Input-orientated Data Envelopment Analysis was used to measure the technical efficiency of 7
university hospitals, 24 regional hospitals and 43 general hospitals in Thailand in year 2009. The results
revealed there were 53 efficient hospitals (71.62%) from 74 total hospitals; in addition, the percentages of
efficient hospitalsin order of highest to least percentage were university, regional, and general hospital
(85.7%, 83.3%, and 62.8%).While the percentages of scale efficiency (SE = 1) in order of highest to least
percentage were regional, university, and general hospitals (75.0%, 71.4%, and 44.2%).
The next step was to identify the determinants of hospital efficiency with regression analysis using
ordinary least squares (OLS). The results revealed three significant explanatory variables for TEVRSi scores
such as bed-physician ratio, numbers of physicians, and nurses-physician ratio. The most positive influential
determinant of TEVRS scores was bed-physician ratio; however, the negative influential determinant of
TEVRS scores was nurse-physician ratio. While the significant explanatory variable for scale efficiency (SEi)
scores was the in-patient visits adjusted with median relative weight of DRG


This study aims to find factors that affect total hospital costs significantly. These
factors may be considered for adjusting the payment of contacted healthcare providers in the
Gold Card scheme. Therefore, contacted healthcare providers may obtain more appropriated
budgets from the NHSO. This study uses translog cost function to find the factors that affect
total cost hospital. Fifty-two contacted healthcare providers where have a good efficient score
are used as the sample of this study.
This study found that Case MIX Index (CMI) and Referral (In) rate affect total hospital
costs significantly. The new budget for the contracted healthcare providers may need to
consider on these two factors. Also, this study notes that doctors and nurses’ work load at IPD
are other two factors that are important in the management of hospital costs.


Non Communicable Diseases (NCDs) is the most important health problem in Thailand, in terms of
both mortality and morbidity. In the Global Status Report on Noncommunicable Diseases 2010, World Health Organization recommends 26 effective and cost-effective interventions to tackle NCDs crisis. Further
divided into 12 Best buys intervention and 14 Good buys, these population-wide policy interventions
aim to address NCDs at their five major risk behaviours. These include tobacco use, alcohol consumption,
food and beverage dietary, physical activity and Hepatitis B vaccination. This study describes theoretical
concepts of the intervention, and analyses situations, gaps and opportunities of Thailand to adopt these
26 interventions. These interventions differ in terms of strength of policy content, implementation and
feasibility to be strengthened. In conclusion, Thailand faces many major limitations in embarking these
Best buys and Good buys health interventions, including priority, resources, capacity, sustainability, monitoring
and evaluation, and coordination. While some are not exists at macro scale in Thailand, some interventions
were not primarily designed for health purposes.


Services to provide screening, treatment and rehabilitation of alcohol-related problems are covered
under the Universal Health Coverage Scheme in Thailand. However, massive number of population with
risks and patients are practically ignored, do not get what they should be serviced, from the current health
care system and practices. Unintentionally but significantly, the shortage to provide proper care, escalates
the magnitude and severity of alcohol problems. Technical evidence shows the need, appropriateness,
benefit and practicability of the comprehensive services for alcohol related problems with in Thai health care system. The comprehensive service should cover four interconnected components; 1) alcohol screening
and brief intervention, 2) Detoxification and treatment of physical co-morbidity, 3) Alcohol treatment
and rehabilitation, and 4) Long term after care. Major limitations at macro scale is the lack of policy to
strengthen health care system in addressing alcohol problems, including in raising significance, building
up preparedness and capacity of the systems, providing incentive, and resource management. Critical
constraints at institutional level include awareness and capacity of health workforces, the lack of risk
assessment and management, the unavailability of clear and comprehensive policy. The framework to
strengthen Thai health care system response to alcohol problems should tackle major system gaps in
current systems, and strike balance of and cover all four components in parallel.


While a fiscal policy has been shown to influence food and beverage prices in ways which help encourage
healthier eating behaviour, evidence about the use of tax and price interventions is still unclear and
questions about their effect still remain. A systematic review on food and beverage tax and price interventions
was conducted in order to explore evidence about tax and price interventions to promote healthy
dietary behaviours and investigate their effect on consumers. The English and Thai-language published and
grey literature for studies on tax and price interventions including monetary subsidies or taxes levied on
food and beverage and their effects were searched. Twenty-seven studies met the inclusion criteria. 4 were
from the peer-reviewed literature, 21 were published online and 2 were from grey literature. The studies
mostly focused on taxing snack, confectionary, soft drink and soda, and on subsidizing staple food such as
rice, wheat and maize. These interventions particularly taxation were found in influencing diet and body
weight. In conclusion, taxes and subsidies in food and beverage may be a useful tool contributing to healthier
consumption patterns at the population level. However, more information is needed on actual response on
food and beverage and consumers in food and beverage taxation and subsidy in developing country particularly
Thailand along with information on how effective food and beverage taxation and subsidy would
be and particularly their effect on people in developing countries.


According to the cost-of-illness studies, economic impact of alcohol consumption is substantial. Impact
of alcohol and smoking on productivity loss due to premature mortality and morbidity is enormous and clearly affect economic system of the country. According to the cost-of-illness studies, the followings
are policy recommendation; 1) Alcohol control policy should be set as the national priority; 2) collaboration
from all related organizations not only those from the health care sectors but also other economic
organizations both government and private as well as enterprises at all levels are needed; 3) Policy/
intervention aims at preventing new drinker as well as encouraging drinker to quit at the early age are
essential. However, policy/intervention targeting at prevention of adolescent from start drinking are more
cost-saving than policy encouraging drinker to quit. In addition, encourage drinker to quit at early age is
more cost-saving than at the older age; 4) Policy/ intervention targeted at preventing new responsible
drinker or encouraging responsible drinker to quit is still important, as responsible drinkers accounted
for the highest proportion in the country; and 5) All related organizations should collect data in term of
the number of new drinkers or quitters attributable to the policy/intervention in order to use them to
conduct cost-effectiveness of such policy/intervention in the future.


The adherence of antiretroviral therapy (ART) higher than 95 % is needed for the effectiveness
of HIV suppression. prevention of opportunistic infections, reduction chance of HIV transmission
and overall health improvement. Aim of the study was to find facility factors related to adherence of
ART under the universal coverage. Methods: A cross-sectional study was conducted among 823 HIVinfected
individuals who were receiving antiretroviral under National AIDS Program (NAP) in 9 public
hospitals in 3 provinces (3 regional and 6 community hospitals). Adherence had been assessed by pill
count and self-report using Visual analog scale (VAS). This study was approved by ethical committee of
the Ministry of Public Health. Results and discussion: Average adherence from pill-counts and selfreport
was 87.4% and 49.7 % respectively. Adherence from regional and community hospitals evaluated
using pill-count respectively was 82.7 % and 95.2 % while using self-report respectively was 46.3 % and
56.5 %. Logistic regression model shows community hospitals were correlated with higher adherence
than regional hospital from self-report by VAS (OR=1.51; 95 % CI:1.13 -2.02, p=0.006) and from pill-counts
(OR=4.17; 95 % CI:2.10-8.31, p<0.001). Although ART service in all hospitals was under the same Universal
Coverage scheme, the difference of adherence is existed. Related factors might be from patient-staff
relationship, ease of travel, ART-one-stop service and exclusively isolate clinic in small hospitals while in
large hospitals there are many patients visited under limited service area and not separated from other
clinics for receiving ART. Conclusion(s): Regional/general hospital might need substantial supports on
budget and personnel as well as the allocation of service space and increasing interest of the clients on
adherence on ART.


Background: Anticoagulation clinic has been implemented in Thailand with considerable success,
mostly in tertiary care hospitals. To improve accessibility of such service, a satellite network of anticoagulation
clinics in rural area was recently implemented. Objective: To compare quality of anticoagulant
control, complications and follow-up frequency among patient receiving warfarin therapy during their
attendance to a tertiary care center versus after referral to satellite clinics. Methods: Satellite network of
anticoagulation clinic was established at the Nakornratchasima province in early 2009 comprising of 4
community hospitals and a community medical unit. Patients receiving warfarin for at least 6 months at a
tertiary care hospital, who were clinically stable, were consented and enrolled in satellite clinics. Data on
anticoagulation control and other outcome variable of pre-referral period were compared with those of
post-referral period using descriptive statistics, paired T-test and McNemar’s test, where appropriate.
Results: Sixty nine patients were enrolled with a total number of 273 visits. Mean age was 56.2 ± 13.7 years
old. Most common indications were prosthetic valve replacement (40.6 %), rheumatic heart disease (20.2
%), atrial fibrillation with stroke (17.3%) and other (21.7 %). For anticoagulation control, time in target
range of patients during pre-referral and post-referral periods were similar (46.5 % vs 46.1 %; p = 0.94).
Incidence of INR value < 1.5 or > 4.0 were similar between the two groups but numerically lower in the
post-referral period (20.0 % in pre-referral vs 17.2 % in post referral periods: p=0.25). No major complication
was reported. Follow-up interval was shorter with satellite clinics (4.5 week/visit and 8.5 week/
visit). Conclusion: Satellite network of anticoagulation clinic can provide quality anticoagulation control
similar to a tertiary care setting. In addition, such service may improve safety of warfarin therapy through
a close monitoring system and improved accessibility.


The objective of the study was to determine the effect of a health education program on drug use
during the month of Ramadan among diabetic patients with chronic renal failure who attended the diabetic
clinic in Nongjik Hospital, Pattani Province, during 1 October 2009 - 31 December 2010. Of the 56
patients, 28 had the Ramadan education program and home visit (study group) and 28 had usual health
care services (control group). Data from hospital records and the drug use follow-up form during Ramadan
of both groups were reviewed. Both groups had comparable characteristics including sex, age, co-morbidity, serum creatinine, estimated
glomerular filtration rate, microalbuminuria, cardiovascular risk score, number of drugs currently
used, fasting blood sugar, and systolic blood pressure. During Ramadan, good drug practice was significantly
higher in the study group (89.3 %) than the control group (14.3 %). Patients in the study group had
significantly lower fasting blood sugar, and systolic blood pressure than the other group. Factors correlating
with good drug practice were principal antidiabetic drugs and modification of drug use during
Ramadan.
It is essential to prepare drug use among Muslim diabetic patients before Ramadan. Good drug
practice during Ramadan will provide effective treatment results in these patients.


