location: , 'Thailand year: 2021 source: HSRI

title: Cost-effectiveness of Refracture Prevention Program for Fractured Hip Patients in Lerdsin Hospital

abstract: Background and Rationale: Hip fracture in the elderly is a common problem in all countries worldwide and tends to increase every year along with the number of older adults. Treatment and rehabilitation of the patients take a long time, resulting in financial burdens for each country. The repeated fractures rate within 1 year was 2-11%. The current treatment of hip fracture patients was to cure and focus on the prevention of recurrent fractures. Therefore, the Refracture Prevention Program with multidisciplinary care was created. The purpose of this study was to investigate the cost-effectiveness of patients with fractured hips in Refracture Prevention Program compared with traditional treatment in healthcare provider’s aspect. Methodology: A prospective and retrospective study was conducted in 2 sample groups, with the control group receiving traditional treatment and the experimental group in the Refracture Prevention Program. Data were collected from 130 fractured hip patients of each group starting from admission day in Lerdsin Hospital for up to 1 year. The economic evaluation used a decision tree to show an incremental cost and effectiveness of each group. Results: The refracture prevention group had statistically significant higher quality-adjust life years (QALYs) than the traditional group (p < 0.05) and the program could prevent refracture better than the traditional group. Refracture rate per year reduced from 6.27% to 4.29%. The unit cost of hip fracture treatment in the Refracture Prevention Program was THB 139,504, while the traditional group was THB 150,720. The QALYs of the refracture prevention group was 0.6023, while the traditional group was 0.5106. New intervention was dominant: treatment under the Refracture Prevention Program was cheaper and better than traditional treatment. Conclusion and Discussion: The model of care for elderly patients with hip fracture should be the fracture liaison service model, with multidisciplinary cooperation and prevention of recurrent fracture risk factors. During the first year, there were 3 main costs of the program (operation, osteoporosis treatment and fall prevention) compared to only surgical treatment cost in the traditional treatment. Further study should be the long-term follow-up of the project. Besides the costing perspective, there should be a study on the financial burden of Thailand, in order to know the magnitude of the problem for future planning.


location: , 'Thailand year: 2011 source: HSRI

title: Expenditure of Civil Servant Medical Benefit Scheme and the use of non-essential medicines

abstract: Over two decades, the expenditure for Civil Servant Medical Benefit Scheme (CSMBS) which employed
the open-ended provider payment methods has a continual double-digit annual growth. In recent
years, the outpatient expenditure outpaced the inpatient one. An analysis of prescriptions and expenditures
of the outpatient drugs of 26 out of 34 large public hospitals under the direct billing system in 2009
revealed that on average 41% of total prescriptions and 67% of expenditure belonged to those not covered
by the current National Lists of Essential Medicines. The highest proportion of the non-essential (NE)
drug prescriptions occurred in university hospitals (45%), whereas the NE proportion in the Ministry of
Public Health hospitals and other ministries was relatively lower (35% and 42%, respectively). However,
the NE share of drug expenditure was similar across the three hospital types (66-68%). The top six therapeutic
classes of drugs, sharing 41% of total drug expenditure, were antilipids, anticancers, antiosteoarthritis
(nonsteroidal anti-inflammatory drugs -NSAID, COX-2 inhibitors and symptomatic slow-acting drugs
for osteoarthritis -SYSADOA), antiosteoporosis, angiotensin converting enzyme inhibitors (ACEI) and
antigiotensin-2 receptor blockers (ARB), and antisecretory/antiulcers (histamine-2 receptor antagonists -
H2RA and proton pump inhibitors -PPI). The NE drugs accounted for 86.4% of the expenditure for antilipids,
87.8% for ACEI-ARB, 93.6% for antiulcers and 97.2% for antiosteoarthritis. With respect to market status,
the single-source products accounted for 92.3, 86.0, 65.0, and 44.0% of the expenditure for antiulcers,
antilipids, ACEI-ARB, and antiosteoarthritis, respectively. A case study of university hospital with relatively
low use of NE drugs revealed that leadership of the hospital administrator and the Pharmacy and
Therapeutic committee is a key to success of cost containment that can counteract threats from market
strategies of drug industry and misunderstanding of prescribers toward the use of the NE drugs. It was
recommended the central administration of CSMBS should give priority to cost-containment policies including
reference pricing systems for drug reimbursement, monitoring and evaluation using prescriberspecific
drug utilization data. In addition, appropriate financial incentive for well-performed hospitals,
capacity building for hospital personnel in data analysis and platforms for knowledge sharing should be
introduced.


location: , 'Thailand year: 2010 source: HSRI

title: Community Capital: A Case Study of a Social Movement for Solving Alcohol Consumption Problems in Namphong District, Khon Kaen Province

abstract: This study involved qualitative research aimed at exploring a social movement for changing the
local tradition regarding alcohol consumption in the community. Its goal was to identify the community
capital which facilitated the social movement in order to illustrate the process of social movement and its impacts on the alcohol consumption behaviors in the community. The research setting was Ban Khokyai,
Namphong District, Khon Kaen Province. It was a qualitative research study, the main data for which
were collected from in-depth interviews, participation observation and document review.
Alcohol consumption, which formerly had been considered as a norm in the community, changed
over time in accord with changing community power and capital. Violence among youths who drank and
got out of control evoked a reaction in the community. A civic group was formed in the name of “So-Le.”
Its leader was a respected monk who possessed three dimensions of capital: (1) cultural capital – the belief
and the faith of the people in Buddhist monks, (2) social capital – his good relationships with the village
head and the School principal, and (3) moral capital – his virtue and kindness. However, the success in
controlling alcohol consumption in the temple was just the first step of the movement. It needed further
strong support to struggle against the resistance of a community group.
The investigator suggests that the social movement for solving alcohol-related behaviors, which was
deeply ingrained in the lifestyle and culture of the people, required actors who possess such capital and
the support of the community to empower them as health promoters.


location: , 'Thailand year: 2009 source: HSRI

title: Health Equity and Human Rights of the Stateless Hill Tribes in Thailand

abstract: This mixed methodology research study was conducted to assess health equity within a human
rights framework, comparing situations among three groups in Thailand in order to close the gap between
these groups. The sample included 789 subjects (ethnic Thais, and hill tribe and stateless hill tribe
people) from 10 provinces in northern Thailand; they were studied from December 2006 to August 2007.
The tool for comparison was the benchmark of fairness for assessing health care reform. Data analysis was by ANOVA, Z-score and fulfilled qualitative data. Based on the research results 17 experts suggested
policy options.
The results revealed significant differences among the three population groups on seven out of the
nine benchmarks (all at p < 0.001). The non-significantly different benchmarks were efficiency and quality
of care (p = 0.170) and administrative efficiency (p = 0.227). With regard to to Z-score analysis, Thai
nationals (group 1) had the highest score (Z = 0.3293), the hill tribes with Thai citizenship (group 2) had a
mid-level score (Z = 0.1275) and the stateless hill tribes (group 3) had the lowest score (Z = –0.3885).
Recommendations from experts to bridge the gap included the need for budget allocations to fit with
population, health care standards, legal reforms and the decentralization of health services to the local
governments.
In conclusion, this research suggested that the Thai government should close the inequity gap by
adopting a policy mix that would affect every population group in Thailand. The establishment of equity
with regard to basic health care will promote human rights concerns within Thailand and will serve as an
example for the promotion of humanitarian efforts elsewhere.


location: , 'Thailand year: 2021 source: HSRI

title: The efficient of procurement and distribution processes for Central Medicines Procurement in UC Scheme

