baht in 2013. However,
52.7% of dentists who started working in community hospitals in 2009 for 1-3 years, had left community
hospital in 2013. Lastly, the productivity of dental health service in 2013 appeared a little higher than 2009
on average, 1,565 cases per dentist in 2013, a 12.3% increase from 2009. Nevertheless, only 25.6% of total
hospitals were able to achieve high performance standard of 1,840 cases per dentist per year. In conclusion,
the data suggested that the hardship allowance appeared to be unable to retain dentists who had 1-
3 years of experience to continue working in the community hospitals with little effect on productivity as
a few hospitals reached the standard level of quantity performance.


Thai health system is currently affected by constantly changing environmental factors. Forecasting
the future of the country is essential for preparing the future health systems. Defining future preferable
health systems is an important first step of country’s future health system developments, which later
would deliver efficient resource allocation and maximize social utility. Literature review and expert consultation
meetings were conducted. There were 18 meetings held with a total of 121 experts or well-known
people to define what are the preferable health systems in 2033, compared with the status quo scenario.
The status quo scenario is the passive health systems, focusing on treatment, using human resources
and being centralized. While the preferable health systems would emphasize on health promotion, make
high use of information technology and promote community to be able to manage and cope with health
problems in own environment with high health literacy level.
In conclusion, the preferable health systems can guide future directions or priorities to support future
health research.


Appropriate standardized research grouping is important for research management of researchers,
research institutes and funding agencies. Health research funding agencies in Thailand have different
management policies and system regarding allocation of funds. As a result, there exists a gap in the information
on which areas of research are progressive. Grouping research projects properly, in the same standard
with other funding agencies, will not only strengthen the funding strategy of each agency, but also
help avoid the duplication of research funding in one area with less funding in another.
This study aimed to review the health research classifications in high-income countries in order to
have a basis for recommendations to Thai health research. Literature review was conducted to find the
key characteristics of successful research classification systems. Five countries were selected for review of
best research classification. These countries include: Australia, Germany, New Zealand, United Kingdom
and United States.
The study found the following six principles of successful research classification systems: 1) simplicity
2) relevance 3) consistency 4) standard 5) multi-dimensionality and 6) flexibility. From assessing the
research classifications in five countries, we concluded that the Health Research Classification System
(HRCS) of the UK Clinical Research Collaboration. (UKCRC) met all six principles. Therefore, based on
this study, we recommended the adoption of the HRCS classification systems. Furthermore, we recommended
adding the health policy and system research as a new classification in order to aid with policy
development and implementation in Thailand. In conclusion, health research funding agencies should
apply the same classification standards.


Adverse health problem of smartphone use has been gradually increased. Prevention of this problem
is essential and urgent. The purpose of this study was to compare the differences of pain and muscle
activity at neck, shoulder, upper back and arm regions after smartphone use for 20 minutes among 3
positions (on the lap level, on the chest level and on the table). Twenty-four asymptomatic females aged
18-25 years old were recruited. The subjects were assigned to use smartphone in random order of 3 positions.
Location and severity of pain were measured by using body pain chart and visual analog scale
(VAS), respectively. Electromyography (EMG) was used to measure muscle activity of cervical erector
spinae (CES), upper trapezius (UT), middle trapezius (MT) and biceps brachii (BB) muscles. The results
showed that 1) After 20 minutes of smartphone use, pain increased significantly (p-value<0.05). 2) Pain
was found apparently, mostly in neck region; participants reported pain in 60 of 72 times, particularly in
the lap position. 3) Pain increased obviously in all positions; however, pain scale did not show any significant
difference among 3 positions. 4) EMG of CES increased up to 50% of maximum voluntary contraction
(MVC), but there was no significant difference of EMG of CES, UT, and MT among 3 positions. In summary,
smartphone use longer than 20 minutes could lead to muscular pain, particularly neck pain. CES
worked increasingly up to 50% of MVC. Therefore, we would recommend that to prevent the risk of
musculoskeletal problems, smartphone users should avoid using this IT device continually 20 minutes,
especially on the lap.