The policy on the promotion of herbal medicine has not yet achieved the target. To achieve the goal,
knowing health care professionals’ views on herbal medicinal products and on the national policy which aims to promote the utilization of herbal medicine in health care facilities is crucial. This study used
qualitative methods. Focus group interview among the frequent user group and in-depth interviews among
occasionally user group were conducted. The results of this study can be divided into 3 parts. 1) Views on
herbal medicinal products: lack of confidence on the effectiveness and safety of herbal medicinal products
is found, the appearance and other characteristics of herbal medicinal products are not attractive, herbal
medicinal products are more expensive than western medicine. 2) Views on the national policy to promote
the utilization of herbal medicinal products in healthcare facilities: The set target in terms of expenditure
of herbal medicine products of 25% of the total drug expenditure for every healthcare facility is
difficult to accomplish. Furthermore, there are no practice guidelines and clear strategic plan to support
the policy. 3) Views on impeding and facilitating factors influencing the utilization: key impeding factors
were the criteria on reimbursement of herbal medicinal and confidence in the quality and manufacturing
standards. The key facilitating factor was the presence of key person who was able to promote the use of
herbal medicine in hospitals. Findings from this study would be used to develop the effective strategies to
accomplish the policy aims at promoting the use of the herbal medicine in the future.


Sexual assault was a critical problem with increasing incidence. It is a challenge to family physicians
as a member of multidisciplinary team responsible for provision of care to the victims. With medical
record review and interviews with sexual assaulted patients of Chaibadan Hospital, this study described
demographic profile, nature of the assaults, type of care given and made suggestions for further improvement
of health care to the victims. Seeking care at During 2007-2009, 95 female victims were identified
with an estimated cumulative incidence of 27.7-49.8 per100,000 population. Majority of them were aged
under 18(94.7%) with high school level of education (65.3%). Most of them were raped by husbands or
boyfriends (42.1%). A quarter was sexually assaulted more than once during the past year. Health care
provided to these victims consisted of birth control pills (32.6% of them), a test for HIV infection (80%) and
anti-HIV medications (25.3%).


The Constitution of the Kingdom of Thailand B.E. 2540 and B.E. 2550, including Determining
Plans And Process Of Decentralization Act, B.E. 2542 is regarded as the starting point of the decentralization
of the state to local administrative organizations, and determined the public health decentralization
to local administrative organizations. These plans included the transfer of the health center (subdistrict
level) to local administrative organizations within 2010. Until now, 10 years gone from the above
mentioned, the progress is still unsatisfactory with a lot of problems and barriers during the operation. In
the preceding time, 28 health centers had already been transferred from 35 health centers targeted. Among
these, some of them were successful while some others faced many obstacles or restrictions in the implementation,
such as uncertainty of the policy and guidelines, coordination between the organizations, and
referring system. These made the health personnels feel insecure in their work. In order to run the process
of the public health decentralization effectively and comply with the Constitution, the related agencies
such as Ministry of Public Health, the Department of Local Government, including other organizations
must solve the problem seriously together to find the best solution.


The objectives of this mixed method study were: (1) to study situation of public health operation of
sub district administration organizations in Nakhon Si Thammarat ; (2) to study role, working process
and outputs of the sub district administration organizations related to development of public health activities; and (3) to identify conditional factors that influenced or hindered implementation of projects for
health development under the sub district administration organizations.
The population of the first phase study was 81 sub district administration organizations in Nakhon
Si Thammarat Province. The data analysis was performed using descriptive statistic. In the second phase
Thakuen sub district administration organization was selected as a case study among sub district administration
organizations and followed by the analysis using content analysis method.
The result of the first phase study showed that most sub district administration organizations were
in medium size. Most of the public health officers were untitled personnel of the manager offices (43.2%),
followed by community health development workers (35.8%). In terms of health projects, the most common
type was those for prevention and control of dengue fever (92.6%). The most successful projects were
those concerning surveillance and solving of problems of malnutrition, supporting to health centers for
their curative care services and supplying of essential drugs to community centers for primary health
care. All successful health projects (100%) were found to have promoting factors as cooperation of the
various organizations in the community such as community health volunteers and health clubs (80.25%).
The main obstacles were lack of knowledgeable, human resources and funding.
The results of the second phase of the study showed that the beginning point of public health development
by the sub district administration organizations was when they enrolled in local community health
fund. The working process was jointly carried out by sub-district administration organizations, local health
centers, community health volunteers, and health clubs. The main factors for successful health development
were team leadership, team working, strong community health volunteers and general public involvement.
Enabling factors are public-mind consciousness and open-mindedness of the public health
staff. The problems and obstacles were lack of experience in community health fund and the indifference
in health by some groups of the people.


The purpose of this study was to evaluate the service to patients with appendicitis among three
schemes: Universal coverage scheme: UCS, Social security scheme: SSS and Civil servant medical benefit
scheme: CSMBS. 401,322 records of in-patients during 2005 -2008 were utilized, and analyzed by descriptive
statistic and logistic regression analysis.
Acute appendicitis admission rate per 100,000 population between 2005 and 2008 showed that it was
highest in CSMBS, 215.4-300.4, while SSS was between 141.6-203.8 and UCS was between 165.9 and 177.6.
The trend was increasing in UCS and SSS, while it was decreasing in CSMBS. Proportion of ruptured
appendicitis to total appendicitis indicated that those of SSS, UCS and CSMBS were 12.5%, 18.2%, and
18.5% respectively. In addition, ruptured appendicitis probability were significantly different among three
schemes (P<0.00) which those of SSS and CSMBS had a lower chance compared to those of UCS, 1.48 and
1.38 times respectively. However, the trends of ruptured appendicitis to total appendicitis patients of all
schemes decreased. The trend of mortality rate of appendicitis patient in each scheme had not change
dramatically. It was highest in CSMBS and UCS (0.2%), while those of SSS were 0.02% respectively. With
regard to percentage of acute appendicitis patient receiving appendectomy, it was found that SSS patients
had a highest percentage, 89.4% while CSMBS and UCS were 83.5% and 83.0% respectively. However, the
trend of those having acute appendicitis receiving appendectomy in all schemes had been increasing.


The objective of this study was to compare the awareness, attitude and behavior on weight control of
the population before and after their attendance of the Camp for Eradicating Obesity and Belly Program
and the Weight Control Program. The study also took into consideration the efficiency of attending the
programs as one of the determining factor. The study design was the quasi-experimental research, which
studied obesity and health problem of the attendees before and after they had attended both programs.
The selected samples included 40 people who attended the Camp for Eradicating Obesity and Belly Program,
operated by Viseschaichan Hospital, and other 40 people who attended the Weight Control Program
of the Department of Health, operated by Pamok Hospital. The methodologies used in this research
were descriptive analysis, statistics pair t-test and the Pearson Product moment Correlation Coefficient. The study results for both programs shown an increase in awareness, positive attitude and weight
control efficiency. Meanwhile, blood pressure, body weight and waist circumference were decrease and
were significantly different prior to their attendance of both programs at p < 0.05. The samples who attended
the Camp for Eradicating Obesity and Belly Program could reduced weight 87.5 and 77.5 % by 8
and 16 weeks, while those who attended the Weight Control Program of the Department of Health could
reduced weight 65.0 and 67.5 % by 8 and 16 weeks accordingly. By week 16th, the studies found that the
unit cost of attending the Camp for Eradicating Obesity and Belly Program was 4,489 baht, while the
Weight Control Program was 3,518 baht. However, in order for the attendance to lose weight effectively,
the cost-effectiveness for the Camp for Eradicating Obesity and Belly Program and Weight Control Program
were 5,793 and 5,212 baht per person, respectively. The result of this study suggested that the Camp
for Eradicating Obesity and Belly Program was more effective but not appropriate to used in weight
control of large group population because of its high cost. The Weight Control Program of the Department
of Health had lower unit cost and consequently, was more practical due to its cost-effectiveness.


Analysis of administrative data between 2008-2010 from the Comptroller’s General
Department, National Health Security Office, Social Security Office and Ministry of Public Health
found that accessibility to health care of Thai Elderly people in 2010 was better than previous
fiscal years. However, coverage of prevention services still low in the elder group. Compare to
other age groups, elderly people had higher utilization rate of annual physical checkup, outpatient
visits (6.3 visit per person per year) and in-patient-visits (0.23 visit per person per year).
There were inequity on access to health care among different age-cohort, geographical regions
and different social health protection schemes. Elderly people had higher utilization rate until
the age around 75 years old. Then their access to health care gradually declined. Analysis for
Preventable Admission of the year 2010 is lower than previous fiscal years. This indicator
showed that performance of primary care was better than previous years. Regarding statistic of
admission for length of stay at least 2 months, nearly 40 percent of this admission type was
occupied by elderly patients. Elder beneficiaries of the Civil Servant Medical Benefit Scheme
(CSMBS) shared 72 percent of all CSMBS’s patients who stayed in hospitals at least 2 months.
This is an indirect evident for need of system of intermediate care and long term care, which do
not exist in current Thai health care system. Total expenditure of social health protection
schemes in 2010 was 0.64 percent of GDP.
Forecast of health care expenditure of social health protection schemes during 2011-
2022 was performed using actuarial model, which include assumption of demographic and
macroeconomic development during that period. Changing of demographic structure from
elderly society plays minor role on the future health care expenditure. Technology change and
inflation are key cost drivers. Health care expenditure of the social health protection schemes at
the year 2022 in status quo will be 1.1 percent of GDP. Sensitivity analysis for expansion of
utilization and unit cost of services showed that total expenditure will increase to 1.4 percent of
GDP. Aggresive cost containment measures may decrease heath care expenditure to 0.8
percent of GDP. Better health status also reduces health care expenditure to 1.0 percent of
GDP. Health care performance indicators for elderly people have been developed using
systematic review, gray literature review and result from administrative data analysis. Three
dimensions of indicators are identified, health care production process, health care function and
burden of diseases. Many indicators were dropped due to lack of accurate or reliable data.
Finally, 9 indicators were identified for the first version. More indicators will be included into the
next version if data is available.
In conclusion, Trend of health care performance for elderly care is better compare to
previous year. However, fragmented and incomplete data is a main problem of this study.
Interpretation of the detail result of the study has to be careful. This study also showed
possibility to establish Information of health care performance at Country level, which needs
systematic and official arrangement with continuous effort to guarantee the comprehensive and
accurate data