abstract: Central Medicines Procurement for National Health Insurance System began in 2008 after the National Health Security Office (NHSO) has set reimbursement for medical used in public hospitals. Starting from reimburse for medication that is used to treat diseases with high treatment costs (through the High-Cost Disease Fund), disease  prevention vaccine  (through the EPI Vaccine Fund  which is in the normal budget) and  medication for  AIDS patients (through the AIDS fund) and others, currently NHSO has gone through the pooled-procurement process and distribution of these pharmaceuticals from central inventory to all public hospital all over the country. Government audit agency. Few years ago, a sudden change in purchasing unit by take into consideration of auditor recommendation that the purchasing unit should be independent from funds holder to comply with good governance practice. The medicine procurement committee has established of a group of public hospitals, a public hospital network (NPHs), as a temporary purchasing unit and under the process of determining what is the appropriate structure and characteristics of purchasing unit should be and how the technology could help solving this issue. Demand forecast. Under the overall procurement and distribution cycle, pooled-procurement supply chain processes, NHSO is responsible for preparing procurement plans by using last year medicine consumed as the baseline to forecast items and quantities to be purchased. Purchasing Unit.  Purchasing Unit is responsible for the procurement processes − biding, tendering, or buying, etc. in accordance with government procurement policy − and then the Pharmaceutical Organization is responsible for managing and monitoring central stock as well as manage to deliver according to the hospital order. Public Hospital. Under this scheme, each public hospital must manage its own medical stock and under this policy, they are not allowed using government budget to buy such the items that that policy restricted to be in pooled purchase. Replenishment and drug quality are issues within the supply chain processes. Tracking medicines lot number those are delivered to hospitals all over the country is needed in the case that any lots found expired or unmet quality, it must be replenished, return, or claim to the supplier who sell them. Central Procurement Monitoring System-CPMS will be implemented to track procurement planning, purchasing and distribution of medicines to the users (public hospital), but still one last mile problem. This research emphasizes on the studies and analysis of procurement and distribution processes for Central Medicines Procurement in UC Scheme to seek for adjustment for concrete execution, and design and develop pilot system to monitor the medicine procurement and distribution. This includes studying and suggesting the integration of IT system development and procedure that are relevant to procurement and distribution for Central Medicines Procurement. The study results are as followed: Study results in guidelines for process adjustment: According to the comparison study between the process in nowadays and before 2017 fiscal year, the procurement and processes for Central Medicines Procurement are being under control of the fiscal year cycle, and sourcing in accordance with the Government Procurement Act in 2017. Some medical and supply lists have an inconsistent condition in supply chain that make them inconsistent with their operations, resulting in congestion. Take an example, as the temporarily drug shortage occurs, the demands in supplies from the market or the seller’s drug storage will augment. Along with the impact on the balance of the fiscal year procurement, and demand planning and the drug storage administration of the next cycle. Analytical results in the gap between procurement and distribution processes for Central Medicines Procurement in UC Scheme: The supply chain downstream is an untraceable system. It begins as hospital receive medical supplies all the way to dispensing medicines to the patient. Due to the Central Medicines Procurement in special project is one of the tremendous supply chains, each hospital has a distinguish drug management system. Despite the medical records are individually recorded, tracking the source of the medicine dispensation are inaccurate, which highly affected the qualitative management, for instance, drug lot tracking, expiration date on borrowing, returning, and changing medicine. Moreover, the drug codes that do not meet the similar standards and agreements are not contributed in every process in managing and monitoring level. Analytical results in the comparison of a general practice and IT potentiality that needs to be developed: When contrasting the IT potentiality of an organization in the procurement and distribution of medicine, the are 3 major agencies are all possessed the nation-leading in IT potentiality. They can analyze, adapt, and develop IT system to accommodate the new arisen demand on time. Whenever the problem in medicine procurement and distribution processes have been discussed, IT system is the essential drive to resolve all the conflicts. Despite its explicit role and a lot of co-operated agencies, it was discovered an ambiguous conclusion on the selection of the IT system’s owner. This will affect the sustainability of system along with the usage expansion, development, and maintenance. Analytical results in design and develop pilot system to monitor the medicine procurement and distribution: Research team have developed the sample screen of pilot system and represented the original screen to 3 dominant agencies, which are consisted of NHSO as a planner in medicine demand forecasting, Rajavithi Hospital as a procurement agency, and GPO as a seller agency. The design for 3 interrelated agencies can monitor the planning and procuring status, and also check the report overview. It has been recognized as a highly benefit function especially in cutting the delayed procedure from communication and confidential exchange of information with each other. Nevertheless, the pilot system has not been assigned to any agencies, it was temporarily installed at NHSO server, which situated in NGO office. Policy Recommendation: The major problem is lack of host to implement IT, and information for management and monitoring. Hence, determining the stakeholder in different level of IT system explicitly will generate confidence for examination and evaluation of the medicine procurement and distribution cycle. Along with expanding the results of pilot system and conducting as mechanism to drive and administrate the cycle of procurement and distribution processes for Central Medicines Procurement in UC Scheme. It is done by regulate the approach and method in directing information in every single process in order to ensure that exchanged data are precise, trustworthy, compliant with the law, regulations, and notices that would shorten and smoothen the procedure, simultaneously. Additional research topics: 1) Applied Global standard Pharmaceutical Product Code: GS1 Automatic Identification and Data Capture Standards in Healthcare.  2) Blockchain-based solution: A new ecosystem should be introduced to enable all stakeholders to share single trusted source of information on the procurement and distribution of the Central Medicines Procurement in UC Scheme using permissionless blockchain to solve the last mile problems within the procurement and distribution processes reconciliation.


location: , 'Thailand year: 2003 source: HSRI

title: Cross-subsidization and risk sharing between health services during the pilot phase of universal coverage

abstract: Background Since cost of providing care at each level greatly differs, the implementation of universal coverage for all Thais by new allocation method is a key to smoothing the transition.  This research aimed to find better way of monitoring cost, to identify providers facing financial hardship during the pilot phase in order to suggest appropriate policy of subsidizing providers.Methods 1. Study cost by questionnaire survey to all providers in 21 provinces Fiscal years 1999-2001 by quick method, 2. Study costs of service and education of teaching hospital by reviewing budget documents from 1992-2001, 3. Fit a formula for subsidizing inpatient services by data from individual inpatient data and yearly report of community, general and regional hospitals in 21 provinces, 4. Action research changing the accounting report from cash to accrual basis in 2 hospitals.Results Response rate was low from 3-60% by type of hospital.  Cost per outpatient visit at community hospital was 100-200 baht, and cost per inpatient admission was 2,000-6,000 baht.  Cost per outpatient visit for general hospital was 200-400 baht and for inpatient was 3,000-7,000 baht.  Cost per outpatient at regional hospital was 300-500 baht and for inpatient was 5,000-8,000 baht.  Cost per outpatient for teaching hospital was 800-900 baht and for inpatient was 17,000-18,000 baht.  Huge difference in cost was a major financial risk for providers.  When fitting the model for subsidizing hospital according to efficiency, quality and equity factors, it revealed that using ranking approach could contribute only 2-4% of the total subsidy while using the real value of each factor could contribute much higher to 51-75% of the total subsidy.  Action research of accrual accounting system found that there was a lack of adequate number of personnel in finance department as well as a lack of capacity in carrying out this new task.  A good system to validate the data for both account receivable and account payable was urgently needed.Conclusions This study confirmed wide differences of costs between each level of health services, however reliability of data was a problem.  The subsidization formula to reduce financial risk was tested to include factors on efficiency, quality and equity of each level of health service.  The accrual accounting system required an urgent capacity building and adequate number of competent personnel.  The system to validate revenue and spending data was used needed urgently.


location: , 'Thailand year: 2001 source: HSRI

title: Expenditure and quality of life lost due to diseases caused by smoking

abstract: Expenditure and Quality of Life Lost Due to Diseases Caused by Smoking	Objective: To evaluate the expense and quality of life of patients with obstructive pulmonary disease and coronary heart disease, their associated factors, and to estimate the economic and quality of life lost among these patients. 	Methods: Analytic cross-sectional study was conducted in 5 regions all over Thailand, Chiang Mai representing the northern region, Khonkaen the north-eastern, Chonburi the eastern region, Songkhla the southern region, and Bangkok including the outer skirt. The study population included male and female patients with clinical diagnoses of obstructive pulmonary disease or coronary heart disease, who self reportedly had smoked for at least 5 years (in the case of coronary heart disease) or 10 years (in the case of obstructive pulmonary disease), and who attended the hospitals as the out-patients or being admitted as the in-patients during the study period. The comparison group comprised of the general people or persons who accompanied patients to hospitals, who did not have any chronic diseases or disabilities. They were matched with the patients according to gender, age and place of residency. Data were collected between June and December 1998, by using a standard questionnaire and a record form containing questions on personal and sociodemographic characteristics, history of smoking and of the disease, direct and indirect medical costs and indirect costs. The WHOQOL-BREF quality of life assessing instrument was used to measure the subject’s quality of life. Data were presented with descriptive statistics. The patient’s expense and the quality of life lost compared to the compariron group were analysed by chi-squared test, exact probability test, t-test, one-way ANOVA, two-way ANOVA, Mann-Whitney-U test or Kruskall-Wallis test for univariable analysis. The multiple regression was used in the multivariable analysis to adjust for extraneous variables. 	Results: The total expenditure of treatment associated with chronic obstructive pulmonary disease were estimated to be 7,656.72 Baht per year per patient. There were no trends of change according to age, duration of illness, or disease severity. After adjusting for gender, age, education, occupation and income differences, patients with chronic obstructive pulmonary disease were paying 7,520.65 Baht per year more than the comparison subjects, or 431 times as much. The costs were estimated to be 4,114 million Baht per year for the patients all over the country. When added to 8,297 million Baht per year paid by the civil sectors, the total costs were 12,411 million Baht per year, which approximated 0.27% of the gross national product, or 4.40% of the national expenditure on health in 1998. The quality of life among patients with chronic obstructive pulmonary diease scored fair, and was poorer than that of the comparison subjects in every way, except for the environmental domain. The quality of life worsened according to the disease severity, but was unchanged according to age and the duration of illness. Patients who became ill at the age of below 50 years were estimated to loss 11.07 years of quality adjusted life throughout their illness. The total expenditure of treatment associated with coronary heart disease were estimated to be 17,746.44 Baht per year per patient. There were trends of decreasing according to age and the duration of illness, but increasing according to the disease severity, and in patients classified as having a heart failure. After adjusting for gender, age, education, occupation and income differences, patients with chronic obstructive pulmonary disease were paying 14,767.06 Baht per year more than the comparison subjects, or 164 times as much. The costs were estimated to be 840 million Baht per year for the patients all over the country. When added to 14,060 million Baht per year paid by the civil sectors, the total costs were 14,900 million Baht per year, which approximated 0.32% of the gross national product, or 5.28% of the national expenditure on health in 1998. The quality of life among patients with coronary heart disease scored good and fair, and was poorer than that of the comparison subjects in every way, except for the environmental domain, in particular items related to income adequacy, extense of information and health service received, and travel convenience. The quality of life worsened according to the disease severity, but improved according to age, and was unchanged according to the duration of illness. Patients who became ill at the age of below 50 years were estimated to loss 9.19 years of quality adjusted life throughout their illness. 	Discussion: The direct medical costs of treatment were the major component of the total expenditure. Decreasing the cost of medical service should therefore, lessen the economic burden of these patients. Some of the expense were used for travelling in the seek of treatment in distant localities. Increasing the diagnostic and treatment capacity of the local hospitals to meet with the standard and with the patients’ acceptance should reduce this portion of expense, through the decrease in the number of patients seeking health care in hospitals located in large cities, including Bangkok. The direct non medical costs mostly comprised of travelling and food expenditure and the lost of income of persons accompanying the patients. By referring patients back to their local hospitals, these cost should be reducible. The patient’s quality of life worsened according to the disease severity. Rehabilitation programme which has an impact on the patients’ cardiac, pulmonary and vascular function, and which is manageable at domestic level, should be considered in order to decelerate the above mentioned worsening quality of life.


