location: , 'Thailand year: 2013 source: HSRI

title: Measures to promote rational use of medicines in public hospitals: a review and analysis of national policy interventions

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


location: , 'Thailand year: 2023 source: HSRI

title: Evaluating the Performance of the Global Diet Quality Score for Determining Overall Dietary Quality Among Thai Adults for Integrating into Non-Communicable Disease Prevention System

abstract: The Global Diet Quality Score (GDQS) is a comprehensive metric that covers both the risks of nutritional deficiency and the risk of diet-related noncommunicable diseases (NCD). Validation tests were previously performed using secondary data from various countries. However, the study of the application of the GDQS to the Thai population is still necessary. Because Thai food usually consists of a variety of components, the GDQS may reflect the risks of nutrient inadequacy and the risks of NCD differently from the previous studies. Objective: This study aimed to characterize the GDQS’s performance by estimating the associations between the GDQS and diverse outcomes reflective of undernutrition and diet-related NCD risks. Methods: A cross-sectional study was conducted in Thai adults aged 40-60 years. GDQS was calculated from dietary data collected using a 24-hr dietary recall (24HR), a semi-quantitative food frequency questionnaire (FFQ), and the GDQS-Assessment System (GDQS-AS). Additional metrics were also calculated, including the Minimum Dietary Diversity for Women (MDD-W) and the Alternative Healthy Eating Index-2010 (AHEI-2010). Nutritional status was determined through anthropometric, body composition, blood pressure, and biochemical marker assessments. Spearman rank correlations and multivariable adjusted regression models were performed to evaluate the associations between GDQS and diverse outcomes reflective of undernutrition and diet-related NCD risks. Wolfe test and Wald test were used to compare the strength and trend of the correlations of the GDQS and outcomes between different dietary data collection methods and different metrics. Results: The prevalence of overweight to obesity (Body mass index ≥25 kg/m2) was 47.5%. Anemia was reported in 8.9% of men and 23.8% of women, hypertension in 54.1% of men and 39.4% of women, and metabolic syndrome in 42.5% of men and 35.9% of women. Mean urinary sodium excretion was 3,397 mg/day (147.7 mmol/day). The GDQS calculated by GDQS-AS and FFQ were relatively similar, while the GDQS-24HR was lower. Multivariable adjusted regression analysis found that GDQS-AS performed better in reflecting nutrient intakes, nutrient adequacy, and nutritional outcomes than GDQS computed from 24HR and FFQ. GDQS, MDD-W, and AHEI-2010 similarly performed in indicating nutrient adequacy and risks of NCD. Nevertheless, GDQS computed from FFQ better reflected nutrient adequacy. Conclusion: Overall, GDQS-AS had a relatively stronger performance in capturing both nutrient intakes and nutritional outcomes compared with GDQS computed from other methods, whereas GDQS scored from FFQ was outperformed
in capturing nutrient adequacy. Findings from this study only reflected a cross-sectional correlation between GDQS and nutrient adequacy and NCD risks. Thus, further study to longitudinally explore the correlations between GDQS and NCD risks is required.


location: , 'Thailand year: 2022 source: HSRI

title: Knowledge Review: A Project to Development Policies and Models of Health and Safety Promotion in the Workplace under Employment System and the Universal Coverage Scheme