การเก็บรักษาและขนส่งวัคซีนที่ไม่เหมาะสมจะส่งผลให้เกิดการเสื่อมสภาพของวัคซีนได้ ฉะนั้น
การบริหารจัดการระบบวัคซีนจึงต้องการระบบห่วงโซ่อุปทานและโลจิสติกส์ที่ดี เพื่อเป็นหลักประกันที่จะได้
ผลิตภัณฑ์ที่มีคุณภาพ ระบบห่วงโซ่อุปทานและโลจิสติกส์ดั้งเดิมของการบริหารจัดการวัคซีนแห่งชาติมี
แนวโน้มด้อยประสิทธิภาพอันเนื่องมาจากมีขั้นตอนจำนวนมากในการกระจายวัคซีน ทำให้เกิดความ
สูญเสียอันเนื่องมาจากวัคซีนหมดอายุ จนกระทั่งเดือนมีนาคม ๒๕๕๒ ได้เริ่มมีการนำระบบการบริหาร
คลังสินค้าโดยผู้ขาย (Vendor managed inventory; VMI) มาใช้ทดแทนระบบเดิม และขยายการ
ดำเนินงานไปทั่วประเทศในปลายปี ๒๕๕๓ วัตถุประสงค์ของระบบ VMI คือการทำให้การดำเนินงานห่วง
โซ่อุปทานมีความกระชับคล่องตัวมากขึ้นทั้งผู้จัดหาและลูกค้า ทำให้ระบบมีประสิทธิภาพมากขึ้น ซึ่ง
รวมทั้งการลดความสูญเสียของวัคซีน (vaccine wastage)
สถาบันวิจัยระบบสาธารณสุข ร่วมกับองค์กร PATH และองค์การอนามัยโลก จึงมอบหมายให้
คณะเภสัชศาสตร์ มหาวิทยาลัยมหิดล ดำเนินการโครงการวิจัยเพื่อให้เข้าใจระบบห่วงโซ่อุปทานของวัคซีน
ของประเทศมากขึ้น และได้แนวทางในการเพิ่มประสิทธิภาพของระบบ วัตถุประสงค์เฉพาะได้แก่ การ
ประเมินผลการดำเนินงานของระบบ VMI เปรียบเทียบกับระบบเดิม รวมทั้งต้นทุน และข้อเสนอในการ
พัฒนาระบบ การศึกษานี้เก็บข้อมูลระหว่างเดือนมีนาคม ๒๕๕๓ ถึง กรกฎาคม ๒๕๕๔ ในพื้นที่ ๑๒
จังหวัด ได้แก่ อ่างทอง สระบุรี ตราด กาญจนบุรี สุรินทร์ เลย อุบลราชธานี อุทัยธานี พิษณุโลก ลำพูน
พังงา และตรัง โดยใช้วิธีผสมระหว่างการวิจัยเอกสาร และ การวิจัยเชิงสำรวจซึ่งทำการสัมภาษณ์ทั้งระดับ
ผู้บริหารและผู้ปฏิบัติ รวมทั้งการวิเคราะห์ทางเศรษฐศาสตร์
การศึกษาครั้งนี้พบว่าการดำเนินงานระบบ VMI ประสบความสำเร็จ ผู้มีส่วนเกี่ยวข้องกับระบบ
การจัดการวัคซีนประเมินว่าการเปลี่ยนผ่านจากระบบเดิมเป็นระบบ VMI เป็นไปอย่างน่าพอใจ ปัญหาที่
พบในช่วงแรกของระบบ VMI ได้รับการแก้ไขไปได้ด้วยดี เทคโนโลยีสารสนเทศที่มีการนำมาใช้ในระบบ
VMI อยู่ในระดับน่าพึงพอใจและสามารถพัฒนาให้ระบบมีประสิทธิภาพยิ่งขึ้นได้
การวิเคราะห์ทางเศรษฐศาสตร์เพื่อเปรียบเทียบระบบทั้งสอง พบว่า ระบบ VMI มีการใช้
ทรัพยากรอย่างประสิทธิภาพกว่าระบบเดิมจากการที่สามารถลดต้นทุน และลดปริมาณวัคซีนในระบบ
ประมาณหนึ่งในห้า ในปีแรกของการดำเนินงาน
จากผลการศึกษาครั้งนี้สรุปได้ว่ามีปัจจัยหลายประการที่นำไปสู่ความสำเร็จของการเปลี่ยนแปลง
จากระบบเดิมไปสู่ระบบ VMI ของประเทศไทย การเปลี่ยนผ่านเกิดขึ้น มาจากปัญหาของระบบเดิม และ
ประสบการณ์ของการใช้ระบบ VMI ในการกระจายยาเอดส์โดยองค์การเภสัชกรรม การมีโครงสร้างระบบ
บริการสุขภาพและเทคโนโลยีสารสนเทศที่เหมาะสม รวมทั้งการสนับสนุนเชิงนโยบาย ระบบ VMI ได้ทำให้
ระบบห่วงโซ่อุปทานสั้นลง ปรับปรุงการสื่อสาร โครงสร้างพื้นฐาน และเพิ่มขีดความสามารถของบุคลากร
ด้านสารสนเทศ
แม้ว่าระบบ VMI จะประสบความสำเร็จตามที่ต้องการ แต่ก็ยังมีประเด็นที่ท้าทายเหลืออยู่ ผู้มี
ส่วนเกี่ยวข้องได้เสนอข้อบกพร่องหลักของระบบ VMI สองประการ ประการแรกได้แก่ขาดการควบคุม
ขั้นตอนและแผนการการจัดหาวัคซีนขององค์การเภสัชกรรมในฐานะหน่วยงานที่ได้รับการว่าจ้าง ทำให้
เกิดปัญหาการขาดสต็อคของวัคซีนเจอี องค์การเภสัชกรรมในฐานะผู้ผลิตวัคซีนเจอีด้วย ไม่ตัดสินใจซื้อ
วัคซีนจากผู้ผลิตอื่น แม้ว่าวัคซีนในคลังกำลังจะหมดลง เพราะอาจเกรงว่ารายได้ในฐานะผู้ผลิตจะลดลง ใน
สถานการณ์ที่ควร องค์การเภสัชกรรมในฐานะหน่วยงานที่ได้รับการว่าจ้างในการกระจายวัคซีน ไม่ควรเป็นผู้จัดหาและผู้ผลิต เพราะจะเกิดภาวะผลประโยชน์ทับซ้อน ข้อกำหนดที่ควรให้มีอีกประเด็นได้แก่การ
กำหนดค่าปรับในกรณีมีปัญหาไม่สามารถจัดหาวัคซีนได้ตามแผนงาน โดยที่ผ่านมาไม่มีการกำหนด
ปริมาณวัคซีนสำรองในสัญญาว่าจ้างระหว่างสำนักงานหลักประกันสุขภาพแห่งชาติและองค์การเภสัชกรรม
ปริมาณสำรองที่จะกำหนดขึ้นนี้ควรคำนึงถึงความสมดุลย์ระหว่างผลประโยชน์จากการจำกัดปริมาณวัคซีน
คงคลัง และปริมาณสำรองที่จะไม่เกิดปัญหาการขาดแคลน
ข้อบกพร่องประการที่สองได้แก่ บทบาทความรับผิดชอบของแต่ละส่วนงานที่เกี่ยวข้องในระบบ
วัคซีนไม่ชัดเจน บทบาทความรับผิดชอบดังกล่าวได้แก่การสนับสนุนระบบบริหารจัดการห่วงโซ่อุปทาน
โดยรวม ประเด็นทางคลินิกและเทคนิคของวัคซีนและระบบการให้ภูมิคุ้มกัน ในระบบ VMI สำนักงาน
หลักประกันสุขภาพแห่งชาติรับผิดชอบการจัดหาและกระจายวัคซีน โดยที่การกำหนดนโยบายและการ
ปฏิบัติด้านการสร้างเสริมภูมิคุ้มกัน ยังเป็นหน้าที่ของกรมควบคุมโรค อย่างไรก็ดีเมื่อมีปัญหาเกิดขึ้น ยัง
ไม่ได้มีการกำหนดแนวทางการแก้ปัญหาอย่างเป็นระบบ ตัวอย่างเช่นไม่ชัดเจนว่าหน่วยงานใดจะ
รับผิดชอบในการเกิดปัญหาในระบบห่วงโซ่ความเย็น การเปลี่ยนแปลงขนาดหรือชนิดของเชื้อที่ผลิตวัคซีน
หรือการเกิดอาการข้างเคียงรุนแรงจากวัคซีน บทบาทในการประสานงาน ติดตาม และให้คำแนะนำของ
เจ้าหน้าที่ในระดับกรม เขตและจังหวัด ลดลงเนื่องจากต้องไปรับผิดชอบงานอื่นหลังจากการเปลี่ยนแปลง
ไปเป็นระบบ VMI การที่จะลดปัญหาเหล่านี้ ควรต้องกำหนดข้อตกลง แนวทางและขั้นตอนการปฏิบัติงาน
ระหว่างผู้มีส่วนเกี่ยวข้องให้ชัดเจน
ประเด็นที่เสนอแนะเพื่อการพัฒนาระบบ VMI ให้ดียิ่งขึ้นได้แก่
 การเพิ่มประสิทธิภาพของระบบ VMI โดยการปรับปรุงระบบเทคโนโลยีสารสนเทศ ได้แก่
การพัฒนาเว็บไซท์ของ VMI โปรแกรมการบริหารคลังวัคซีน และระบบอินเตอร์เนตที่มี
คุณภาพและรวดเร็ว การขยายระบบเบิกจ่ายผ่านอินเตอร์เนตไปสู่สถานีอนามัยก็เป็น
ประเด็นที่น่าศึกษาในอนาคต
 การปรับปรุงคุณภาพการกระจายวัคซีนระหว่างองค์การเภสัชกรรมและคลังอำเภอ โดยควร
มีระบบการควบคุมคุณภาพ เช่นการกำหนดระบบคุณภาพ และแนวทางการปฏิบัติด้านการ
กระจาย (Good Distribution Practice Guidelines)
 การปรับปรุงคุณภาพการบริหารวัคซีนที่คลังอำเภอและสถานีอนามัย ซึ่งต้องการการอบรม
และการติดตามให้คำแนะนำ
 การขยายระบบสารสนเทศไปยังระดับสถานีอนามัยเพื่อเพิ่มประสิทธิภาพ
 การปรับปรุงระบบการบริหารที่ส่วนกลาง เพื่อให้มีระบบห่วงโซ่อุปทานที่ดีขึ้น การสนับสนุน
ทางวิชาการด้านเทคนิคและคลินิก โดยเฉพาะอย่างยิ่งการกำหนดบทบาทความรับผิดชอบ
ระหว่างผู้เกี่ยวข้อง ได้แก่กำหนดให้กรมควบคุมโรคเป็นผู้จัดการโครงการสร้างเสริม
ภูมิคุ้มกันและกำหนดให้สำนักงานหลักประกันสุขภาพแห่งชาติทำหน้าที่จัดหาและกระจาย
วัคซีน โดยมีองค์การเภสัชกรรมรับช่วงในฐานะผู้รับจ้าง