location: , 'Thailand year: 2015 source: HSRI

title: Situation analysis and study on the factors affecting the achievement of problem solving of maternal health care in the 3 southernmost provinces of Thailand

abstract: Maternal and child health (MCH) situation in three southernmost provinces has
been in a critical stage. MMR was about three times higher than country’s targets and
almost two times in MDGs Plus target, lower than the performance in almost all
indicators. Most deaths due to causes that can be prevented in the context of modern
obstetrics. There is only a small detail that seems to be absent. Prenatal care to pregnant
women with traditional midwives. The way of life, religion and cultural norms determine
the practice of pregnant women. But it is not seen as important as surveillance and health
complications. Key factors which affect the success of maternal and child in three
southmost provinces are
1. Manpower : Turnover rates are frequent, bcause it is a difficult task,
required high skills and experience. More tools and indicators and some indicators are not
consistent with the context in three southmost provinces.
2. Belief : Two believes persists that determines the norms and practices of
pregnant women are 1) do not eat more and do not take the medicine 2) seek female
personnel’s service for delivery. Including lifestyle, religious values are very high in regard
to procreation, and that the death is natural. The attitude that contraception is wrong,
against the principles of Islam.
3. Traditional Birth Attendants (TBA) : TBA is the strength of maternal and child
health in the southmost provinces. Pregnant women are faithful and believe in TBA. While
Islam still had limited access to medical services.
Suggestion and Policy Brief
1. Urgent measures : Cooperation with TBA to reduce MMR (Maternal
Mortality Rate) in three southmost provinces. Development competency TBA to learn
assessment of high risk pregnancy, refer and delivery of emergency cases safely.
Appropriate Incentive measures are important. We should also encourage Muslim
husbands to have proper attitude and to help woman during pregnancy and childbirth.
2. Medium and long term measures : Department of Health and related
agencies should review policy, strategy and tools that is flexible, affordable and possible.
Provides analysis and support capacity in maternal and child health. We should put more
ostetricians in the three southmost provinces and enhance them and their MCH team to
understand the way of truly Muslim.


location: , 'Thailand year: 2011 source: HSRI

title: Reducing Impoverishment Caused by Costly Health-care Payments: Outcome of Universal Health Care Coverage in Thailand

abstract: The major aims of the universal health care coverage (UC) policy initiated in Thailand in 2001 are not
only to increase the access of people to essential health services, but also to reduce the financial risk they
face due to out-of-pocket payments for health care. This study employed secondary data analysis of the
Socio-Economic Survey (SES) conducted by the National Statistical Office to estimate the number of households
becoming impoverished because of the payments for health care they had to make before implementation
of the UC policy (1996, 1998, 2000, and 2002) and thereafter (2004, 2006, 2007, and 2008), and to
compare the findings with a counter-factual UC-absent scenario, using segmented linear regression analysis.
At the national, regional, and provincial levels, the proportions of households falling below the poverty
line declined gradually during the study periods. Without the 2002-UC, a total of 100,604 households
nationwide would be impoverished by out-of-pocket payments for health care in 2008. The UC policy in
the same year could reduce the number of health-impoverished households by 37,628 (37.4%), which is
equivalent to 0.2 percent of 19 million households nationwide. The health insurance system design that takes into account both “breadth” (that is, the number of the population covered) and the benefit package’
s “depth” dimensions, provides better financial risk protection and prevents households from falling into
the poverty trap due to the necessity of making costly health expenditures


location: , 'Thailand year: 2017 source: HSRI

title: Holistic and Humanized Health Care: A Case Study of HIV/AIDS Patients at Bamrasnaradura Infectious Diseases Institute

abstract: Holistic and humanized health care is an essential guideline for health care personnel. The modern medicine that focuses on only biological aspect is not adequate and has neglected the psychosocial and spiritual aspects. The clients may feel that their self-esteem and dignity have been decreased especially for people living with HIV/AIDS (PLWHA) suffering from society’s stigma and discrimination. This article illustrates the experiences of holistic and humanized health care for PLWHA provided by Bamrasnaradura Infectious Diseases Institute. This institute has been providing care for PLWHA since the early period of HIV infection and has continually improved its services to be recognized nationally and internationally. This article also displays evidence to confirm that holistic and humanized health care has yielded excellent outcomes for the clients, health care providers, and health service systems. However, implementing this concept systematically and broadly remains challenging for health care personnel and health service systems of Thailand.


location: , 'Thailand year: 2007 source: HSRI

title: Temporary Bilateral Hypogastric Artery Occlusion for Minimizing Blood Loss during Abdominal Hysterectomy

abstract: The study was undertaken to determine the effectiveness of bilateral hypogastric
artery occlusion in minimizing blood loss from abdominal hysterectomy. The subjects
under study were patients with myoma uteri who attended the Kabinburi Hospital for
surgical intervention in the period August 1, 2000 to July 31, 2007. The patients were
divided by simple random sampling into two groups; the initial numbers were 33 in the study group undergoing bilateral hypogastric artery occlusion right before hysterectomy
and 32 in the control group with no artery occlusion. After the abdominal hysterectomy,
Five patients were excluded after hysterectomy but not the cases of myoma, thus making
the patients numbers 30 each in both groups. With the same provision of preoperative,
operative and postoperative care for all patients, the procedure of bilateral hypogastric
artery occlusion was performed on the study group by the present author just before the
uterus removal operation and occlusion release after the hysterectomy was completed
and all the bleeders were checked.
The results of this study showed no statistically significant differences between the
two groups regarding their personal data and the operative outcomes. The average blood
loss in the study group was 350.67 ± 140.38 ml, whereas in the control group it was 572.83
± 207.82 ml; the difference was statistically significant (p < 0.05). The study group received
0.13 ± 0.346 units of blood transfusion during the operation, whereas the control
group received 0.63 ± 0.765 units; the difference was statistically significant (p < 0.05).
The operative time taken in the study group was 85.23 ± 17.17 minutes compared with
104.53 ± 16.06 minutes in the control group; the difference was statistically significant (p
< 0.05). There were no significant differences between the two groups regarding preoperative
and the 24-hour postoperative hematocrit levels, the numbers of pads used in the
first post- operative days, incidence of postoperative fever or infection, other organ injuries,
and the average length of hospital stay post operation. The study was conducted to
support the practice of temporary bilateral hypogastric artery occlusion in order to minimize
blood loss during abdominal hysterectomy.


location: , 'Thailand year: 2015 source: HSRI

title: Serotype and Drug Resistance of Salmonella Isolated from Patients Stool and Blood in Trang, Phattalung and Songkhla Province

abstract: A total of 517 samples Salmonella strains isolated from stool and blood patients, hospitalized in Trang,
Phathalung and Songkhla provinces in 2011-2014. The ratio of female to male was 1 : 0.98. The predominant
age group of isolates were < 1 year (137 cases 26.5 %). Serotypes of Salmonella isolated from stool were
438 samples and blood were 79 samples by Kauffmann-White scheme and Sven Gard method. Salmonella
serotype Weltevreden was the most predominant 120 samples (27.4%) followed by serotype Typhimurium
97 samples (22.1%) isolated from stool. Salmonella serotype Enteritidis was the most predominant 31 samples
(39.2%) followed by serotype Typhi 19 samples (24.1%) isolated from hemoculture Drug susceptibility of
Salmonella by the disk diffusion method with 5 antimicrobial agents such as Ampicillin, Tetracycline,
Co-trimoxazole, Chloramphenicol and Norfloxacin. Salmonella strains isolated from stool were the most
predominant resistant to Ampicillin (54.5%), followed by Tetracycline (45.2%). Salmonella strains isolated
from hemoculture were the most predominant resistant to Ampicillin (36.0%), followed by Tetracycline
and Co-trimoxazole (28.0%). All of Salmonella isolated were susceptible to Norfloxacin (100%).
The results showed serotype and drug resistance pattern of Salmonella isolated from stool and blood
for fundamental data and guidance in selecting antimicrobial agents in Trang, Phathalung and Songkhla
provinces