abstract: Non-communicable diseases (NCDs) are major health problems in the working-age population. As the workplace health promotion (WHP) plays a crucial role in reaching this group, the measures for the WHP need to be implemented. This project aims to review literature and gain stakeholders’ perspectives in order to synthesize policy recommendations. The mixed methods had been used, including literature review and stakeholder interviews using the Delphi technique. The literature review was carried out in 5 different topics: 1) policies and legislation, 2) behavioral economics and social science theories, 3) Information system and applications supporting lifestyle modification (LSM), 4) personal data protection laws, and 5) comparison of WHP packages (the results of studies in topic 2, 3, 4, and 5 will be published elsewhere). Fifteen stakeholders including representatives from units in the Ministry of Labour, employers, and employees were interviewed twice. The policies and legislation which provide opportunities for WHP were categorized into 4 groups: 1) health insurance scheme, especially Social Security Scheme (SSS), 2) welfare and quality of life, 3) control, diagnosis, and compensation for work-related illnesses or injuries, and 4) control of risk factors of NCDs in the workplace. Stakeholders had agreed upon most of the proposed recommendations to amend the legislation regarding group 1, 2, and 3, except in reducing working hours. These proposed amendments can be implemented immediately through the Ministry’s efforts. The proposed amendments to the legislation to provide the opportunities for the WHP are: 1) To include the LSM consultation in the health benefit package There is a proposal to clearly incorporate the LSM consultation to adjust health behaviors in the National Health Security Act B.E. 2545 (2002). 2) To include the SSS reimbursement in the first aid room service The National Social Security Act B.E. 2558 (2015) Section 24 indicates that the insured shall have the right to receive compensation when they experience dangers or illnesses as well as receiving health support and preventive care. In addition, the document attached to the Act indicates that hospitals shall collect health information to analyze the health problems of the insured in order to create health and preventive care plans for the insured, and inform the insured, Social Security Office, and the employers to be aware of the health problems in the establishments. 3) To provide health-promoting environment in the workplace The Ministerial Regulation B.E. 2548 (2005)regarding the welfare arrangement in the workplace indicates that the establishments must provide the environment which promotes health and wellness such as installing signs to encourage the use of stairs instead of elevators, building outdoor and indoor walkways, having more healthy dishes in cafeteria alongside with providing knowledge about nutrition for employees. 4) To expand the role of healthcare personnel in the first aid room to be able to provide LSM consultation The Labour Protection Act B.E. 2541 (1998) broadens chances to upgrade the role of healthcare personnel in the first aid room, allowing them to take part in providing healthcare consultation to adjust health behaviors. 5) To expand the role of the safety committee to include WHP According to the Safety, Occupational Health, and Environment at Work Act B.E. 2554 (2011), the role of the safety committee should be expanded to include the health promotion of employees, based on the concept of integrated health protection and health promotion for workers’ health which is globally recognized for the better outcome than separate operations. 6) To include illnesses caused by long working hours in occupational diseases and diseases covered by SSS Adding illnesses caused by long working hours into the list of work-related or occupational diseases will emphasize the importance of health problems and facilitate disease diagnosis which can lead to preventive and controlling measures in the future.


location: , 'Thailand year: 2007 source: HSRI

title: Community Participation in the Prevention and Control of Addictive Substances in Tambon Patan, Khuntan District, Chiang Rai Province

abstract: The problem of substance addiction in communities is still a serious and increasing
social problem.  It has a great impact on families, communities, society and the country.
Inefficient means for prevention and control of this problem will shortly lead to substan-tial social complications in communities. Therefore, the participation of the community
in coping with widespread substance addiction is crucial.
The objectives of this participatory action research study were to explore the situation of addictive substance abuse and develop a model for prevention and control by
emphasizing community involvement.  One hundred and fifty villagers, who were community leaders, health volunteers, guardians, and youths living in villages 5, 9, and 11 of
Patan, Khuntan district, Chiang Rai Province, participated in the research activities. The
researchers and the community groups analyzed problems and determined solutions by
using the AIC-technique.  They collected information by using the participatory observation method and focus group discussion technique. The study was conducted between
October 2001 and February 2002.
The result of the study revealed that there were 40 drug users in these villages. The
sources of substance distribution were identified in all three villages. Community regulations for the prevention and control of addictive substance abuse were established through
village consultative meetings. After the regulations were implemented continuously, the
scale of substance addiction became dramatically more limited in these three villages.
Local organizations played a very important role in minimizing these social problems.
However, community participation needs to be strengthened and continued in order to
sustain the success of substance control in these villages.


location: , 'Thailand year: 2018 source: HSRI

title: Assessment of community health fund, Public Health Region 11, to support the next phase of policy making