This study was conducted to evaluate practical guideline manuals for health promoting
hospital in aspects of the level of use, appropriate use and delivery process. Data collection were
collected by self administered questionnaire with directors or staffs of health promoting hospital,
and focus-group discussion with directors or staffs of health promoting hospital and focus-group
discussion with administrative staffs of health provincial office, health district office and
contracting unit for primary care.
Results showed that most of health promoting hospitals received the set of practical
guideline manuals from Bureau of Policy and Strategy, Ministry of Health. The levels of using
each practical guideline manuals were moderate to high, and most of respondents revealed that the
contents in manuals guided them to complete work easily. However, not all contents in these
manuals could be applied in practical. The barriers of using these manuals were the lack of
communication and public relations, and the lack of staffs to work at health promoting hospital.
The finding of this study suggested that the policy of using manuals should be established
and informed to all organizations: health promoting hospital, provincial health office, district
health office and contracting unit for primary care. The monitoring and evaluation should be done
continuously and the knowledge management should be conducted in each area to gain specific
guidelines for area.


There is a notion saying “the most reliable prediction of the future is to build it”. This synthesis of
tacit and explicit knowledge in shaping referral network of health services in the upper north of Thailand reflects collective actions among doers of the region in accord with such a notion. The actions started from
a health manpower crisis of the former single node of referral chain in 2006 characterized by draining of
almost 300 nurses instantly from the node hospital to private hospitals after dramatic increased workload
without perceived competitive adjustment of financial incentives. The crisis forced the node hospital to
shift its policy of hospitalizing referred cases from unlimited to a limited quota. Joint coordinating and
collaborating mechanisms among networks of public and private hospitals were set up under the jurisdiction
of public health administrative region no. 15. The mechanisms facilitated 1) restructuring roles and
functions of the hospitals into zones of referral chains each with a node and sub-nodes; 2) capacity building
of public hospitals under the restructured zones; 3) planning of human resources, service delivery and
upgrading of facilities including buildings, medical equipment and communication technology through
public and private subsidies; 4) adjustment of payment mechanisms to mobilize previously untapped
capacity i.e., specialized cares of private hospitals; neurosurgery of a public hospital which previously
excluded emergency cases. During 2008-2010, evidence has shown a decline in the number of referred
cases being turn away; better access to standard care such as thrombolysis for acute STEMI, traumatic
brain surgery; neonatal care. Strengths and weaknesses were discussed. Finally, opportunity for future
improvement of continuity of care within the referral network was identified in terms of relational, informational
and managerial continuity.


Recently, rate of medical malpractice claim and file a law suit on the medical adverse events are
increasing. The primary etiology of claims and filing were adverse medical events which caused by either
preventable medical error or mishap. No one wants adverse event occurred. In the past ten years after the
Institute of Medicine (IOM) reported the facts of medical errors in “To Err Is Human: Building a Safer
Health System”, health care personals have been deeply concerned with and have tried to improve their
practice for patient safety worldwide. However, there are still many medical errors in recent years and
will inevitably occur in the future. So, health care providers should learn how to manage and disclose
when the medical errors occur. Several studies have proved that disclosure of medical error have taken
more benefits than risks. The main benefits are decreased in filing rate, decreased in payments for adverse
events, and maintenance of doctor and patient relationships with trust. Disclosure of medical error is the
process which closely related to the incident report system. The importance of full open disclosure to the
patient after medical error occurrence will significantly increase in the future for patient’s safety and
should be simultaneously integrated into the mediation system.


Doctor shortage has long hindered the development of Thai health service system. It is thus crucial
to understand attitudes towards working and living in rural areas and factors driving job of choices of
doctors. The cross-sectional study conducted with 1,219 newly gradated doctors in 2011 was conducted.
Self-administered questionnaire comprising individual characteristic information, questions on attitude
towards working and living in rural areas, factors affecting their jobs of choice was used. Statistics used
were percentage, and Logistic regression.
The results showed that of the population 1,219 (527 from normal track and 313 from rural doctor
track), the majority of doctors were female. Half of the rural track doctors were from regional areas, and
the majority graduated from regional universities. Whereas, the majority of normal track doctors were from Bangkok and vicinity, and graduated from universities located in Bangkok and vicinity. Factors were
likely to affect their job of choices were workplace that : close to their hometown, enhance their learning
experience, provide case consultancy. With regards to their intention to work, few of them intended to
work at rural areas after 3 year and factors associated with their intention to work in rural areas were:
rural background and regional training.


As a crucial component of a health system, the shortage of health workforce could deteriorate health
outcomes. Though newly graduated physicians entering the rural areas every year, the turnover rate of
rural physicians was as high as 11% of rural physicians. It is thus crucial to explore strategies to attract and
retain physicians in rural areas. This study was a cross sectional study with 255 physicians serving in
years 1-3 from 9 provinces included in the sample. Job preference was assessed using the Discrete Choice
Experiment (DCE) method, which involved asking subjects to indicate their preference between 2 hypothetical
jobs, one rural and one urban. Each job was characterized by 7 job attributes. A total of 211 physicians
responded, with females (57.8%) responded slightly more than males. The majority of subjects was
from an urban background (83%), and graduated from a regional university (63%). There were 24% of physicians under the rural recruitment project. In relation to their job preference, all attributes were found
to be statistically significant in determining the decision to choose a job in a rural area. The results showed
that high salaries, workplace close to hometown, small hospital size, less overtime work, opportunities
for specialty training and faster career promotion were important for young physicians to choose rural
posts.
The results suggested that the combinations of salary increase, specialty training opportunities, reduce
overtime work, and accelerated promotions seem to be good policy candidates to attract and retain
physicians to rural areas.


The study is aimed at evaluating the recent effects of increasing hardship allowance paid for dentists
who are particularly working in community hospitals. The focused effects were 1) distribution and retention
of dentists; 2) hospital financial status; and 3) performance and productivity of dental workforce. Overview data was collected from many secondary sources such as dentist personnel database and payment
during 2005-2009; dentist mobilization from personnel management database (2008-2010); and dental
service outcome database in 2008 compared to 2010. Primary data included surveying hospital finance
during 2008-2010 using self-reported questionnaire to 725 hospitals and then interviewing a group of 7
senior inspectors in the Ministry of Public Health. The result was revealed that financial measure was
likely to have no impact on distribution pattern or retention of dentist workforce as the mobility found
was mainly from remote areas to rural areas with better social amenity. Regarding community hospital
financial status, paying hardship allowance showed no effect because a budget of 2,750 million baths was
subsidized by the government in 2010. Lastly, comparing performance outcome between 2008 and 2010, it
was found that oral health promotion activities by dental hygienists in 2010 was pushed up to 707 cases/
personnel per annual, while basic dental service performed by the dentist showed no difference in their
productivity.


As the health needs increased, health workforce requirements have been increased too. However,
the policy to downsize the civil servant positions implemented has made the Ministry of Public Health
failed to attract and retain health workforce into public health facilities. This study therefore aimed to assess the factors affecting the health workforce’s decision making in choosing public health facilities as
their job of choices. A Discrete Choice Experiment (DCE) tool was used and that each health workforce
was asked 16 questions to choose between 2 jobs which have different attributes. The data were analyzed
by conditional logistic regression.
The findings showed that both financial and non-financial incentives played important roles in health
workforce decision making to choose their job of choices. Benefit packages that were significantly associated
to their choices of non-civil servant positions were: salary increase at 20%-40%, career advancement,
opportunity for continuing education, bonus provision, pension fund and a longer employment contract.
The results indicated that the government needs to develop the appropriate employment packages that
could attract health workforce in public sectors. The attractive benefit packages comprise: higher salary,
career advancement, opportunity for continuing education, bonus provision, pension fund and longer
employment contract. These packages could be attractive for health workforce to choose to be hired as
non-civil servants.