location: , 'Thailand year: 1998 source: HSRI

title: Survey on OPD Users at Kon-Kaen Hospital In 1997

abstract: OPD Case Survey at Kon-Kaen Hospital in 1997	The survey objectives were to study information of OPD care given. The studied information was general information, information of OPD care provision, views of physicians and views of users. The data were collected through interviewing users and providers from March 17 to March 21, 1997.. Systematic random sampling was used for sampling 1228 cases. The response rate was 82.65%. 	The results showed that the majority of users lived in Muang District spending their visit time approximately 1-2 hours. 48.5% of well baby clinic users lived in metropolitan area while 60% of the pregnant visiting the hospital lived outside the metropolitan. Most receiving general practice were new patients with non-serious conditions. 40% of the users were uninsured. Most general medicine users were from Muang district. 59% of this group could be taken by general physicians whereas 31.4% needed special care. 22.3% were aged people. Only 21.1% had insurance.	Common illness presenting for pediatric care was respiratory problem. Most examiners viewed that most presenting problems could be handled by health personnel and nurses. 63.3% of users were 1-4 year-old. 21.7 % were uninsured. For general surgery, tumor, respiratory problems and accidents were most common. 63.9% could be given care by general doctors. 32.7% gave the reason of specialist availability for visiting the hospital.	33.3% seeking orthopedic care lived outside Muang district and 93.1% living outside the metropolitan. Convenient transportation were most reasoned for coming the hospital. 15.3% were uninsured. Most seeking eye care were middle aged and could be given care by general doctors. Special care was most given to those living outside the Muang district. Most users were previous patients and made appointment. Such a group spent relatively longest time at the hospital.	On average, each patient spent his or her time at the hospital about 3 hours and 25 minutes (almost half a day). 26% paid on their own pocket (14% were later remunerated). 65% agreed with exising prices while 16.7% considered expensive. Nevertheless, most said expensive if paying more than 500 Baht. 72% said they well understood their illness told by providers. The lowest rate of understanding their illness told by providers was found at general medicine and general surgery clinic. Expenditures for medicine and special examination were averaged at 215 Baht. General medicine and cardiac clinic were found larger expenditures respectively. 1/3 of payment was subsidised by the government. Average transportation cost was 85 Baht.


location: , 'Thailand year: 2014 source: HSRI

title: Evaluation on the Development of Laboratory Quality System Regional Medical Sciences Center 10th Ubon Ratchatani During 2009 - 2013

abstract: Regional Medical Sciences Center 10th Ubon Ratchatani is the medical and public health laboratories
which play an important role in public health surveillance and improvement for the Regional of Service Provider 10th. Laboratory Quality System was used as a parameter for customers reassuring.
To evaluate the development of laboratory quality system, the CIPP model including context, input,
process, and product evaluation was used. In this process, the secondary data was collected as well as the
questionnaires for customers, satisfaction surveys of the target groups including customers, official
workers and executive/head of the agency in the Regional of Service Provider 10th during July to
September. The results concern the quality, efficiency of the service, and outcome of the development.
The service quality showed that 82.3% of the items passed the criteria for an inter-laboratories proficiency
testing while 90.4% of the proficiency testing showed the accurate results. The customer’s satisfaction also
showed 83.0-90.0 % and moreover, customer’s complaint showed 2-19 items in fiscal year 2009-2013. The
service efficiency showed that 89.2, 97.5, 98.8, 97.6 and 95.2% of the tests were completed by the cutoff
time in fiscal year 2009 - 2013, respectively. In addition, development outcomes are ISO/IEC 17025 for
testing laboratory; ISO 15189 for medical laboratories; and the silver award for excellence in medical and
public health laboratory of the year 2013 from the Ministry of Health. The present study showed that the
development of the Laboratory Quality System of the Regional Medical Sciences Center 10 Ubon
Ratchathani is consistent with an organizational policy for international standard. Laboratory Quality
System is a continual improvement process which requires continuous support so as to become the
reference laboratories in the Asian region.


location: , 'Thailand year: 2008 source: HSRI

title: Nurse Led Diabetic Clinic Network Development with Social Support Model in Primary Care Units of Health Department, Bangkok Metropolitan

abstract: Objective: To determine the model of nurse led diabetic clinic network, the effects of model on vascular risk factors in primary care units of health department, Bangkok metropolitan.
Study design: Prospective descriptive study, and action research
Materials and methods: Fours primary care units 251 diabetes were recruited, and the model was developed on the 2 stages as following: stage1 preparation, in this stage, we review the diabetic burden,  nursing role and service pattern for diabetes patients these primary care units, before model set up. and in stage2,  we developed The Nurse led diabetes program to help nurse manager in providing standardized care for diabetes as recommended in national guideline, and nurse educator development by educational motivation from multidiscipline conference, and clinical set up with periodic auditation and brain storm to re-evaluate, re-modeling the model.
Results:
•	The risk burdens as in obesity, truncal obesity were high initially 78%, 62%  in subsequently, and the patients having target LDL cholesterol, blood pressure, fasting sugar, HbA1c were 36%, 38%, 31%, 34%  in subsequently, However These un-optimized risk factors had trended to lower after the model implementation.
•	For the model had improved the nursing attitude as nurse manager, confident , quality service and standardized diabetes care, and the patients had improved coping skill in behavior modification, and most importantly the good relationship between the community and clinic which could motivated patients adherence and confidence in nurses.
•	The Nurse led diabetes program could help nurse manager in risk factor development, sugar control, complication detection and improved standardized protocol as in national guideline recommendation.
Conclusion: The nurse led diabetic clinic network could provide more standardized care by The Nurse led diabetes program, multidiscipline approach, and community relationship.


location: , 'Thailand year: 2012 source: HSRI

title: Health and Economic Impacts of Antimicrobial Resistant Infections in Thailand : A Preliminary Study

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


location: , 'Thailand year: 2002 source: HSRI

title: Quality assurance of health promotion services in provincial health system

abstract: Health promotion service is the most important component of the Universal Health Care Coverage Scheme. However, many evidences suggest that its quality could be directly and indirectly impaired, mainly because of capitation payment mechanism. Consequently, quality assurance system is necessary. Most of the national quality assurance systems in Thailand concentrate on curative care instead of health promotion. However, there are a number of quality assurance initiatives in many provinces. In order to set up the efficient system, extensive review of the current situation and ideal solution should be conducted. In this study, literatures regarding quality assurance of health promotion services will be analyzed. Information on existing and expected quality assurance system and factors affecting the quality of health promotion services will be gathered by in-depth and focus-group interview of system experts and medical personnel at the operational level in five provinces—Bangkok, Ayuthaya, Chiang Mai, Nakornratchasima, and Pattani. It can be concluded that quality assurance system of health promotion services is essential. The system should help improve the services by using positive approaches and can merge with some existing quality assurance system. However, there is diverse comprehension among system experts and health care providers regarding the principles and responsibilities of health promotion services. This results in varieties of provincial quality assurance system. Factors that can impact the quality assurance system of health promotion can be categorize into four major aspects—principles and policy, budget, providers, and target population.


location: , 'Thailand year: 2010 source: HSRI

title: An Expert’s Opinion on the Role, Function and Activity of Accredited Pharmacies as Primary Care Providers under the National Health Security Scheme

abstract: Although community pharmacies normally provide health services to communities, they have never
been officially recognized as a primary care unit under any health security scheme. After the National
Health Security Scheme had been implemented in Thailand, efforts were made to test accredited pharmacies as part of a network within the scheme. In order to put a community pharmacy into the network, it is
essential to clarify the role and function of a community pharmacy as a primary care provider within the
network. Therefore, this study was aimed at projecting the role, function and activity of community pharmacies
from the viewpoint of community pharmacy experts, both from the private and government sectors.
The Delphi method was used by sending questionnaires to experts twice. Seventeen experts completed
the questionnaires twice. Levels of agreement were calculated as in the median, mode and
interquartile ranges. The results showed that the experts agreed that it was possible to have community
pharmacies play a role in treatment, health promotion and disease prevention in a community. The medians
of agreement levels were between 4 and 5 out of 5 on the Likert scale and the interquartile ranges were
narrow. With regard to the treatment role, a community pharmacy would have functions and activities in
dispensing drugs for common illnesses, refilling prescriptions for chronic diseases, and providing patients
with counseling. Regarding the health promotion and disease prevention role, a community pharmacy
would have functions and activities in screening for risk of chronic diseases, referring a high-risk
patient to physicians, promoting appropriate drug use, providing advice regarding nutrition and exercise,
campaigning for smoking cessation and reducing alcohol consumption, and coordinating with local
authorities to promote community health.


location: , 'Thailand year: 2003 source: HSRI

title: Development of a Primary Care Model: A Case Study of NhongTong Primary Care Unit, Hangdong  District, Chiang  Mai  Province

abstract: This   participatory   action   research  aimed  to study model for the   to development of a primary health care service system at NhongTong Primary Care Unit, Hangdong  District, Chiang  Mai  Province.  Data  were  collected from health  personnel  and clients (community leaders  and  people), by  focus  group  discussion,  in-depth interview, and  observation.The participatory approach was focused by brain-stroming, reflecting on problems and needs, capacity building of health personnel, and development of the health care service system. Content analysis was used for data analysis.  Results:  It  was  found  that the  health  care service system did not reach the standard for a primary care service system. For example, the management system did not function well, equipment was inadequate, and office space was not well organized, health personnels lacked of confidence in providing proactive services and primary medical care and participation from local authorities and village health volunteers was limited. As the result of the findings, health personnel were trained, health service management was conducted and office space was organized and equipment provided. Furthermore, understanding was created and empowered  the community,  attitudes were changed  towards the health service among people in the communities, learning from best practice communities, the village health volunteers were encouraged  to be more confident, and was provided  support for  health promoting activities of the people. As a result, health personnel have developed their potential as follows: office space was better organized, cooperation from local  authorities,  village health volunteers, and community leaders has been increased in terms of budgeting and participating in community activities such as elderly clubs,  health promoting clubs, Thai massage clubs, mobile clinics, training of drug-users, and the prevention of hemorrhagic fever. Suggestion: The results of the study suggested that the development of a health care service system will be successful  by using a participatory approach and integrated methods such as  training, supervision, conducting forums, suggestions and learning from best practice communities.