abstract: The implementation of decentralization concept under Thai health policy follows the National Health Security Act B.E. 2545 (2002) and Determining Plans and Process of Decentralization to Local Government Organization Act, B.E.2542 (1999). Community health funds (CHF) have been set up by National Health Security Office (NHSO), Ministry of Public Health, and Department of Local Administration, Ministry of Interior at the subdistrict level, emphasizing on participatory process. CHF primarily aims to support health-related activities done by communities and organizations based on community demand and readiness. CHF can be used for health promotion, prevention, rehabilitation, and proactive primary healthcare. This study was a mixed-methods study conducted in the Public Health Region 11 (upper southern Thailand). First, tertiary data from NHSO region 11 was analyzed to provide an overview of the regional situation. Afterwards, interviews were conducted; interviewees included NHSO region 11 personnel and subjects from 10 subdistricts (6 subjects for each subdistricts: 3 CHF committee and 3 non-CHF committee). We were able to complete 57 of 60 planned interviews from the subdistricts. Among 10 subdistricts, 5 were selected from the eastern coast; other 5 were selected from the western coast with mixing between good and bad performance CHF of those subdistricts. Two subjects from a provincial state audit office were also interviewed. Moreover, a population survey was conducted in those 10 subdistricts. The sample size was 350 (35 subjects from each subdistrict). Subjects were residents of each subdistrict aged 18 years and above who did not work with SAO or public health centers/hospitals. Preliminary results were presented to stakeholders including NHSO, SAO, community members, public health officers, and HSRI on 28th June 2018. Discussion during the presentation were recorded, analyzed, and included in the final report.


location: , 'Thailand year: 2022 source: HSRI

title: Social Movements Towards Healthy Life of Vulnerable Families in Thai Society

abstract: This research aims to study families in Thai society from the historic to the modern period and take a look at policies, measures, mechanisms, and methods to strengthen the foundation of families and presents possible means to improve the healthy life of vulnerable families in Thai society through public debates with related parties and experts and revision of relevant documents. The research shows that 1) The vulnerable families, or the target group, are unprepared for the collective lifestyle as a family and other factors unrelated to age as individuals, regardless of their age, could face difficulties in having a family, 2) The target group lacks comprehension on a concept of family and how to conform with such kind of relationships and do not realize own’s duties to bring the family together as a whole, 3) People in charge lacks supportive system, tools, or methods to help them set goals or adapt to work together; each section works separately toward their specific goals without communication or cooperation, 4) The importance of family is neglected causing the family to be excluded from any development plans or national policies, 5) Without coordination, the gap of interpretations on ambiguous policies leads to unorganized work and demotivates unity. This research summarizes and presents the following policy proposals; 1) Family crisis can be solved with logic and vision expansive enough to help recognize family crisis as a systematic crisis caused by multiple factors and dimensions with complexity. It is the reflection on the mainstream development which emphasizes materialization exchanged with family failures, social regression, and moral decline. It is the development that destroys the mind, family, and society as it drives people to go out into fierce competition for materials and money. Resources are spent on “country development” while they should be used to expand the prosperity of children and families., 2) To solve the family crisis, it is essential to see the importance of families as a foundation of future sustainability and security of the society and the country. The health of families fluctuates with each and every government policy, especially economic, academic, social, and labor policies. Therefore, we should recognize the healthy life of families and children as an ultimate goal of the nation.


location: , 'Thailand year: 1999 source: HSRI

title: Guideline for the pharmacotherapy of treatment-resistant schizophrenia

abstract: Guideline for the pharmacotheraphy of treatment-resistant schizophreniaObjectives: Treatment-resistant schizophrenia is a common problem in patients with schizophrenia that creates a huge economic burden for society. Since there has not been a guideline for the treatment of TRS, the PTRS Guideline Working Group, therefore, proposed to develop an evidence-based clinical practice guideline for the drug treatment of TRS. Method: The PTRS Guideline Working Group comprised eleven psychiatrists, a psychologist, and a pharmacologist. A MEDLINE search was performed to identify the relevant articles published between 1966-1998. The evidence presented in 163 articles was extracted and graded by the use of a system modified from that of the Agency for Health Care Policy and Research (AHCPR). The strength of recommendations was categorized into A, B, and C. Results: For a schizophrenic patient who does not respond to a classical antipsychotic, physicians should switch from the first classical antipsychotic to the second one, which belongs to a different class (A). A schizophrenic patient who does not respond to at least two adequate trials of classical antipsychotics should be classified as a TRS patient. For a TRS patient who is taking classical antipsychotic in high doses (at least 50 mg/day of haloperidol or its equivalence), a dose reduction strategy may be applied at this stage (B). In a TRS patient who is taking a usual dose of classical antipsychotic, clozapine should be considered as a first-line treatment (A). If a TRS patient does not respond to clozapine, physicians should add a classical antipsychotic to the ongoing clozapine, especially sulpiride (A) and loxapine (B). Risperidone should be considered in a TRS patient who refuses to have regular blood monitoring or have a contraindication for clozapine (A). Although there is no evidence supporting the use of olanzapine (or other atypical antipsychotics that will be available in the future) in a schizophrenic patient who resists both classical antipsychotics and risperidone, giving olanzapine (or other atypical antipsychotics that will be available in the future) may be worth a trial if the TRS patient refuses to take clozapine (C). Discussion: Physicians should regard the PTRS Guideline as a tool for assisting their practice but not for replacing their clinical judgments. Optimal management for a TRS patient requires the integration of medical treatment with psychosocial interventions. Electroconvulsive therapy may be a treatment option for schizophrenic patients who fail to show adequate improvement with classical antipsychotics. The definition of or the set of criteria for TRS still cannot reach a conclusion. In using this guideline, physicians should be aware of its limitations, e.g., the search, the patients' ethnicity, the study cites. Whether this guideline will affect treatment practice remains to be seen.