One of the factors that contribute to obesity in children is food advertisement because it can influence
the eating behaviour of children. Advertising is a marketing strategy to build brand recognition of food. The goals are to promote the product and increase children’s food consumption. . The objectives of
this survey research were to assess the recognition of brand logos among students in primary 6and to
examine the relationship between individuals’ abilities to recognize brand logos and their demographic
eating behaviour. Methods: There were 453 children from two primary schools in Bangkok and in
Phetchaburi joined in this study by purposive sampling. A self-administered questionnaire survey was
administered to gather demographic characteristics, nutrition, and their abilities to recognize brand logos.
This study found that 64.7% (239 students) of the children demonstrated a high brand logos recognition
recognizing 14 food brand logos in the questionnaire. Among these children, the number of children who
ate unhealthy food; consumption of snack, fast foods, and soft drinks was higher than those who ate
vegetables and fruit. In addition, BMI, parent’s educational level, mother’s occupation, habit of eating
breakfast every day, eating snacks and, fast foods were associated with the abilities to recognize brand
logos. To conclude, there is a correlation between poorer eating behaviours and brand logos recognition
ability of school children. However, health promotion campaign should be emphasized among school
children to increase their awareness of how unhealthy eating habit can affect obesity


This study was conducted to learn of the changes that had occurred during the five-year period of
the transfer of subdistrict (tambon) health centers to Tambon Administrative Organizations (TAOs) and
municipalities. Both quantitative and qualitative data were collected from primary and secondary sources;
and then data were processed and policy recommendations were synthesized for submission to highlevel
administrators of the Ministry of Public Health (MoPH) and other relevant agencies in the next phase. Documentary review was conducted on program implementation documents of agencies concerned,
various evaluative research papers, and reports on program monitoring and evaluation carried out continuously
by administrators of the local government organizations (LGOs), the transferred health officials,
and the people who had received health services from the health centers before and after the transfer,
and the participatory observation of the transfer process especially to the LGOs as the management
agencies. The results in the three dimensions are as follows: (1) The progress of the transfer, over the past
five years, have shown positive changes in most of the local health programs as their services are responsive
to the needs of the communities. Of all 26 transferred health centers, only 2 health centers had only 1
health official transferred to each of them, which was too few and the recruitment of additional staff by the
local agencies was constrained by the local context. (2) The lessons learned from transfer with regard to
specific cases and overall common lessons are the information that can be used for consideration for
policy and operation improvements. (3) The policy recommendations for MoPH and the Office of the
Decentralization to Local Government Organizations Committee (DLOC) regarding the options of transfer
are: (a) transfer in the old pattern, but with the revision of criteria, conditions, and process to prevent
negative effects; and the roles and responsibilities of relevant agencies have to be made clearer by an
independent mechanism; (b) the new model of transfer, i.e. MoPH has to take this matter seriously especially
in the pilot-scale decentralization and the synthesis of lessons learned; and the DLOC has to have a
strong and adequate support mechanism and procedures; and (c) non-transfer but working together
collaboratively by MoPH and LGOs with clearly specified roles and responsibilities.


Role of community pharmacies for caring chronic disease patients together with primary care units is still new in Thailand. The objective of this study was to compare clinical outcomes of providing pharmaceutical
care in patients with diabetes mellitus and hypertension who got prescriptions refilled between
two accredited community pharmacies (the intervention group) and two primary care units (the
control group). The study was quasi-experimental design with a control group. The duration of the study
was between September 2008 - July 2011. The intervention group received the individual care each month
for 5 months by the community pharmacists and PharmD students. In the fifth month at the community
pharmacies, the patient medication record of each patient was reported back to the primary care units.
Blood pressure, blood sugar, drug related problems and patients’ satisfaction were recorded. There were
totally 59 eligible patients (28 and 31 patients in the intervention and the control group, respectively). The
proportions of patients who achieved target goals of blood pressure control and blood sugar control were
1.242 (OR 1.242; CI: 0.458-4.312) and – 0.675 (OR 0.675; CI: 0.174-2.653) when compared with the control
group. There was not different between groups. The community pharmacists mostly solved the drug
related problem of non-adherence in the treatment group (81.8 %) and made a referral to the primary care
units due to an adverse drug event (bradycardia was probably from atenolol). The treatment group was
highest satisfied with the relax feeling to talk to the pharmacists. The control group was highest satisfied
with the willing to comply for the next schedule. In conclusion patients received prescriptions refilled
from accredited community pharmacies have potential clinical benefits as received from the primary care
units. Patients in the treatment group had a high satisfaction to the pharmacists’ service


Cold weather is one of causes that can be effected to higher morbidity and mortality in Thai citizens.
Hypothermia condition can lead to a dangerous of the brain and heart. A cross-sectional study aimed to
monitor trend, described characteristics of the deaths, identified risky behaviors and risk factors of coldrelated
to death for future planning in assistance to the victims. The guidance, definition of cold-related
deaths and reporting form have been developed for the surveillance system. The results showed that total
number of 30 deaths and suspected cases related to the cold weather had been reported from 21 provinces.
Out of these, 2 from Lei and Chiangrai province were confirmed for cold-related deaths. Most of them
were male (86.7%), mean age was 49 years, 30.1% were elderly (> 60 years). 40.0% were indoor deaths
whilst the others were outdoor deaths. The major risk factors were exposure to cold weather combined
with alcohol drinking, having underlying diseases and wearing clothing that could not prevent cold weather
(60.0%, 53.3% and 83.3% respectively). The above results can be beneficial to the health care guidance,
providing appropriate assistance to the risk group such as children, elderly or people with underlying
diseases including health service, referral system and provide warm clothing in order to decrease coldrelated
mortality.


The study is part of continuous review of the Ethics Committee. The objective of the study is to
follow up the adherence of the research proposals approved by the Ethics Committee of the Institute for
the Developments of Human Research Protections (IHRP). Methods: All the studies approved during the
year 2008-2010 were randomized by stratified random sampling. The sample size is 20 from the total of
197 studies. The relevant documents were revised and the researchers were interviewed. The data were
analysed by percentage. Findings: Majority or almost all of the studies adhered to the approved protocol,
i.e., volunteer recruitment, information provision and consent process, submission for protocol amendments,
documentation in case of protocol deviation, keeping and control of studied drugs, provision of
compensation for the volunteers, keeping of confidentiality, data record and the operating procedure in
case of termination of the study. Conclusion: The studies that strictly adhere to the research protocol are
those drug studies, including both new drugs and bioequivalent studies. The main reason for good adherence
is to maintain the credibility of the data, otherwise it will not be accepted for drug registration. Some
studies that were not fully adhere to the practice guidelines for drug studies were social science studies.
Since there was no appropriate guidelines available. The operational guidelines for social science studies
should be developed.


Back ground: Valvular heart disease, a chronic illness with high mortality rate, is difficult to treat
and prone to complications, especially from warfarin. In 2009, before implementing the network of care in
Health region 13, we found that about 50 cases of total 217 cases (23.04%) had been brought back to the
hospital due to warfarin using. Because of this problem, the network of care for warfarin use has been set up in January 2010 to look after these patients for continuity of care and to maintain wafarin level. Objective:
To study the result of implementing network of care for post-operative valvular heart disease patients
who use warfarin. Setting: Health region 13 Method: The study is divided into 3 phases;1) situation
analysis 2) developing network of care guideline and 3) implementing and evaluation. The data were
collected during January to March 2009 by questionnaire, depth interview, observation and focus group
discussion. A descriptive statistic and content analysis were used to analyze the data.
Result: During January to March 2009, only 9 patients (8.11 % & 0.48% of post operative patients & of
1,881 patients who use warfarin during that time respectively) came back to the hospital due to warfarin
using ( 5 due to overdose & 4 due to valve dysfunction ). From 15 committed hospitals, 13 hospitals were
ready for implementation, 9 & 4 were community hospitals & general hospitals respectively. Conclusion:
The network of care with guideline, monitoring and supervisioon can improve the quality of life by decreasing
the complication of warfarin use.


Drug price control is one of the measures to contain health care costs. This paper briefly reviewed
the price control methods that have been commonly employed in developed countries. Experience in controlling drug prices by government agencies in Thailand was analyzed and recent findings from the
Research Projects on Drug Prices (B.E. 2553-2555) that have been supported by the Health Systems Research
Institute were summarized. Policy recommendations for the control of both purchased and reimbursed
prices were additionally proposed. The National Lists of Essential Medicines should be strategically
mobilized as an indirect measure of price control. To control the purchased prices of new drugs,
innovative strategies of pool purchasing and price negotiation should be implemented under collaboration
with health insurance funds. Routine monitoring of the hospital-purchased prices should be supported
so as to obtain the regular and update information on drug pricing. The reimbursed price of a
generic drug that is covered by the National Lists of Essential Medicines should be set at an adequately
high rate that can incentivize the use. An agency for the development and maintenance of standardized
drug databases should be established. The long-run development should include the price monitoring
infrastructure in every step, from essential drug selection, drug purchasing, utilization and reimbursement.


People living in urban areas are growing; therefore, urban primary medical care is more crucial.
Studying urban primary care systems in various countries will make us learn from best practice in each
country which may be applied to Thai urban medical system. Objectives of this study were to analyze and
compare urban primary care systems among each country. Study design was documentary research about
urban primary care systems in 14 countries including Brazil, Canada, Spain, Cuba, Republic of Korea,
Japan, Taiwan, Hong Kong, Denmark, Sweden, Belgium, United Kingdom, United States of America, and
Australia. Primary Care Evaluation Tool (PCET) of WHO European Region was used as a framework for
analysis. From this study, countries with gatekeeper system (patients were screened by general practitioners
or family physicians ) had good continuous, collaborative, and coordinate care with appropriate
health care costs. Most of countries which governments spent budget for people’s medical care expenses
had provided general practitioners or family physicians as gatekeepers acting in patients screening. There
was no gatekeeper system in countries which people were responsible for their own medical care expenses
but co-payment system was involved to reduce unnecessary service uses.


This study focused on a review of the national system for drug price policy. Methods including
interviewing key persons in various organizations, meetings with experts, studying related documents
and literatures, were used. The study revealed that Ministry of Public Health (MOPH hospitals) had several
indirect drug price control mechanisms for government sector especially for the MOPH hospitals themselves. Drug price control has been started in the process of national essential drug list (ED) selection.
Cost effectiveness and budget impact analyses were parts of the consideration criteria. After drugs
were selected as the ED, median price would be set as the price control measure for procurement process
of MOPH hospitals. In addition, central negotiation was used for controlling price of single source nonessential
drugs in MOPH hospitals. National Health Security Office takes the leading role in price negotiating
of high cost ED to ensure accessibility for their beneficiaries. However, limited items were negotiated
in each year. Group purchasing in level of provinces and regions was not much expanded from the
past.
There exists no autonomous body and no regulation for controlling of manufacturer price setting
before drug registration processes. No regulation and system for controlling mark up in private sector
have been implemented. Selling price was controlled to not more than price list. For drug price monitoring,
only voluntary reporting of MOPH hospital purchasing price was available under the Drug and
Medical Supply Information Center (DMSIC).
As the ways to improve drug price control system in Thailand, manufacturer production cost structure
should be submitted as the condition for national essential drug list consideration. In terms of negotiation,
knowledge management of negotiation and purchasing strategies, expanding of items for central
negotiation for all three health insurance schemes are encouraged. Drug price setting for procurement
and a monitoring system should be improved. Moreover, a study on adverse effects of drug price control
system on domestic pharmaceutical industries is necessary.