location: , 'Thailand year: 2008 source: HSRI

title: Reviewing the Literature on Governance in Health System

abstract: The goal of Thai health system development is to achieve a balanced and sustainable society in which
all Thai citizens have the security needed to live a happy life in a healthy and better condition. The objective
of this study was to perform a literature review to form a foundation and knowledge base on good governance
in the Thai health system, analyze and plan for research mapping.
In this study, good governance in the health system was divided into 10 sectors: rule of law, ethics,
transparency, participation, accountability, value for money, human resources development, knowledge organization,
management and information technology. These were simultaneously analyzed in macro- and
micro-analysis systems that were influenced by economic, social and political conditions as well as the agency’
s role.
The literature review revealed that there were problems in every aspect of health governance. If these
problems were solved more effectively, that would generate better and improved services in the health-care
system. Consequently, it would create a sustainable society in which all Thai citizens would live a happy life
in a healthy condition.
The study found that governance is a function of the health system, that each governance principle
should be developed and adapted, and that governance issues should be identified at all levels. The problems
encountered in studying health governance were that the issue needs more research, especially that
undertaken with a qualitative approach and comparison of the international governance functions.


location: , 'Thailand year: 2008 source: HSRI

title: Health behavior of health club members in Wang Sammoh district, Udon Thani province, 2007

abstract: This action research was aimed at assessing the health behavior of members of the
health club, Wang Sammoh district, Udon Thani Province. One hundred and ninety-eight
members were purposively selected to answer a questionnaire and to be physically examined
during the period from September 2006 to October 2007. This study employed
both qualitative methods, including focus group discussion, and quantitative methods in
collecting and analyzing data using descriptive statistics: average, percentage and chisquare.
The results of small group meetings found that 86 percent of the members of the
club had diabetes mellitus and/or hypertension; 90 percent of them wanted to know the
causes of leg-pain and back-pain. A method for self-care in a communal way for solving
health problems would be to buy medical supplies from drug stores in conjunction with
promoting the use of herbs.
General data analysis revealed that 79.3 percent of the subjects were women (average
age was 36 years old), 30.81 percent had chronic illnesses or personal diseases;
average body weight before entering to the club was 55.9 kilograms and after was 56.4
kilograms.
The researcher and his team used the results of this research for devising a plan in
such a way as to create two projects: (1) one for adapting and changing heath behavior in
exercise and health checks for monks, civil servants, beneficiaries (insurees) of the social
security assurance scheme; and (2) the other, related to abdominal fat, by using tactics
concerning how to eat food properly; how to exer cise appropriately depending on age
and health status. These projects would be monitored and evaluated every three months
and it could be expected that the people of Wang Sammoh would have awareness about
developing their own health behavior in order to attain better physical, mental and social
health status.


location: , 'Thailand year: 2014 source: HSRI

title: The prevalence of and factors associated with stress among medical interns in 2012

abstract: This is a cross-sectional descriptive study which aimed to explore prevalence of stress and its associated
factors among medical interns. 283 medical interns in 2012 participated in this study. A self-administrative
questionnaire was used to collect the data during April to August 2013. The response rate was
71.11%. The study results revealed that the prevalence of stress among the medical interns was 29.40%.
Most of them illustrated normal and none of stress levels. The significant factors associated with stress
found in this study were income (p value=0.036), preparation before working as a medical intern
(p value=0.007), time constraint ( p value<0.001), risk of being sued due to duty ( p value=0.004) and lack of
leisure time (p value<0.001).


location: , 'Thailand year: 2018 source: HSRI

title: Factors Associated with the Use of Hearing Aids in People with Hearing Loss under the Universal Health Coverage Scheme

abstract: Hearing aids can rehabilitate hearing and improve communications abilities of people with hearing loss for efficient daily living. This study aimed to analyze factors associated with hearing aids use by analyzing data obtained from a survey conducted. The survey sample comprised 380 people with hear-ing loss who received hearing aids under the Universal Health Coverage scheme (UHC) from 2005-2015 in five provinces: Phayao, Samut Prakan, Chonburi, Khon Kaen, and Songkhla. The data were collected via interviews based on a questionnaire. Of the 200 people interviewed in the community, it was found that internal factors such as gender, age, occupation, and economic status were not significant factors related to usage. However, users who were satisfied with their hearing aids significantly used their hearing aids more than those who were not satisfied (adjusted OR = 3.99, 95% CI; 1.09-14.67, p-value = 0.037), and users who came for follow-ups significantly used their hearing aids more than those who did not (adjusted OR = 2.60, 95% CI; 1.22-5.53, p-value = 0.013). Thus, the National Health Security Office should provide hearing aids with improved follow up system to ensure appropriate use of hearing aids as well as to prevent discontinuation of use in the future.


location: , 'Thailand year: 2001 source: HSRI

title: Search for methods to develop the health service model at  Sirinthorn hospitals : a case study of the community by the dam

abstract: Search for Methods to Develop the Health Service Model at Sirinthorn Hospital : A Case Study of the Community by the Dam.	This study is a qualitative study and uses the Rapid Rural Appraisal (RRA) technique to study a community. The purpose is to find a model for the public health service for the promotion of health in the hospital for the community around the dam, so that is consistent with the operating principles and accepted by the community. Semi-structured interview was used to collect information by interviewing informants in the community and informants at the family level. The data obtained was analyzed collectively for content, and then taken to the community for approval.	The results of the study were that the community around the dam was in a drought area, without rice fields and without their own land for farming for their living. The main occupation of the inhabitants of the area was general labourer. It is a community which is strongly dependent on outside, both for occupation and food which must be found outside the community.	People in the community have 3 forms of treatment seeking behaviour when sick, which can be separated depending on type of illness: emergency illness, chronic illness and general illness. Each type of illness has its own pattern of acceptance and treatment. Villagers still having wrong understanding and acceptance with regard to health promotion behaviour in some aspects, especially some old beliefs such as using anti-biotics for the treatment of all diseases,using condensed milk for rearing babies etc.	When studying ways in which the community and the hospital can collaborate in implementation of health promotion work, it was found that people with an important role were villagers, village leaders, village health volunteers and hospital personnel or public health officers. Villagers realize and see the importance of health promotion and see that they should be educated to create correct behaviour and stress the development of village health volunteers so that they have greater credibility. The setting up of a health network should be stressed in the community, as well as giving information about using medicine, and stressing health education which is consistent with the needs of the community. Also, the hospital should stress the development of an aggressive service system, with an active team working with the community.


location: , 'Thailand year: 2020 source: HSRI

title: Epidemiology and infection control of carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Enterobacteriaceae (CRE) in hospital network of lower southern Thailand

abstract: Antibiotic-resistant bacterial infections are a major problem at the national level, especially for patients admitted to hospitals. Additionally, patients with infections have a high mortality rate, prolonged length of hospital stay, and high hospital cost. The most common concerned gram-negative bacteria as the major problem is Acetobacter baumannii and Enterobacteriaceae, particularly the strain which is resistant to carbapenam antibiotics. Objectives To study the clinical and molecular epidemiology of carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae in the lower southern hospital network as well as spatiotemporal analysis of these two species from clinical specimens and from screening in patients with systemic survey as well as from the hospital environments in each hospital and in the hospital network. To measure the efficacy of infection control strategies based on the investigational data. Methods To collect the specimens of carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae from clinical practices and surveillance and do the laboratory to identify molecular strain of those specimen. Clinical data was used to analyzed the factors influencing mortality as well as probability for colonization of those bacteria. Clinical and non-clinical outcomes were compared between the patient with colonization and those without colonization. Molecular data and demographic data was used to performed spatio-temporal analysis. The number of the patients infected with these two bacteria was compared before and after intervention. Results From February 2019 to July 2019, there is the distribution of both bacteria every hospital in the network as well as in the whole of network with identically detection of molecular closeness and spatio-temporal relation. The infection due to both bacteria had relatively high mortality and unfavorable economic burden. Factors influencing mortality is Acute Physiology and Chronic Health Evaluation II (APACHE II) score and appropriate empirical antibiotics. Among of the patients with colonization of these two bacteria, unfavorable clinical outcomes and particularly high hospital costs were identified. The significantly associated factors influencing colonization is previous use of antibiotics, particularly carbapenems even the short duration of administration. The number of cases infected with carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae were significantly decreased after implement of infection control measures based on the finding from surveillance data. Conclusion Systematic control of the use of antibiotics is sufficient to reduce the infection due to carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae. Measures for screening patients before admission is potentially necessary supplementary measures.