The desirable goals and directions of the Thai health system are to promote health prevention and
promotion for healthy Thai people. To achieve those goals, a number of innovations and new knowledge,
mainly derived from quality research, need to be generated in order to fill the current gap of knowledge.
Thus, a clear framework of potential research should be developed. This can help research funding agen-cies work transparently and effectively in granting research projects. This study presents a framework of
potential research that should be supported in order to achieve the desirable goals of healthy Thais. With
regard to each aspect of the goals, document and literature reviews were accumulated to collect background
information on the current situation and gap in knowledge. Interviews and meetings with seven
groups of experts were arranged to discuss and deliberate the potential research issues that should be
supported in the future. The results were then analyzed and categorized into three categories: (1) health
research issues by age groups - children, adolescent, adults, and elderly; (2) research issues in the health
systems - health service delivery, health workforce, health information, health technologies, health financing,
and health governance; and (3) research issues for promoting heath and health literacy. These issues
and sub-issues are also related to the policies of many granting agencies in Thailand. It is important to
raise the concerns of relevant agencies to determine the gap of knowledge that should be funded, then,
there would be enough research generated to move toward the desirable goals.


Health research is an essential tool to improve health system and quality of life but it is costly. Therefore,
in a resource-limited country, it is necessary to better understand health research priority setting
processes in order to assist decision-makers in allocating funding and resources more effectively and
efficiently. This study aims to learn from the world’s experiences regarding health research prioritization for a better understanding in prioritization approaches and how to apply them for health research priority
setting in Thailand. The results of literature and document reviews from national and international databases
showed that there were 23 studies categorized into two Thai and 21 international studies. The major
criteria found in research priority setting were the specific areas of health research and those of the patient
groups. The lesson learned from this study provides evidence on what needs to be considered in order to
design for effective health research prioritization processes in Thailand. This study suggests that multiple
relevant stakeholders should be involved throughout the processes, prioritization criteria have to be clearly
set and identified, and the deliberative process is recommended.


This research aimed to propose a model for Social Security Hospital and its financial feasibility. Mixed method was used, which comprised review literatures, hospital management of the Mexican Social Security and the Kaiser Permanente of U.S.A, legal framework, in-depth interview, focus group, questionnaires survey from 519 members under Social Security Act on the new Social Security Hospital and financial feasibility study. The study found as follow : 1) Social security hospital is theoretically possible and well practice in the Mexico and the United State. Integrated care model should be used, which will provide patient centre care for all health services. 2) The Social Security Hospital should be 150 beds hospitals, which provide high quality of medical services include 12 specialty medical services. Quality of its hospitality service should be the same as private standard. Its revenue can cover expenditure since the first year of its operation. It needs ten years for break-event with low rate of return if there are 200,000 employees register with the hospital. 3) Focus group discussion with represent from employers and employees on the design of Social security hospital found that they agreed with the design and support the Social Security Office to invest for Social security hospital in the needed area, which has problems of overcrowded patients together with measures to improve standard and quality of care for current main contractors. 4) For short term intervention, the Social Security Office could be set up new Social Security Hospitals by contracting with Ministry of Public Health or Local Government, which have mission to provide health services However, amendment of the Social Security Act is needed in long term plan.


Wheelchairs have been widely used for walking disabled people.  In order to operate a wheelchair to move straight or turn left/right, the user has to use his hands in order to control the motion of left and right wheels of the wheelchair.  If the user cannot provide force to move the wheelchair, a helper is required to push/pull the wheelchair from the back. Electrical wheelchairs were developed in order that the users could operate the wheelchairs through control panel/joy stick.  The wheelchairs can be used only on flat surfaces. Mobility between different levels are possible only through slope surfaces.  The existing wheelchairs cannot move through steps; for example stairs, etc.  Furthermore, the existing wheelchairs cannot plan the paths and cannot move to destination locations by themselves. They still require every
single commands from the users.  Based on the above reasons, this research has been conducted in order to research and develop an autonomous mobile wheelchair which has an ability to move through steps for walking disabled people; for example, elderly people. The user is required only to provide the destination location, the mobile wheelchair will plan the paths and navigate itself to go to the destination. On the way to the destination, if there exist steps, the mobile wheelchair will climb the steps automatically. The developed mobile wheelchair consists of 16 degrees of freedom for all 4 legs. Each leg has a motor to drive 2 wheels in forward/backward direction, a motor to adjust the length of each leg, a motor to swing a link connecting the 2 driving wheels to climb up/down steps, and a motor to turn direction of each leg to have only a point of center of motion during turning.  The results from experiments confirm that the developed mobile wheelchair can move in manual mode to follow commands from control panel/joystick and in automatic mode to follow commands from computer correctly with some small error of distance/angle.