Rational drug use would lead to sustain health care financing. Currently, most hospitals have prescribing
data recorded in standard electronic databases. However, an analysis of these electronic data-bases providing a performance feedback on quality of prescribing is limited. The analysis algorithms to
assess prescribing indicators for 18 standard files on out-patient services using SQL program were developed.
Pharmacists and computer staff from 134 hospitals voluntarily attended the 3-day training sessions.
We reported the results of analyses of fiscal year 2553 data of the 88 attending hospitals. The information
presented could be used to guide not only health care settings, but also health policy makers, in terms of
rational antibiotic prescribing for common cold and diarrhea, inhaled coticostroid (ICS) prescribing for
asthma patients, and angiotensin converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers
(ARBs), and statins prescribing for diabetes patients.
More than half of hospitals had greater than 50% of oral antibiotic prescriptions in common cold,
and quinolones prescriptions in non-infected diarrhea. ICS prescriptions in asthma patients, and ACEIs/
ARBs and statins in diabetes patients were moderately prescribed. However for the latter two conditions
high variations across hospitals were found. The findings urge that all hospitals should promote analysis
of the hospital electronic database to obtain the feedback information, which in turn can guide the implementation
of activities to increase quality of prescribing, at least for the reported conditions.


Background: There are many effective drug pricing systems which Thai Government should employ
to solve drug pricing problems especially at the reimbursement level. This research focuses on a
comparison of budget saved by the payer after the application of different drug pricing measures at the
reimbursement level.
Methods: This was a quantitative research. The budget impact analysis modeling to estimate the
budget saved from the pricing policy implementation was employed.
Drugs belonged to the group HMG-CoA reductase inhibitor (statins) were purposive sampling to be
the sample for the budget impact analysis. They were divided into 3 groups and the sample of each group
was shown in the bracket: 1) Innovative drug with therapeutic improvement (Rosuvastatin), 2) Innovative
drug with technical improvement (Amlodipine+Atorvastatin), and 3) Innovative drug with Generic
drug (Atorvastatin).
Drug pricing measures assigned for each drug groups were 1) Price Volume Agreement, 2) Value
Based Pricing, 3) Maximum Allowable cost, and 4) Reference pricing.
Results: In terms of budget saving for: 1) Innovative drug with therapeutic improvement group:
Reference Pricing measure saved more budget than Price Volume Agreement. 2) ) Innovative drug with
technical improvement group: Value Based Pricing measure saved more budget than Price Volume Agreement.
3) Innovative drug with Generic drug group: Reference Pricing measure saved more budget than
Maximum Allowable Cost.
Discussion: The magnitude of saving in each measure depends on the factors such as percentage of
drug rational use, numbers and prices of drugs available in the market, and availability of local made
drugs.
Conclusion: There are many effective drug pricing measures which can be used to reduce the reimbursement
budget. The government should place the right measure to each drug to gain its most benefit.


Total drug expenditure for Civil Servant Medical Benefit Scheme (CSMBS) has rapidly increased.
Reference pricing (RP, or maximum reimbursable limit) for drugs is proposed as a means to control drug
expenditure. The objectives of this study were to determine the RP of five high expenditure drug groups
and estimate the budget impact of RP implementation. Prescription records of 29 public hospitals in 2010
were collected. Drug utilization and several RP’s of each drug product were determined. Then, overall
budget impact was determined for RP under three different scenarios.
Results showed that there were 1.7 million prescriptions, accounted for 2.5 billion baht. By drug
group, total number of prescriptions were 39.96%, 26.25%, 16.57%, 13.68% and 3.55% while total expenditures
were 44.65%, 20.43%, 20.59%, 4.47% and 9.85% for statins, Proton Pump Inhibitors (PPI), Angiotensin
Receptor Blockers (ARB), Angiotensin-Converting Enzyme Inhibitors (ACEI), and Bisphosphonates
(BIS) respectively. Brand name drugs accounted for 94.8% of expenditures but 50.6% of prescriptions. If
RP was implemented, the highest savings (50.39% of expenditure) would be from pharmacological substitution
(eg. price of Atorvastatin is equal to median price of generic Simvastatin). Generic substitution
(median price of generic for brand Simvastatin) would result in 20.56% savings while 15.91%-17.26%
savings would be achieved if brand drugs were reimbursed at cost plus 50 or 30 baht dispensing fee per
item respectively.
Use of high price, brand drugs has burdened the overall drug expenditure of government hospitals.
Reference pricing would encourage generic drug use and thus, help not only to control overall expenditure,
but also strengthen the local manufacturing drug industry.


This qualitative research used purposive sampling through in-depth interviews from main caregivers
whose severe ex-thalassemic children underwent successful hematopoietic stem cell transplantation (HSCT). Participated caregivers were interviewed using a semi-structured questionnaire based on openended
questioning and tape-recorded after receiving their informed consent. Transcripts of the interviewed
were created verbatim and examined using content analysis.
Results revealed that HSCT treatment procedure requires comprehensive understanding and cooperation
from patients and their families. Economic household burden is the main hindrance for accessibility
toward this service owing to its high direct non-medical costs as well as service charges although
HSCT can be reimbursed from all Thai health insurance schemes.
It is very crucial to prevent new thalassemic cases in order to alleviate the impact on the resource
allocation for treating a preventable disease in both household and public sectors. Therefore, public health
policy makers should consider creating a disease awareness campaign among citizens as well as healthcare
personnel who should have the comprehensive understanding about potential obstacles of the patients or
families and should commit to perform more effective thalassemia screening and prevention both in policy
and routine practice aspects.


The Statue on National Health System B.E 2552 section 7, the health system must promote human
value and dignity and attach importance to fairness and equity in society. This concept leads to an attempt
to capture interaction between providers and users in order to improve and develop the health service
system. Every person should be treated equally even though he/she accesses to care under different health
insurance schemes and hospital types. The purpose of this research was to assess the responsiveness of
Thai health care service system according to different types of national health insurance schemes and
health care facilities in 9 provinces. An exit survey of 6,507 out-patients covered by 3 health care schemes:
Civil Servants Medical Benefit Scheme (CSMBS), Social Security Scheme (SSS) and Universal Coverage
Scheme (UCS), was conducted. The health care settings included 4 hospital types: regional/general hospital,
community hospital, university hospital and private hospital. The field survey period was from April
to June 2011.
The study revealed that there were significant difference between median scores, both overall and
hospital-type based, of responsiveness to users among three schemes in some domains and responsiveness
scores under the CSMBS was higher than those from the SSS and UCS. Nevertheless, results from
logistic regression show that, when 75 percentile of score of each component was adopted as cut point for
high responsiveness, health insurance scheme was not significantly associated with all responsiveness
components, except choice: the scores of the CSMBS was significantly higher than those of the UCS. On
the other hand, type of hospital was significantly associated with responsiveness in all components. Overall,
the score of private hospital was significantly higher than those of the others, whereas that of the
university hospital was significantly lower than the scores of the other hospitals, except choice, which was
significantly higher than in the university hospital than in the regional/general hospital.


The collaborative project to increase rural doctors (CPIRD) has been implemented since 1995. This
study therefore aims to assess whether the medical graduates trained by the CPIRD project were retained in rural areas longer than those trained by regular training project.
The total of 1,093 CPIRD medical graduates and 6,064 medical graduates from regular training project
during 2001 - 2007 were included. The data was traced back from 2001 to 2010 in relation to their mobility.
Survival analysis was used for data analysis.
The study found that at the 4th year of their work, 69% of CPIRD medical graduates were retained in
the Ministry of Public Health (MoPH) compared to 59% of those trained by regular training project were.
Harzard ratio was 0.66 (p<0.001) and it indicated that normal track medical graduates had a probability to
resign from the MOPH 1.5 times than that of the CPIRD, significantly. After 3 years of public compulsory
work ended, 52% of CPIRD medical graduates were retained at rural hospitals while 47% of the normal
track medical graduates were. Harzard ratio was 0.88 (p= 0.001) and it indicated that normal track medical
graduates had greater chance to move out of rural areas 1.14 times than that of the CPIRD ones, significantly.
The median survival time in rural of the CPIRD medical graduates was declined from 10 years to 4
years, comparing to that of the normal track medical graduates that was declined from 6.5 years to 3 years.
Although physicians under the CPIRD project have higher rural retention, the median survival time
in rural had declined over 10 years and it become close to that of the normal track physicians. The trends
indicated that the improvement of the CPIRD project is needed in order to attract and retain more physicians
in rural areas.


This study aimed to assess the impact of a financial measure on public and rural facility retention of
physicians in Thailand. It used a retrospective approach using secondary data from the Ministry of Public
Health (MoPH). The study population included all physicians who graduated and entered the workforce
during 2001-2007, and the data were retrieved from 2001-2011. Survival analysis was used.
Results showed that the high turnover rate of young physicians was still persistent. Large proportions
of physicians, at about 30%, resigned before the 3-year compulsory contract ended, and this trend
repeated even after the financial measure was implemented. Resignations from MoPH have increased
since 2001, and the rate remained high after the increase of special allowance. Rural retention was low,
especially after 3 years of compulsory public services. The proportion of physicians retained in the rural
area after the 3-year compulsory period was about 20-24%, and this trend repeated even after implementation
of the financial measures in 2009.
The results suggested that to retain physicians in the rural area we need both the financial and nonfinancial
measures in an appropriate combination. Non-financial measures such as, working close to hometown,
opportunities for specialist training, improvement of work environment and infrastructure would
be important for rural retention of physicians as well.


Medical council is the core component of health system governance and the regulatory body of
medical profession in many countries. In the case study of the medical councils in the United Kingdom,
New Zealand and South Africa, they have development and changes from time to time so as to protect,
promote and maintain the health and safety of the public and to keep the public trust and confidence. The
study is a qualitative and documentary research and aims to study the philosophy, conceptual framework
and the role of these medical councils as an organization regulating the medical profession, and to propose
the good governance to be applied to the Medical Council of Thailand as appropriate.
The results showed that Medical Councils of these countries have good governance mechanisms, especially,
the General Medical Council (GMC) in the UK which is the model of the Medical Council of Thailand.
The reform or changes of the these medical council have been developed with its aims of effective,
accountable with greater patient and public involvement and with faster, fairer and more transparent
procedures in making decisions on fitness to practice of alleged physicians.