location: , 'Thailand year: 2022 source: HSRI

title: Social Returns on Investment from Employment Innovation Initiatives to Enhance Community Capacity to Provide Well-Being Support Amidst Emerging Health-Related Incidences

abstract: The outbreak of COVID-19 had caused businesses to shut down. As a result, unemployment incidences soared. Being unemployed not only affected ones’ incomes, Physical and psychological well-being were also adversely affected as well. These undesirable effects were more predominant among new graduates, unskilled workers, part-time workers and elderly workers. In Thailand, some of those affected were fortunate to be able to return to their original provincial residences. There were also those who decided to stay due to lack of jobs in the communities or nearby areas to support them if they were to return home. These lack of employment opportunity issues were known to the government both at the national and provincial levels. Thus there were several initiatives on area-based job creation project to ensure that those who returned would find an employment to support them until the breakout subsided. Many of these initiatives tided their program to the improvement of community well-being. While employment benefits were apparent, other indirect social and economic benefits were more subtle. Assessing the success of these publicly-funded programs based only on apparent employment benefits would grossly underestimate the programs’ contributions. This study aimed at providing a broader view as to how such initiatives generated both direct and indirect social and economics benefits. With the use of Social Rates of Returns (SROI) as the key empirical workhorse, the study provided supplementary information of the magnitude of programs’ contributions whose values could be used as financial measure against the resources spent on the program; therefore, the benefit and cost ratios would be closer to their true boundaries. Five projects were chosen as case studies. SROI calculation based on primary and secondary sources had yielded the followings: 1. For Khok Nong Na Sufficiency Economy project, the SROI was 1 : 4.23; 2. For 1 Subdistrict 1 New Theory Agriculture Group project the SROI was 7.13; 3. For U2T Project, the SROI was 1 : 5.15; 4. For Local Volunteer Care-Takers, the SROI was 1 : 3.55; and 5. For Traditional Thai Massage Training, the SROI was 1 : 22.70. By and large, based on the above empirical findings, it could be concluded that these initiatives were sound investment of the public fund. There were three essential lessons learned from these projects. The first being finding the right match between the project participants and the need of communities. It was found that when the skills of participants matched with communities’ needs, participants would receive considerably more support from communities; this would increase the chance of the participant to successfully meet the requirements of the project. The second lesson was designing exit strategy prior to the implementation of the project. There were cases whose community capacity deteriorated significantly after the project participants were withdrew. This would not had happened if there were properly designed exit strategy to pass on all the responsibilities held by project participants to the designated persons in the communities. The third lesson was on enhancing participants’ soft skills, digital skills and communication skills so they could work more effectively with community members. This skill enhancement should be part of the pre-project orientation of the participants. The last one was integrating monitoring and evaluation process as a part of the project. This was because the project of this nature required certain time period before outcomes and impacts could be felt and measured. Without having a proper M&E process, there would be no way to collect required data to measure the true success of these endeavors.


location: , 'Thailand year: 2023 source: HSRI

title: Improving Accountability and Effectiveness of Observed Therapy for Tuberculosis Using the Mobile Application

abstract: In Thailand, directly observed therapy (DOT) has been performed for tuberculosis treatment monitoring for two decades. However, this program lacks an accountability system leading to becoming an unsustainable strategy, especially to continue DOT during the pandemic of COVID-19. The research team developed a video observed therapy (VOT) system using the mobile application called "TH VOT" to monitor medication adherence among tuberculosis patients. The system provided feasibility and safety to both the patients and their observers. The observers can remotely inspect the patient’s taking medication through the videos sent by the patients. The system was implemented in Hat Yai and Mueang Songkhla District, Songkhla province, Southern Thailand, and assessed its usability by the participants in these jurisdictions. All of the users could use the system to perform the VOT sessions, and they rated the system above-average level of the general benchmark of UEQ for its usability. A cluster randomized controlled trial of patients with pulmonary TB and their observers was conducted over a 60-day period to compare the cumulative compliance days, smear conversion rate, and the number of adverse events reported in the VOT system with those in the traditional DOT system. The study recruited 63 patients for the VOT program and 65 patients for the DOT program. Patients in the VOT program had an average of 27.6 cumulative compliance days, while those in DOT had 12.4 on average. The mean difference was 15.2 (95% confidence interval [CI]; 0.6 to 29.7). Observers in the VOT program averaged 21.5 cumulative compliance days, while those in DOT observed 0.3 days on average. The mean difference was 21.2 (95% CI; 10.8 to 31.6). There is no significant difference in the smear conversion rate, and the number of adverse events reported. In conclusion, TH VOT significantly outperformed the traditional DOT in ensuring compliance with TB treatment for both patients and observers. However, the low compliance rates observed in both groups suggest a need for system improvements and regulatory policies to ensure accountability of the observers.


location: , 'Thailand year: 2008 source: HSRI

title: Factors effecting the compliance of diabetes mellitus patients in Somdet Prayannasangworn hospital, Chiang Rai province

abstract: The purpose of this study was to identify factors affecting the compliance of diabetes
patients and to examine the relationship between the compliance of the patients and
the levels of Hb A1c. The subjects included 274 type 2 diabetes mellitus patients attending the diabetes mellitus outpatient clinic of Somdet Prayannasangworn Hospital in Chiang
Rai Province. Patients were interviewed using a structured questionnaire. Data were analyzed
by both descriptive and inferential statistics, i.e., paired t-test, analysis of variance
(ANOVA) and the Pearson‘s product moment correlation coefficient.
The results of this study were as follows: there were statistically significant differences
in patients‘ compliance behavior regarding the relationship between the selected
relationship between doctor and patients and the patients‘ perception of self-efficacy (pvalue
< 0.01), and the relationship between the selected patients‘ compliance behavior
and the level of Hb A1c (p-value < 0.01).


location: , 'Thailand year: 2015 source: HSRI

title: Evolution of Advertising Regulations of Food and Beverages with High Sugar, Fat, and Sodium in Thailand and Foreign Countries

abstract: One of the interventions in order to prevent unhealthy diet habits of children is law or regulations to
control advertising. This article is the review of an evolution and enforcement of the regulations in 6
countries, UK, USA, Brazil, Australia, Singapore and Thailand. A wide variety of publications, databases from websites, reports and books from 2001 to 2011 that involving about regulations of food advertisement
were studied. It was found that the content of laws and regulations related to advertising food and
drinks with high sugar, fat and sodium in all six countries indicated that advertising must not contain any
false, misleading, and deceptive statements, and/or misrepresentation on products. However the limitations
about times and duration of advertising were different. Brazil has a bill to ban advertising from
6 a.m. to 9 p.m. but Singapore has no time limitation.
In conclusion, Thai government should develop advertising legislation and regulations related to
food and drinks with high sugar, fat and sodium in order to reduce consumption of these risky foods and
beverages among children and youth in Thailand.


location: , 'Thailand year: 2015 source: HSRI

title: Evaluation of Dental Services Quality

abstract: In 2010, the Dental Council has prepared Thai Dental Safety Goals and Guidelines 2010 which was
distributed to members to learn and put into practice. It could be adjusted according to different context
of use to ensure maximum safety for both service providers and recipients. The purpose of this study was
to evaluate the dental service quality in Dontan Hospital against the Thai Dental Safety Goals and Guidelines
2010. Data was collected from 240 patients using a questionnaire to access patient treatment quality
according to Thai Dental Safety Goals and Guidelines 2010. The evaluation also assessed 240 copies of
complete medical records and self-evaluation was included. The methodology used is the quantitative
analysis of frequency, percentage, mean and standard deviation. The process started from July 1 and
ended on July 30, 2014. The study found that : 1. On average, patient evaluated the quality of treatment at
92.8 percent. 2. The average of completeness of information, especially in dentistry was about 66.3 percent.
3. Self-assessment evaluation was done at 89.09 percent for patient safety, the improvement of communication,
safe dental treatment, safe infection control and complete record. Nonetheless, there are also
rooms for improvement. Written treatment plan in complicated cases needs to be recorded. Quality of
service in pediatric treatment could be improved by using the dental dam.


location: , 'Thailand year: 2003 source: HSRI

title: The health insurance development for the informal workers and their families

abstract: The  Health  Insurance  Development  for  the  Informal  Workers  and  Their  Families	The objectives of this research   are  two fold.  The first objective is to examine the health care situation and health care among the informal workers and their families.  The second objective is to develop  a  proposed guideline for health insurance plans for the informal workers  and  their families.The  study  reveals  that  informal  workers  and  their  families  still  lack  preventive health  care  and  maintenance  health  care.  The  majority  of  them  do not have health insurance and have to pay for medical care at their own expense, especially for costly severe illnesses and injuries.  However, their family members who are elderly and children are covered under the Free Medical Cards.  For these reasons, there should be health insurance plans for the underprivileged especially  the  informal workers and their families.  They should be guaranteed health care in accordance with the Human Rights Act and the Thai Constitution of 1997, stating that all citizens are entitled to quality health care, both preventive and maintenance health care.  Thus, health insurance plans provided must contain reliable long-term programs with competent and effective management.	In order to achieve effective health insurance management, four components are required namely a policy component, a fund management component, a health care network component, and a quality assurance component.  There must be a network of health care services for the people.  The network should insure cooperation among the government, the private sector, the  business  sector  and the people’s organizations.  Tax revenues must be allocated to provide basic health care services for illness, child delivery, disability, annual physical examination, and health information for informal workers.  Program monitoring mechanisms are needed  to ensure quality health care, a high standard of services, and effective fund management.  These mechanism should consist of both internal  and external examiners.  Informal workers should participate in the program, especially in preventive health care, and ensure their rights to health care services.	In addition to the components mentioned above, effective health insurance management requires supportive laws, development of an information network, ongoing public relations programs, development of an appropriate taxation system, and establishment of organizations for informal  workers.	The following  suggestions are herein proposed :Informal workers and their families should be encouraged to gain competence in preventive health care and during the time of illness or injury.The organizations concerned should take responsibility in solving health care problems for informal workers.Informal  workers and their families should be encouraged to organize themselves and to form health care networks.The government must provide quality health insurance plans for informal workers and their families on the basis of equal rights.Health  insurance management should emphasize the development and improvement of existing  organizations rather than the establishment of  new organizations unneccessarily.Health  insurance plans should provide alternative programs.A  health care database for informal  workers and   their families should be developed.