location: , 'Thailand year: 2015 source: HSRI

title: Development of Prescribing Decision Support System (PDSS) with Electronic Health Records to Prevent Drug-related Problems, Support Patient Safety and Rational Use of Drug

abstract: Drug-related problems (DRPs) such as overdose drug use, drug used without indication, concurrent drug use with possible drug-drug interaction may cause harm to the patients who receive healthcare service at the hospital. Therefore, DRPs are the national burden. Electronic health record (EHR) was widely adopted and used in many hospitals. However, collecting DRPs was not developed and implemented systematically. In addition, categorization of DRPs was not standardized, this could hamper pooling DRPs regionally and provincially. The objective of this research was to develop EHR, which is a part of hospital information (HI) system, to be able to systematically collect DRPs and to standardize categories of DRPs to be user-friendly and can be used in routine work. The committee for EHR and HI development of community hospitals in Ubon Ratchathani Province was met to identify management problems related to DRPs and to gather opinion towards DRPs system. Thereafter, DRPs program was developed and tested to identify any technical problem which was consequentially fixed to make the program more user-friendly and implemented in HI system. The results showed that DRPs management system was different among community hospitals although these community hospitals used the same HI system. Thus, DRPs report was dissimilar. DRPs program developed from the committee’s consensus was user-friendly and appropriated for the routine work. DRPs categories were also standardized. Pooling and reporting DRPs regionally and provincially was reliable and valid. Thus, it is possible to benchmark and evaluate the quality of medical services.


location: , 'Thailand year: 2018 source: HSRI

title: Differences in Physical Activity Levels between Urban and Rural Adults in Thailand: Findings from the 2015 National Health and Welfare Survey

abstract: Physical activity (PA) is proven to have great benefits to health. Previous studies found that differences
in social determinants of health and environment affect physical activity levels; different policy
interventions are, therefore, required. This study explored the association between physical activity
levels and residential areas in Thailand in different household asset indices. The data were obtained
from the 2015 National Health and Welfare Survey of 113,882 Thai adults aged 15 and above. Descriptive
and analytic statistics were employed in the analysis.
The result showed that urban respondents with higher income tended to have less energy expenditure.
People with the highest income level (Quintile 5) spent the least energy expenditure (1,159 and
1,437 Metabolic Equivalence of Task-minute/week in urban and rural areas, respectively). In contrast, the
poorest (Quintile 1) had the highest energy expenditure (2,182 and 1,921 MET-minute/week in urban and
rural areas, respectively). When analyzed by three PA domains, it was found that rural and poorer
people tended to have higher occupational energy expenditure, whereas urban and richer people had
significant higher recreational energy expenditure. In transportation, urbanites had slightly higher energy
expenditure than rural people.
Our findings will benefit the formulation of the national PA-promotion policies by tailoring physical
and social environments conducive to PA needed for each subgroup according to their socioeconomic
status.