Cigarette smoking is one of the most important causes of chronic diseases and immature deaths
globally which has led to numerous epidemiological studies conducted to identify the association between
smoking and various types of diseases. The objectives of this study are systematically review existing
epidemiological literature on cardiovascular risk from smoking and to synthesize a pooled relative
risks based on meta-analysis of those literature. Review protocol has been developed to identify relevant
and comprehensive keywords and to ensure appropriate inclusion/exclusion criteria are applied without
bias.
Between 1994- 2011, 881 and 272 papers have been identified from the literature search for ischaemic
heart diseases (IHD) and cerebrovascular diseases (CVD) respectively. This was later reduced to 14 for
IHD and 20 for CVD. When meta- analysis was performed, it was found that the relative risk of developing
IHD from smoking was 2.14 (1.76-2.60) for men and 2.84 (1.90-4.24) for women, while for CVD, it was
1.66 (1.43-1.93) for men and 2.18 (1.67-2.85) for women. For sub-group analysis, it was found that for Asian
population, the relative risk of developing IHD was 2.15 (1.69-2.75) for men and 1.99 (1.18-3.34) for women,
and for CVD, it was 1.31 (1.19-1.44) for men and 1.60 (1.25-2.04) for women.
This study has confirmed the harm from smoking and the association between smoking and cardiovascular
morbidity. The fact that relative risk in Asian population is relatively lower compared to the rest
of the World does not imply that there is less harm from cigarette smoking in this population but may
occur as a result of significant presence of other risk factors, such as quality and access to medical treatment
for hypertension and dyslipidaemia, within the population.


Efficiency in clinical practice has become of increasing concern in the healthcare system in Thailand.
Cost-effectiveness analysis is a concept that helps in the efficient allocation of healthcare resources; however,
evidence showing the use of the cost-effectiveness (CE) information in clinical practice in Thailand is
limited. The aim of this study is to assess physicians’ attitudes towards the use of CE information in
clinical practice.
A cross-sectional survey was carried out to collect information from 140 physicians at Suratthani
Hospital, a central hospital in Southern Thailand, during 12-26 March 2012. The questionnaire consisted
of 3 main parts: physicians’ attitudes, obstacles in the use of CE in clinical practice, and sources of CE
information.
The results showed that the sample response rate was 52.1%. Concerning physicians’ attitudes, 68.5%
of physicians agreed that it is appropriate to consider CE information in the clinical decision-making
process. 76.7% of physicians agreed that cost containment in current healthcare system is necessary. The
main obstacles in the use of CE in clinical decisions are: 1) unwillingness to accept that healthcare resources
are limited by the public; and 2) social expectation for medical services exceeding the capacity of
public health system. Results pertaining to the source of CE information showed that 96% of physicians
attributed CE results to clinical practice guidelines. In addition, CE information from the same source
gains more attention from physicians when presented verbally rather than in written form.
Increasing the use of CE information in clinical decision-making is one way to improve efficiency in
resource allocation in the healthcare system. Findings from this study can be used to inform policies that
promote more efficient utilization of healthcare resources.


Background: Acute illness and accidents are the leading cause of death in Thailand. Developing a
good systematic pre-hospital care can help reducing morbidity and mortality. To achieve this goal, the
Ministry of Public health has issued a policy for all hospitals in Thailand to set up an Emergency Medical Service (EMS) system. Nevertheless, this service system is not widely acknowledged in Chiang Mai. Most
of the patients did not use the service and go to the hospital by themselves Objective: To determine reasons
of underuse of Emergency Medical Service in patients visiting the Emergency room, Maharaj Nakorn
Chiang Mai hospital. Methods: This was a prospective observational study by means of questionnaires
filled by the patients or anyone accompanied them to the emergency room, Maharaj Nakorn Chiang Mai
hospital. Only 3 level of triage was used; level 1-Resuscitation, level 2-Emergency, and level 3-Urgency.
This study was conducted during the period from March to October 2011. Analysis was made by dividing
participants into 2 groups; patients coming to the emergency room by themselves, and the ones coming
by using EMS system. Results: There were 102 participants; 64 coming by themselves and 38 using EMS.
There were 44 traumatic patients, and 58 non traumatic patients. 4 participants were of triage level 1
Resuscitation, 42 of triage level 2 Emergency and 56 of triage level 3 Urgency. Sex, degree of education and
occupation were not related to EMS activation. Many reasons accounted for this problem; 64.1% of the
patients had their own vehicles, 50% did not know of the service, and 25% thought that their symptoms
were insufficient to activate EMS system. People in Chiang Mai learned of the EMS system through many
advertising media, in sequentially billboards, television, and radio programs. Conclusion: The reasons of
underuse of EMS system in Chiang Mai were: unknown of existence, failure to recognize the importance,
and doubt in the Emergency Medical Service systems.


Empirical evidence of oral health care and dental service delivery systems for people with disabilities
in Thailand is needed. An important question for the national health policy-makers is how to improve
oral health promotion for disabled patients in healthcare priority-setting. The objective of this paper was
synthesis of common wisdom regarding financial management of the oral health promotion system for
the disabled people in Thailand. This study systematically reviewed the literature in PubMed and MEDLINE
databases and the unpublished-literature that reported data in Thailand, Japan, the United States of America,
Canada, and the Commonwealth of Australia. The relevance of 82 retrieved articles was reviewed for each
country based on its current oral-health insurance systems, cost-benefits, and healthcare financial management.
Thirty-seven stakeholders commented on these findings and made suggestions by group panel.
This evidence supports the need to develop oral-healthcare policies to support dental care service, especially
oral health promotion and prevention, and improvement of equity and quality of the disabled access
to dental primary, secondary, and tertiary healthcare delivery systems in Thailand.


Since the number of diabetic patients has been dramatic increasing in Thailand year by year, so the
good medical care is needed for serving all patients’ requirement. In the present, the medical care for
diabetic patients in Pua district still has many problems.Most patients could not meet the standard outcomes
on controlling the plasma glucose. This problem has been found to relate on the obstacle of transportation
to DM clinic in hospital and the confidence in the service of intermediate facilities. The aim of
this research was to develop primary care for diabetic patient by Nurse Practitioner. The period of quasiexperimental
research was started from 1st October 2010 to 30th September 2011. The study was focused
on the 418 patients that had well control of plasma glucose from 70 - 130 mg/dl and had level of HbA1C<
7%. The patients were divided into two groups. The first group was the 98 patients that received service at
the Subdistrict health promoting hospital. The second was the 320 patients that received service at Pua
Crown Prince Hospital. The result showed that the DM patients from Subdistrict health promoting hospital
could control the level of plasma glucose better than those from Pua Crown Prince Hospital. The level
of HbA1c< 7% of the DM patients from primary medical care and Pua Crown Prince Hospital were 72.55%
and 54.37% respectively. In conclusion, the developing primary care for diabetic patient by Nurse Practitioner
had found to be suitable for applying in Pua Contracting Unit Care. This concept is better to put
more effort and need simultaneous development for keeping fast track on the observation.


This study aims to analyse the situation of Cancer disease and demographic
characteristics of Cancer patients in 8 Upper Northern provinces which are Chiang Mai,
Chiang Rai, Phayao, Lamphun, Lampang, Phrae, Nan and Mae Hong Son. It also analyses
the distribution of environmental-related health problem in the area, and suggest for further
research questions in health and environment problem-solving and policy for the Upper
North. This study analyses the overview of regional and provincial levels by using secondary
data from related organization, in particular, the provincial public health offices and Cancer
Units in both Chiang Mai and Lampang.
The study result shows that the Northern region had the highest rate of Cancer
patients, and Cancer deaths have continuously be the first rank in cause of death in every
province in the Upper North. Lamphun province had the highest increase rate of Cancer
deaths, for 8.5 times between 1999-2009. Lampang had the highest prevalence rate during
the same period, with the rate of 23 per thousand. Cancer type or position mostly found in
Northern provinces is Lung Cancer which are found mostly in Male patients. Other
environmental-related health problem is Respiratory Disease which has been the major
disease found in the Upper North, and Mae Hong Son province had the highest rate of
Respiratory Disease patients (61 per cent).
Results found from this research indicate that the population of the Upper North has
been threatened by polluted environment, especially from air pollution. Not only being
enhance by its topography, climate, and settlement locations, but also by human activities s
including urban growth, economic development, lifestyle, beliefs, and culture of its population
which have accelerated and worsened the air polluted situation. Therefore, there is an urgent
needed to solve and prevent this threatened situation.