location: , 'Thailand year: 2005 source: HSRI

title: The research questions on quality and quality improvement in health care Thailand project : Phase 2

abstract: This research project comprises two parts.  The first part is the review of experiences in researches in quality of health care and setting a preliminary proposal for research question frameworks.   The second part is a survey of situations and questions among stakeholders, namely providers and clients, regarding quality of the health services system and quality improvement and a summary of strategies to approach quality of health care research.  The project report presents the findings of the Phase 2 study, which aims to a survey of situations and questions among stakeholders, namely providers and clients, regarding quality of the health services system and quality improvement and a summary of strategies to approach quality of health care research.  The focus areas, which are drawn from the findings in the Phase 1 study, include problems and obstacles in quality improvement, patient safety, and expectation and perceived services from patient perspective.   Descriptive studies by questionnaires were conducted health care providers and patients in 39 public and private hospitals and 39 primary care units in 12 areas nationwide and Bangkok.  In addition, hospital accreditation surveyors were surveyed.  There were also in-depth interviews among primary-care-unit patients and a telephone survey of people in Bangkok and its vicinity area.  The studies were conducted during January 2004 to December 2004.	Major findings include 33 interesting research topics on quality improvement issues and 40 topics on patient safety issues from the studies on health care providers.  There are four topics on primary care units.   There are 12 topics identified by the surveyor group; some of which are similar to those of the provider group.  In addition, there are another 22 research topics set apart from the patient and consumer studies.   In sum, these findings are details consistent with what have been found in the Phase 1 of this research project.


location: , 'Thailand year: 2003 source: HSRI

title: Family violence: state of the art review and research promoting system in the future

abstract: Family Violence State of the Art Review and Research Promoting System in the Future. This paper reviews research on domestic violence internationally and nationally and suggests the direction of research promoting system in the future. The analysis of this literature considers historical context, methodology issues, concepts and theories related to domestic violence and situational reviews on wife abuse, dating violence and child abuse. As domestic violence is emerging as a significant social problem all over the world, there is a growing body of multidisciplinary research on domestic violence. However there are key issues of controversies in the study of domestic violence including definition, method of measuring and data sources. The review suggested to create the structure and the process of domestic violence research. It is suggested to develop a National Research Center that could collect, process and disseminate reliable information, which can support policy and practice efforts in the field. It will develop data from practice and return it to practice. The Center will cover several areas of study including violence against women and all forms of spousal violence; child abuse and neglect and dating violence.


location: , 'Thailand year: 2008 source: HSRI

title: Factors Associated with Depression and Risk of Suicide among Residents Aged 35 Years and Older in Ko Sichang District, Chonburi Province

abstract: A study was conducted to determine the factors associated with depression and
suicidal risk among 359 residents aged 35 years and older living in Ko Sichang district,
Chonburi Province. The subjects were recruited by random sampling from the household registry. Information was obtained using the questionnaires prepared for the detection of
depression and suicidal risk by the Department of Mental Health of Thailand’s Ministry
of Public Health. Chi-square test and probit regression analysis were used to determine
the factors associated with depression and suicidal risk. Of the 359 persons interviewed,
35.93 percent were male and 64.06 percent female; 34.26 percent of them were aged 40-49
years and 64.35 percent had an educational level of primary school; 59.33 percent had a
monthly income of less than 5,000 baht; and 38.44 percent suffered a chronic disease. The
care-givers who accompanied the study population to the health-care centers for treatment
were mainly their family members (53.20%). Of the persons surveyed, 22.56 percent
suffered depression (depressive score > 6) and 13.37 percent were at risk of suicide
(suicidal score > 2). It was apparent that chronic illness was a significant factor associated
with depression, while higher educational levels and having intimate care from family
members or relatives such as accompanying them for health-care services seemed to reduce
depression. Having a chronic disease was also a significant factor associated with
an increase in suicidal risk. Further prevention or reduction of depression or suicidal risk
among people with a chronic disease is essential. Family members and relatives may help
this population at risk to reduce their depression.


location: , 'Thailand year: 2021 source: HSRI

title: Treatment Pattern and Effectiveness of Trastuzumab in Early Breast Cancer Patient: A Real-world Data Analysis

abstract: This study is a retrospective study using real-world data to compare treatment patterns with the guidelines for drug administration of the National List of Essential Medicine (NLEM) category E(2), and to compare effectiveness with the efficacy of clinical studies. This study focused on the treatment pattern and effectiveness of trastuzumab for early breast cancer (ICD-10 C50). Data were retrieved from the reimbursement database of the NLEM category E(2) during fiscal year 2015-2018. Time to follow-up was truncated at the end of fiscal year 2018. The data were analyzed by using descriptive statistics and non-parametric with Kaplan-Meier method. As a result, there were a total of 2,492 early-stage breast cancer patients, mostly between the ages of 50-59 years (37%), with a median follow-up of 34.98 months (interquartile range 16.75 months). The majority of patients received trastuzumab in accordance with the NLEM category E(2) guideline, 1,996 cases (80%) received drug less than 18 treatment cycles and 2,217 cases (89%) received drug less than 14 months. Subgroup analysis of the less than 14 months found 942 patients (38%) received the drug less than 12 months. Analyses of real-world effectiveness by using survival analysis in all trastuzumab patients found a 4-year survival rate of 80.02% (95% CI: 77.69-81.62); 78.74 % (95% CI: 76.36-80.90) for less than 18 treatment cycles, and 85.07 % (95% CI: 82.24-87.48) for the 12-14 months. These rates were lower than the efficacy reported from randomized controlled trials. Therefore, the present study of real-life data analysis concludes that most of patients received the trastuzumab in line with the NLEM E(2) guideline. Non-adherence may result in reducing the effectiveness of treatment lower than the efficacy from the RCT. However, this study did not explain the reason of non-adherence due to lack of important data, such as responses to treatment, recurrence and occurrence of side effects from drug use.


location: , 'Thailand year: 2021 source: HSRI

title: Cost of Emergency Patients in Public Hospitals for Financial Policy Recommendation to the Universal Coverage for Emergency Patients (UCEP)

abstract: The objective of this study was to estimate the cost of emergency patients in public hospitals for financial policy recommendation to the Universal Coverage for Emergency Patients (UCEP). Financial and service information for the fiscal year 2019 was gathered from eight hospitals, two of which were general hospitals of the Department of Medical Services, four regional hospitals, and two general hospitals of the Office of the Permanent Secretary, Ministry of Public Health. The traditional cost method with the cost matrix method was applied to analyze the unit cost of emergency patients. We used the cost matrix in two steps: (1) cost distribution of the fundamental cost centers to each patient based on the services received; (2) summing all medical activity costs on each patient and reporting them as individual patient data. The result showed that there were a total of 82,811 emergency patients from eight hospitals, 20,503 were triaged as resuscitation patients (red), and 62,308 emergency patients (pink). Labor costs were the highest share of the overall costs, followed by material costs, and capital costs. Unfortunately, the present study could analyze complete cost information from only one hospital (hospital A). The total cost of 18,027 emergency patients was THB 472,317,273. The average cost per person was THB 26,201, and the average cost per adjusted relative weight by diagnosis related group was THB 9,661. This costing method that required accurate hospital financial and emergency medical service information reported only data from one hospital. Further studies should explore alternative appropriate costing methods that data from more hospitals could be analyzed as more representative.


location: , 'Thailand year: 2001 source: HSRI

title: Health impact evaluation

abstract: Health Impact EvaluationFast development of socio-economic environment was regarded as a promoting factor to environmental changes particularly air, water, soil pollution. This change had impact on life quality of Thais and huge expenditures for health care. For example, in 1998, economic value of life loss and injuries caused by road accidents was estimated at 100,000 million Baht. Overall, expenditure for health care represented about 6% of GDP.To reduce that loss, preventative measures and initial correction must be emphasised by all parties in our society. Health impact assessment (HIA) was a new measure to determine level of consequent impact on health. Development of the HIA system was considered important and should be stated in National Health Act.  Issues which should be available in the Act were health impact assessment or environment health impact assessment covering both acute and chronic diseases, injuries, crimes and society violence. The implementation of HIA should not be taken by sole party. Instead, working in alliance form or networking must be promoted with accountability and transparency. HIA was composed of two parts which were HIA under analysis of environment and risk management. Organisations responsible for HIA can be grouped into 3 types. The first group was the organisation responsible for determining policy, measures, standards, regulations and mechanisms for HIA. The second group was the organisations which were evaluated, involved in using information for making decision, the evaluators, trainers, responsible for accreditation, registration and monitoring standards. The third group was the organisations providing community information and performing research and development.Main issues for research and development in short term were as following:preparation for system development, education and human resource development should be firstly done,manual of risk management and health risk management should be developed,HIA under analysis of environmental impact should be strengthened.