Objectives: Peripheral arterial disease (PAD) in diabetic patients is associated with high morbidity and mortality. The mortality rate in such patients is 56.5% in 3 years follow up period in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. Therefore the incidence and predictive factors to determine the mortality, myocardial infarction, stroke and worsening PAD is of paramount important. Researchers aimed to explore these outcomes in our population.

Method:  500 diabetic patients with being diagnosed as PAD between June 2014 to July 2016, were followed up in 18 months follow up period. Primary end point was major adverse cardiovascular event (MACE), which composed of non fatal myocardial infarction, non fatal stroke, worsening PAD and death. The potential clinical predictors were entered into a Cox proportional hazard model with backward stepwise regression was performed.  Researchers also evaluated the adequacy of treatment by assessing the risk factor control for atherosclerosis. The target of the risk factor control for atherosclerosis has been using the criteria of American Heart Association (AHA) and the Royal College of Physicians of Thailand.

Result: During a mean follow-up of 18 months period, 95 MACE events occurred, corresponding to the incidence of 19.0%. The number of death was 43 patients. The predictive factors, that were significantly associated with MACE, were history of chronic kidney disease (hazard ratio (HR) 2.32, 95% confidence interval (95% CI) 1.41-3.80), gangrene or chronic ulcer (HR 3.03, 95%CI 1.82-5.06), history of aortic surgery (HR 24.07, 95%CI 5.28-109.71), patients with history of taking clopidogrel (HR 2.16, 95%CI 1.13-4.12), patients with history of taking warfarin (HR 3.24, 95%CI 1.50-7.02), patients with history of taking sulfonylureas (HR 0.44, 95%CI 0.24-0.83). In terms of risk factor for atherosclerosis management, patients had reach the target in majority (>50%) in the control of diastolic blood pressure (73.10%) and stop smoking (91.83%).

Conclusion: The incidence of MACE was 19%. The predictive factors for high MACE in the first 18 months in diabetic patients with PAD was chronic kidney disease, gangrene or chronic ulcer, history of having aortic surgery, patients with history of taking clopidogrel, patients with history of taking warfarin. This may be used to identify high-risk patients for MACE to assist optimize medical treatment and intensive risk factor control for atherosclerosis to increase life expectancy and to decrease vascular event.


This research aims 1) to know the difference in locomotor skills classified by causes and levels of
amputation in persons with lower limb amputation, 2) to know the difference in quality of life classified
by causes and levels of amputation. The research population was people with lower limb amputation
who are older than 18 years living in Lamphun. The samples were selected by stratified random sampling from 82 people by using questionnaire developed by Locomotor Capabilities Index-5 and the World Health
Organization’s WHOQOL-Bref-Thai quality of life version. Validity was examined by experts and a reliability
test was obtained from 30 cases excluded from the study samples. Data were analyzed by frequency,
percentage, mean, and t-test.
Results of this research showed that 1) overall locomotor skills classified by amputation causes were
different at the significant level (0.05) but there was no difference in overall locomotor skills classified by
amputation levels; 2) overall quality of life scores classified by amputation causes and levels were not
different but physical domains classified by amputation causes were different at the significant level (0.05).
Research results indicated the differences in locomotor skills and physical domains were by causes rather
than levels of amputation. Thus, rehabilitation teams should design interventions carefully for different
groups of amputation causes, to encourage amputees to have better locomotor skills in prosthetic use and
to have better quality of life.


This paper aimed to study the elderly families situations and factors contributing to the elderly
families hardship in 10 provinces of Thailand. The study applied quantitative and qualitative methods to
collect data; from selected 4,561 elderly families using quantitative method and another 214 using focus groups interview with community officers and families with home dwelling elderly. The collected data
was analyzed using descriptive statistics and content analysis.
Overall, the study found that half of the surveyed families were families with the elderly who looked
after children in the families, following elderly living alone and living with their spouse respectively.
There were more than half of the elderly who had ability for self-caring and moderate caring for other
members. Level of relationship among other families members were no significant different at all levels;
good/moderate/bad. There was 1 in 3 of the elderly who responded that they had poor economic selfreliance.
For the type of support, the elderly dwelling with disabled person reported the highest hardship
and the need of dietary/feeding was the most expected support; whilst the elderly dwelling with children
reported highest need on financial support. Factors having high impact on hardship of the elderly families
were residential area, family profile, income, asset, saving, debt, and burden of caring on any family
member of elderly/child/disabled (p-value <0.001), including mental state, 4 basic needs of life, family/
community relationship, ability to access rights and social welfare.
The study recommended that social welfare should be fair, systematic including enhancing community
participation in promoting health and well-being among aging people. Lastly, further in-depth study
on factors influencing family health and caring for the elderly ought to be accelerated to promote better
quality of life for the elderly.