According to the survey for gold deposits by the Ministry of Industry of Thailand, it has
attracted a private investment for further exploration and development of gold mines. In 1987,
several gold mining sites were opened for investment from the private sector including Chatree
Gold Mine located in Phichit Province. Mining is a large-scale enterprise that can potentially create
a number of negative health impacts. The health effects were concerned after the mine started
the operation, the villagers found they suffered from the increased incidents of illness. Therefore,
conflicts between the community and mining operation over environmental and health impacts
have become increasingly aggressive. The compiled evidence of contamination and filed
numerous complaints with authorities and the water quality was tested and found traces of
cyanide used in gold extraction, and heavy metals such as arsenic, iron, and manganese in the
underground water and tap water. People living near the mine site have suspected to have health
effects since the signs and symptoms of acute and chronic illnesses, especially skin rashes were
commonly found in children, and dust and noise nuisance. This study focused on the processes
undertaken to establish the community participation framework coordinated with environmental
and health agencies that could be implemented locally to the identification, collection and
analysis of environmental hazard, environmental exposure and health data.
The review of environmental and biological monitoring data was performed for computer
mapping and revealed that the key point of a cause of conflict is environmental and health data
have been collected and analyzed separately with little integration between governmental
agencies and community participation. Using the existing environmental data indicates the analysis
and mapping difficulties due to the validity and reliability of monitoring data. Biological monitoring
for the exposure of toxic contaminants has been carried out a few times only when the
complaints and concerns were addressed by the community through the government. The
appropriate health surveillance program was not provided to the community affected by mining.
Thus, the environmental health surveillance program has been established by the community
participating with local and regional government sectors response to environmental, health and
industry for the appropriate environmental health surveillance program and long-term financial
support. The networking of environmental health surveillance could initiate the community to
develop the environmental health surveillance program that could empower the community for
health impact assessment.
The environmental exposure related to health effects is difficult to identify for the
symptoms or diseases, especially chronic diseases due to limitations of biomarker specificity and
the various factors involved in symptom or disease endpoints. The linkage of environmental and
biological monitoring information such as environmental contaminations, exposure data, and
disease reports are needed to support environmental health statuses. In Thailand, very few
integration among responsible organizations was found for environment and health working group.
In this case, the difficulty of data interpretation for health consequences relating to environmental
contaminants resulted from the lack of environmental and health information as well as the data
quality used for database entry.The database of environmental and health is an effective tool and the quality of data is
required for a good surveillance system. Laboratory quality assurance and quality control (QA/QC)
in sampling and analysis are required for the accuracy of the results. The community participation
should be involved in all monitoring processes for conflict resolution. This case study indicated
that the resources of environmental data for the initiation of a database were mainly from EIA
process. The sampling and analysis had been done and sent to laboratory by mining company.
Therefore, it should be reconsidered that the monitoring process has to be reorganized and
community participation is required in all steps for a clear process.
Data on health had been retrieved from the conventional surveillance system used the
same database as other areas. Data collected by the number of morbidity and mortality which
can be obtained by health information flows from the registry of local health care. It
demonstrated that the system is not enough and suitable for the specific area having
environmental hazards. It is suggested that a special medical surveillance program is required for
to identify the environmental hazard exposure and health status, especially the early stage of the
diseases.
The appropriate environmental health surveillance is required with well-defined of the
parameters for both environmental and biological monitoring program. Indicators for the
assessment of environmental quality and contamination must be considered for the specificity
including the validation of the methodology. In this case the monitoring of cyanide for
environmental monitoring and exposure assessment is also considered for the uncertainty.
The networking of environmental health surveillance has been established based on a
concept of community participation. The concern issues of environmental health impacts were
discussed by community. Due to the limitations of budget and resource, the priority setting was
used for the investigation of environmental hazards and exposures. The community was trained
for parameter selections, environmental sampling and preservations. The quality laboratory was
also introduced for the selection of sample analysis to get the quality data. The outcomes of the
surveillance program consist of two sets of mapping, computer database and manual maps, that
are used to link the environmental and exposure data. The key persons were trained to input and
analyze the information from computer database and it shows an effective tool for the
assessment of environmental health status to the community. The manual map is also a
surveillance tool that has an advantage over the computer database in the number of people to
assess the data because of the limitation of computer skill in most population in the community.
The local health organizations and academic intuitions take action in supporting the knowledge,
specific skills and budget. The community could have a potential to be as its own environmental
health surveillance data center. However, the long-term financial funding is needed to be
resolved for the sustainable surveillance.


This report presents drug price control measures that have been implemented by government
agencies in a number of developed countries and in Thailand. Findings from the Research Projects on Drug
Prices (B.E. 2553-2555) funded by Health Systems Research Institute are included so as to recommend
further policies on drug price control.
In the developed countries, various drug price control policies have been implemented, especially in
the step of reimbursement. The reimbursement price has been set according to therapeutic classes of drugs.
Generally, healthcare purchasers seek to maximize several objectives, not limited to cost containment.
Innovative products under patent protection would be reimbursable if their increasing effectiveness and
decreasing significant adverse events were remarkable. In case of the narrow market drugs, such as orphan
drugs and drugs used in special populations including infant and newborn, healthcare purchasers may be
under pressure to provide the coverage and have limited power to bargain with drug manufacturers. The first
launched generic product is allowed to set a price higher than other following products so as to increase an
incentive for the manufacturers. VAT differential and mark up systems in supply chains are the important
factors affecting drug price variation. Some countries require no VAT or relatively low VAT for the
reimbursable drugs.
External price benchmarking is a common measure for price control in the European Union. Price
cap at 10% above an average of the three lowest-price countries has been used in Slovak Republic. The
average price across France, Germany, the United Kingdom and the United States has been used in Japan. It
is likely that manufacturers launch their products in the first countries where drug prices can be set freely or
are controlled only for the reimbursable lists such as the United Kingdom and Germany. Such a measure may
have positive impacts on market entry price convergence. There is evident that the market entry price among
five big markets in Europe is similar.
Profit control is an indirect form of price control regulation. This measure has been used in United
Kingdom before 2008. Manufacturers sign an agreement capping the industry profits in exchange for a
flexible framework for price setting. If the profit rate exceeds an authorized level, the manufacturers have to
pay back excessive returns to government or they may not have the permission to increase the prices.
In Thailand, drug price control has been implemented in government sector aiming for controlling the
national health expenditure. Ministry of Public Health (MOPH) and National Health Security Office (NHSO)
play a major role in drug price control. The MOPH’s Drug and Medical Supply Information Center (DMSIC)
provides descriptive data on the purchasing prices of non-essential (NE) and essential drugs (ED) based on
voluntary reports from the MOPH hospitals. In 2011, the MOPH announced the medium prices as a guide for
procurement of 546 items of ED. Major limitations include lag-time, unregular data and under-representation
of hospitals outside the MOPH.As mandated by the Cabinet Resolution on March 13, 2007, The MOPH’s Bureau of Health
Administration has negotiated purchasing prices for single source products, covering 12 items and 45 items
in fiscal years 2011 and 2012, respectively. However, price volume agreement was not used in the process.
Therefore the price negotiation committee has limited bargaining power.
At the MOPH regional level, group purchasing for high cost drugs is encouraged. However, this
method is not well accepted because of variation in drug specification and rigidity of the price setting
outcome. The group purchasing could reduce the purchasing price on average. However, large hospitals
could obtain a price lower than the bidding one if they acted independently. In general, the group purchasing
is acceptable for multisource products, of which the quality is not much an issue as for the high cost single
source products.
All three public insurance schemes cover drug products based on 783 items included in the current
National Lists of Essential Medicines (NLEM). Therefore, the NLEM is considered as an important indirect
price control. However, the three schemes vary in the degree of restrictiveness. Close ended provider
payment used by the Universal Health Coverage (UC) scheme and Social Security (SS) scheme is the key
incentive for hospitals in using ED.
Another drug price control is price negotiation for high-cost ED. This is a mechanism to increase
drug access implemented by the NHSO for the UC beneficiaries. Price volume agreement has been used for
negotiating antiretrovirals, antipsychotics, and special class of the ED.
Health Systems Research Institute (HSRI) has supported Drug Price Policy Research Program which
focuses on specific target groups as the way to control drug expenditure for Civil Servant Medical Benefit
(CSMB) scheme. The Program covers four major areas: (1) price setting strategies; (2) decision support
system for improving drug acquisition price using the pharmaceutical acquisition capability (PAC) approach;
(3) reference pricing system; and (4) the CSMBS beneficiaries’ preference and willingness-to-pay for
expensive medications.
For the first area (price setting strategies), the project suggests risk sharing by price volume
agreement to be used for the innovative drugs because it could reduce expenditure better than the external
price benchmarking. For a new drug with generics, brand premium for the first launched local generic should
be used as the pricing strategy. After the patent expiration, price cutting should be applied for multisource
drugs.
For the second area, purchasing price data obtained from DMSIC was used to show substantial
price variation across hospitals even after volume adjustment. With an implementation of the PAC approach,
efficiency could be increased and the expenditure for purchasing drugs would decrease by 25%.
For the third area, setting the reimbursed prices at the median values of drugs within the same
therapeutic class could reduce drug expenditure by 50% of the CSMBS’ direct billing system in large hospitals. Setting the reimbursed prices using the price of same generics would decrease the expenditure by
20%.
For the last area, the CSMB beneficiaries having hyperlipidemia have shown their willingness to pay
of not more than nine Baht per day for switching simvastatin (ED) to rosuvastatin (NE). In addition, they were
not willing to pay for any other NED antihyperlipidemics.
In addition to the four major areas above, the Research Program supports the development of drug
coding databases that link the MOPH’s 24-digit standard codes to the WHO’s Anatomical, Therapeutic and
Chemical (ATC) code system and defined daily dose (DDD). Classification based on the NLEM classes and
market status of the drug products were included. The database helps facilitate further data analyses and the
monitoring and evaluation (M and E) system for controlling drug expenditure and utilization.
Recommendation for drug price control
Country should keep improving existing drug price control mechanisms as implemented by past and
current governments. Use of the NLEM is a powerful indirect control measure. In the long run, manufacturers
should be enforced for cost structure declaration as the criteria for selecting drugs on the NLEM.
As market characteristics of drug products are matter, group purchasing and price negotiation
should be the strategy of choice for the single source products. Capacity building for price negotiation
techniques should be encouraged under the cooperation between MOPH and health insurance schemes
because the comparative advantage of the MOPH on provider profiles and the schemes on demand
information. Innovative methods such as risk sharing with price volume agreement, value-based pricing and
cost effectiveness analysis should be used. In addition, the M and E system for the hospitals’ purchasing
prices should be improved for timeliness and representation of the price information.
For setting the reimburse price, use of branded and single-source NE products should be restricted
for only the true candidates. The NLEM should be used as the reimbursed lists for all three insurance
schemes. For the CSMBS, financial incentive should be made when setting the reimbursed price based on
the generic ED.
Standardization of the drug price data and coding is necessary for evidence-informed policy
formulation. Therefore, an organization for maintaining drug price and use database and coding system
should be established. System to feedback the demand information would help supporting decision during
price negotiation and reimbursed price setting process.
In the long run, structure for drug price monitoring should be developed. Drug price should be
monitored for every step, from the NLEM process, hospital drug procurement, dispensing and reimbursement
for insurance. The monitoring of drug prices across hospitals and time-trend comparison should be
conducted. In addition, health care provider drug price index for both acquisition and reimbursement should
be developed.


Biological products are very complex molecules, therefore the same regulatory
approach of assessing chemical drugs cannot be used. Although a variety of assays are
available, they may not be adequate to reliably predict the safety and efficacy of
biological products. Several studies indicated that the treatment responses of biological
products are not the same especially the immune responses. This study was a
descriptive study conducted by intensive literature reviews and group discussions. The
result showed that the dossiers of registered biological products were partially
incomplete comparing with international guidelines, which may cause the risk over
benefit. Thus, researchers have proposed a future system to regulate biological products
by shifting the registration and re-evaluation paradigms of biological products to be in
compliance with current international guidelines on biological products and biosimilars.
The implementation of this new proposed system requires the development of
administrative and technical aspects.