location: , 'Thailand year: 1998 source: HSRI

title: Need and want analysis for public health information services

abstract: Need and want analysis for public health information servicesThe purpose of this study is to explore the needs and wants of nine target groups in using health information : the massmedia practitioner, the public health personnel, the teacher, the housewife, the factory worker, the community leader, the teenager, the working adult, and the elder. The study employed the qualitative research method. The data was colleccted by the technique of in-depth interviews and small focus-groups access  745 key informants who were  members of nine target groups and lived in Bangkok and Chiengmai. The results of the study were as follows : 1.All nine target groups felt more the need for health information concerning various types of deseases than for of health information concerning good health. 2.The finding indicated different purposes using health information among the nine groups. The mass media practitioner, public health personnel and the teacher used health information for their professions. The houswife's purpose was to  both take care of herself and others in the household. The teenager and the elder used the information just for themselves. The working adult and the factory worker did not pay much attention to health information. The community leader was the  only group which  wanted to develop their capacity to use health information.3.The importance of needs and wants in using health information depended on the relationship that one has to the care of others  ; for example, nurses have to take are of patients, teachers   have to teach students, housewives have to take care other people in the family. 4.The proper way to respons to the needs for health information is to start first by creating attention/interest in health information. Then, by using the communication strategies which are compatiable with the target group, to associate the information with their previous understanding.  It is important as well to use the medium as which target groups indicated as their preferred source of health information.


location: , 'Thailand year: 2019 source: HSRI

title: Development of rapid screening tests for neurodegenerative diseases for self-reliance and sustainable development (2nd year)

abstract: Thailand has become an aging society. Old age people risk of developing dementia including Alzheimer's disease (AD). Therefore, early diagnosis is crucial in order to prevent the serious health problem. Herein, the rapid simple and low cost detection method have been developed for screening test of Aß1-42 which is essential biomarker of AD. Firstly, the antibodies used were investigated and selected to perform in the assay. The gold nanoparticles (AuNPs) was used as a labelling materials because the results can be seen by naked eye and provide the stability. The dot-blot with direct and sandwich immunoassay were developed for measurement the level of Aß1-42. However, the sandwich immunoassay provides higher sensitivity when compared with the direct assay which was then selected to use in further work. For the assay, the anti-rabbit Aß pAb was immobilized on nitrocellulose membrane. To test, the sample was dropped on the test zone and incubated for 10 min. After that, 2 µL of anti-rabbit Aß mAb conjugate- AuNPs was applied on the test zone and incubated for 10 min following by washing. The results can be visualized in few min. Under optimized conditions, the limit of detection was found to be 5 µg/mL. In order to enhance the signal, the silver enhancer was applied in the system after test. In the present of silver enhancement solution, the darker color in signal becomes more strengthened due to silver precipitation on the AuNPs which providing better sensitivity. The limit of detection was observed at 1 µg/mL. Moreover, the approached assay would be applied to detect of Aß1-42 antigen in real blood sample and the results showed the different between the sample with and with out Aß1-42. However, the further development to increase the sensitivity of detect tool still need more study to apply for the measurement of the plasma Aß in clinical sample.


location: , 'Thailand year: 2022 source: HSRI

title: Development of a Prototype of Virucidal Sticker (COVID GUARD) for Medical Application

abstract: This research is continuous innovation and an effective additional protocol to reduce and control the COVID-19 pandemic by creating free COVID-19-surfaces and environments without the required routine cleaning process. A prototype of a clear “DSci sticker” has been coated with a solution of Ag-TiO2/WPU nanocomposite, which is a smart material that can generate active species with long-lasting property. Our sticker with virucidal efficacy of 99.99% against SARS-CoV-2 according to ISO 21702: 2019 standard has been developed. The ROS and Ag+ accumulate on the surface of virus particles and denature the viral proteins, offering broad action against unspecified targets (all virus proteins, not just the spike proteins), which could be helpful in all SARS-CoV-2 variants of concern. In addition, the cytotoxicity test was determined according to ISO 10993-5: 2009 standard to ensure that our sticker is safe and non-toxic to humans and animals (% cell viability >70%). To take this research into real practice, we tested antiviral efficiency against SARS-CoV-2 under the simulated practical conditions following ISO 21702: 2019. We mimicked a spreading of virus in air (coughing and sneezing) using a direct spraying model. The results showed that our sticker completely eradicated SARS-CoV-2. Our sticker is used for medical equipment with clear readability and labelling. It reduces risks of high-touch contaminated surfaces and its virucidal efficacy lasts for at least three months (≥99.90%). The prototype is prompted for Thai FDA registration of class 1 medical devices. Furthermore, a production process in this work can be scaled up for an industrial production.


location: , 'Thailand year: 2019 source: HSRI

title: The Geographic Information System for Health Management of District Health Board

abstract: District health system considered as a lever point to improve the quality of life of people which mechanism of driving in the district area rely on district health board in which the development process would be sustainable successfully, the process must be consistent with the context of the area and the empirical information is needed for the decision. The objectives of this study were to develop the geographic information system for health management of the district health board and to synthesize the purposed policy of using the geographic information system to improve quality of life among population in the area. Mixed method of research and development design integrated with participatory action research (PAR) were applied in the study. The study processes divided into three phases: phase 1: the development of geographic information system to improve quality of life, phase 2: the assessment of the implementation of the system, and phase 3: the synthesis of purposed policy in the development of the system. The study was set in two districts of Nakhonsawan province. The finding showed that: 1. The development of geographic information system to improve quality of life had five steps: 1) the study of essential information, 2) the distribution of data resources both in an original database and new information, 3) the connection of essential information from the database of organizations which related to the improvement of quality of life among population in the area, 4) the creation of conditions for analyzing data and presenting in the program that called Geographic information system: GIS through website (http://118.175.82.80/dhb/web/index.php) in which general population and the district health board can access to by computer and mobile phone but in a different level, and 5) the implementation combines with decision making in determine issues for improving quality of life of people, planning and evaluation 2. The assessment of the implementation of the system revealed that the for the long term care of vulnerable group, especially the elderly is thoroughly taken planning of care, can access to essential services and social welfare, and having skills for self-care that help to reduce the risk of complication from their existing diseases. 3. The synthesis of purposed policy in the development of the system had four issues:1) having district health data center for quality of life improvement, 2) having organizational structure in geographic information system management, 3) having the potential development of the committee in using information for decision making related to public health, and 4) having an exchange process for learning from practice. Therefore, in using geographic information system for the decision making to improve the quality of life of people in the area, the district health board must use the empirical information which consistent with the context of those areas. These will lead to the management of population health which is the true concept base of the district health system as saying that “The development that use community as base and people as center”.


location: , 'Thailand year: 2008 source: HSRI

title: Coverage of health promotion and disease-prevention services for children aged 0-5 years in Lop Buri province, 2006

abstract: This cross-sectional survey was aimed at exploring the health-promotion coverage
of and disease-prevention services for children 0-5 years old in Lop Buri Province. A total
of 173 children were selected by two-stage cluster sampling probability proportional to
size. This study found that the persons most frequenlty acting as checkers of the children’s
progressive development were their mother and father (68.5%); 2.2 percent of the children had abnormal results and all of them were take care of by physicians; of the 71.8
percent that were weighed, 68 percent had normal weight. Almost all (98.3%) had received Bacillus-Guerin (BCG) vaccine, hepatitis B vaccine (97.7%), polio vaccine (95.4%),
diphtheria, tetanus toxoid and pertussis vaccine combined (94.8%), measles vaccine (93.3%)
and Japanese encephalitis vaccine (86.2%). Most of the children did not get dental care
(65.9%) and 42.4 percent had dental carries. More than half (56.7%) of the parents had
read their children’s health record and almost all (96.9%) of them used their books. The
three most useful aspects of the books were for child-feeding, checking the progress of
the children and making appointments for vaccination, respectively.


location: , 'Thailand year: 2003 source: HSRI

title: The cost per unit of health services in Health for All : a case study of Health Servic Center(No 16)

abstract: The Cost per Unit of Health Services in Health for All:  a Case Study of Health Service Center (No. 16)To illustrate the cost of services in health promotion and prevention , out patient (OPD) and dental care through a Health Service Center (No.16) Bangkok Metropolitan Administration. The analysis of the cost components could be used as key data for future planning, budgeting and resources preparing for the short and long terms.The cost centers were categorized to be executive, services and supporting unit. The simultaneous  equation  method was employed to allocate all costs from other associated cost centers to the service unit.The unit cost per visit was  372.76  baht, while the unit cost per capitation was  532.83  baht . The unit cost of health promotion and prevention per capitation  was  288.95  baht, whereas the unit cost of OPD per capitation   183.47  baht and the unit cost of dental care per capitation  55.37  baht. The labor cost accounted for 83.67  per cent, capital cost  6.09  per cent and material cost  10.24  per cent of the total cost.  Unit cost of OPD and dental care was lower than the proposed budget while the unit cost  of health promotion and prevention was higher. That could because of some patients seeking the OPD care from the King Chulalongkorn Hospital, while the health promotion and prevention offered was more than other Health Service Centers provided. The labor cost was the main factor to be improved for more efficient and the decrease  of labor cost would be in the short and long term strategies respectively.