The expansion of benefit package covering patients with chronic kidney diseases (CKD) since 2007
resulted in increased access to care and minimized disparity of access to renal replacement therapy (RRT)
across public health insurance schemes. Nonetheless, growing concerns of financial burden to the public
health programs ensued. This poses a challenge for policy makers in terms of inventing preventive or
mitigation measures for CKD.
Recently (2016) Ministry of Public Health promulgated upscaling of Klong Klung Model (KKM) as a
prototype for such measures after the findings of effectiveness of the model. Given complexity of the
health care systems, the upscaling might not be straightforward. There is still need for clarification of
what and how building blocks of the model were developed under specific circumstance of Klong Klung
District in Khampang Phet Province, a lower northern province.
Using comparative cross-case analysis, this report gathered data from focus-group discussions,
direct observation and documentary review relevant to development of CKD care models in Klong Klung
District and its comparator in Kong Rha District, Phattalung Province in the South. It was found that KKM, with a focus on prevention and mitigation of CKD, was developed based on
randomized controlled trial to test a standardized protocol jointly determined by Klong Klung Hospital
and the Kidney Disease Institute of Thailand. To the contrary, the care model at Kong Rha District covered
a spectrum of care ranging from prevention to RRT. Kong Rha adopted a trial and error approach in
applying existing knowledge acquired by the local team in close collaboration with a multidisciplinary
team of Phattalung Hospital (the referral center of the province) led by an internist with training in kidney
dialysis. Given such differences, both models shared a common feature of leadership: sustained leading
role of a senior nurse head for Kong Rha and of the hospital director for Klong Klung. Both leaders was
found to perform in a remarkably autonomous status based on patient-centric principle. Under this leadership
style, multidisciplinary team members interacted on an equal ground rendering ongoing learning
and adaptation.
In term of generating knowledge on the effectiveness, KKM was found to be much more systematic
in data management and analysis reflecting a significant technical contribution from academic experts of
the institute. In contrast, Kong Rha faced with limited capacity in terms of manpower and technical
expertise in making use of the data. This resulted as expected in more ambiguous findings to prove the
effectiveness of the model. In effect, the limitations of Kong Rha reflect widespread phenomenon of sluggish
development of the capacity to make use of existing health information systems in the country despite
substantial investment in the hardware.
Finally, we did not find “vulnerable population” as a common language among the study areas. This
does not mean that the health professionals play down the importance of ensuring access to care of the
poor or the disadvantaged. To the opposite, they have made substantial attempts to do so. For instance,
community resources were mobilized to reconstruct a sufficient hygienic space for home-based peritoneal
dialysis in Kong Rha. Under KKM frequent home visits to all the patients especially the poor enabled
better understanding of limited food choices contributing to difficulty in sodium reduction. This led to
modification of dietary education to be more suitable to the poor patients’ situation.


Objective: To synthesize lessons learned from the existing community-based health interventions
for vulnerable populations in Thai contexts in order to create policy recommendations for further health
systems development and response to health needs of vulnerable populations. Methods: This study utilized
qualitative study design to investigate and compare community-based health interventions for vulnerable
populations in eight district health systems (DHS) of Thailand, including Umphang, Ubolratana,
Dan Sai, Khon Buri, Kuchinarai, Lam Sonthi, Kong Rha, and Khlong Khlung. Qualitative data were collected
from the local practitioners by semi-structured interviews, focus-group interviews, and non-participant
observations, and were synthesized by thematic content analysis. Results: Content analysis reveals
four emerging themes. First, sense-making of the vulnerable population concept was challenging
for practitioners in Thai contexts. Second, effective community interventions for vulnerable populations
were initiated by local practitioners, not from policy and planning at the national level. Third, effectiveness
of community interventions for vulnerable populations depends on services design being customized
to the nature of vulnerability. Lastly, traits of local leadership, not authority, are necessary for creating
and implementing sustainable community-based health interventions for vulnerable populations.
Discussions: Despite no mutual understanding of the vulnerable population concept in Thai contexts,
we found strong evidence of innovative community-based health interventions in Thailand. To
scale up such programs, policymakers should create criteria to help practitioners identify vulnerable populations
in their contexts, allow for contextualizing health needs of different vulnerable populations, and
put more emphasis on developing information systems at both the national and the local level, so there
will be more systematic monitoring and evaluation of community-based health interventions for vulnerable
populations in Thailand.


Parasitic helminth infection remains to be a public health problem of the students and children in
remote rural areas, especially in the Northeastern part of Thailand. This survey was aimed to find out the
parasitic helminth infection rate, to analyze the spatial distribution with the application of geographic
information system (GIS), and to study the risk behaviors of parasitic helminth infection amongst students
in eight schools under the responsibility of the Border Patrol Police (BPP) Sub-division 21. The
survey was conducted during October 2014 to July 2015. The instrument for the survey was modified Kato-Katz technique for examining stool samples, and in-depth interview. The results showed that the
infection rate of helminth parasites was 8.27% (72 cases from overall 871 cases). The most common species
of helminth parasites found was hookworm at 51.39%. Others were Opisthorchris viverini 25.00%, Echinostoma spp. 12.50%, Enterobius vermicularis 5.56%, Trichuris trichiura 2.78%, Ascaris lumbricoides 1.39%, and co-infections of O. viverrini and hookworm 1.39%. When applying the GIS to analyze the parasitic helminth infection’s spatial distribution of the 8 BPP schools, the results showed that the parasitic helminth infection was higher than target limit of less than 5% in every school (14.71%, 12.30%, 10.00%, 8.96%, 6.43%, 6.14%, 6.00% and 5.41%). The distribution and the concentration of helminth parasite species were different in each habitat of the students. Most of the infections were caused by soil-transmitted helminths (STHs). Bad sanitation and inappropriate food consumption habits increased risk of infections. The findings of this research can be used to estimate helminth infection situation of the community and also can be applied to create strategic plans which focus on changing behaviors of students, their parents and their teachers to solve this problem.


This article aims to apply the concept of social stratification to explain social inequality. This will
help understand who is vulnerable population in the society. The authors have reviewed the literature of
concepts and theories in social sciences that can explain and rank the social stratification. Moreover, this
first phase of the big research project “Social Stratification in the Context of Thai Society and Health Status”
applied in-depth interviews and meetings with experts from March 2015 to March 2016 to select indicators of social stratification measurement appropriate to the context of Thai society. The research finding explains that social stratification and social inequality are conceived from the life chances concept as the beginning point of differences of human being. Life chance either by nature, by culture, or by social situation, leads to social differentiation, social stratification and eventually social inequality. Social stratification measures can be used to rank people by two approaches: 1. Objective measures of social stratification cover five indicators; 1) Birth origins 2) Standard of living in household 3) Economy 4) Education and 5) Health, and 2. Subjective measures of social stratification also cover five indicators; 1) Social status 2) Freedom and liberty 3) Fraternity 4) Consumption and lifestyle and 5) Class awareness. All of the above indicators of social stratification will be utilized to find populations who are the most disadvantaged, or the “vulnerable populations.” This finding has contributed to help build life chance guarantees, social equality and social equity for the vulnerable in Thai society in the future.


Television advertising is an effective medium for reaching young children and influencing their
food purchasing and intake. The objective of this study is to explore food and beverages advertising during children’s television programs.Methods: Records of children’s free television programs on channels 3, 5, 7 and 9 was the main data
collection method. Data was collected during March 24-April 7, 2014 on Monday-Friday at 03:00 p.m. to
08:00 p.m. and on Saturday-Sunday at 06:00 a.m. to 10:00 a.m. and 03:00 p.m. to 08:00 p.m. A total of 42
programs from top three programs that had the most food and drinks advertisement were selected into
this study. Unhealthy food and beverages advertisement was included in the analysis. Food advertisement was organized according to the food group classification from the Nutrient Profile. The study found that the majority of the advertising of food and drink is unhealthy food and drinks
advertisement. The most popular form of advertisement used by the food industry was using presenters
such as celebrity children and adults, athletes, and cartoon characters. Moreover, food and beverages industries used a loophole of regulations for advertising and did not comply with the law. Inappropriate forms and contents of the advertisement for children were observed. Considering the law enforcement, there is currently no comprehensive control of forms and contents of advertisement targeting on children. Therefore, government should seriously develop the law enforcement and should prepare including update regulations and guidelines to control forms and contents of unhealthy food and beverages advertising in order to protect the health of children and youth.