location: , 'Thailand year: 2010 source: HSRI

title: Relationship between the Information Received and the Satisfaction of Health Personnel with the Health Security System in Six Upper Northeastern Provinces of Thailand

abstract: The National Health Security Office (NHSO) region 8 in Udonthani Province surveyed health personnel
in six provinces: Loei, Nongbualampoo, Nongkhai, Udonthani, Sakon Nakhon and Nakhon Phanom
for the purpose of evaluating understanding of the benefits, information and people’s satisfaction with the health security system. The results revealed that the majority (76.9%) of pharmacists and dentists
knew about the benefits of the health security system, which was less than that of other health professions.
Most personnel received information about health security via television (68.1%). For radio, the
popularity of songs, news and general events was almost the same proportion (31.5, 30.2 and 26.5%,
respectively). The most popular period was between 6 and 8 a.m. (37.1%); 62.6 percent of health personnel
did not read newspapers. The satisfaction of personnel with health security was 8.15 out of a possible
score of 10 and general personnel had highest satisfaction at 8.5. The least satisfaction was among pharmacists
at 7.37. The study found that the satisfaction of the personnel who were positive related to their
knowledge of health benefits in the health security system and satisfaction with the media provided by
the national health security office. The Internet is also an interesting route as it is easy to use and efficient
in communicating to target populations.
It is suggested that NHSO should perform specific public relations campaigns and work more specifically
with each group of health personnel. Attention should be paid to the low level of information that
personnel had received. Formal letters are still the main route for providing information to health personnel.
Alternative routes of information dissemination should be used, especially newsletters, to create
good attitudes toward the national health security system, taking into consideration aspects such as quantity,
style and content conforming to the taste of the personnel concerned.


location: , 'Thailand year: 2004 source: HSRI

title: The evaluation of circumstances for choosing a health service unit on voluntary basis in 5 pilot provinces

abstract: The National Health Security Law of B.E. 2545, in Chapter 1 stated that the right to receive public health service is assured and in section 5 the people’s right are indicated to receive an efficient public health service of high quality. In section 6 it is stated that people, who intend to use their rights according section 5, must submit an application for registration to the unit or office, which they want to choose for their regular health service: The unit they want to choose had been identified by the National Health Security Office. Those who are registered must comply with regulation procedures and conditions defined by the Local Health Committee. Convenience and needs of individual’s will be considered. It is obvious that the Act intends to open an opportunity for people to make use of their rights for universal health care coverage and that they can choose where to receive regular health services according to their needs and convenience. But there is still the opportunity of the Committee as well as the respective unit to define by themselves proper criteria and condition which health service unit should be chosen based on the convenience and needs of a given individual. The Ministry of Public Health and the National Health Security Office decided to conduct a pilot project which did allow people to make use of the right within the universal health care coverage scheme, also named 30-baht scheme (golden card), to choose their regular health care unit by themselves on a voluntary basis. The project was conducted in the provinces Prae, Saraburi, Surin, Songkla and the Pravej district of Bangkok Metropolitan. The corresponding offices in each province issued a regulation in October 2545 by defining the period of 2-3 months while the people could contact the offices in case they want to change the main or sub-main health service unit they previously had been allocated to, to select another one according to their needs. At the start of the project people were allowed to use the services at the defined health service unit since late 2545 up to present. This study project was divided into 4 sub-projects for the purpose of monitoring and evaluating. The main results and significant findings are summarized and concluded in this report. Recommendations are made for policy formulation and project management. The model tested, in which the people could choose the health service units according to their needs will provide guidelines for consideration of the National Health Security Office and related units or organizations at local level. 1. The needs of people to change the health service unit 2. Model for choosing the health service unit on a voluntary basis Main health service unit3. Project management of the rights of people to choose health service units on a voluntary basis Project management


location: , 'Thailand year: 2023 source: HSRI

title: Incidence and Associated Factors of COVID-19 Infection among Newborns: A Cross-Sectional Study in Thailand

abstract: Background and Rationale: COVID-19 is the pandemic that has significantly impacted disease control measures, daily life, and healthcare services. Pregnant women and newborns are vulnerable populations at increased risk of severe illness and adverse outcomes. This study aimed to identify the incidence and associated factors of newborn COVID-19 infection. Understanding these would benefit in developing effective strategies to mitigate the risks associated with COVID-19 infection during pregnancy and infancy. Methodology: This cross-sectional quantitative study utilized data from a country-wide reporting system of pregnant and postpartum women infected with COVID-19 and their newborns in Thailand. The study included 6,048 newborns born to infected mothers from December 2020 to May 2022. The outcome was the incidence of newborns infected with COVID-19. The exposure factors were mothers’ characteristics including age, nationality, vaccination status, gestational age at infection detection and at delivery, the severity of COVID-19 infection, delivery mode, and newborns’ characteristics including birth weight, mother-newborn separation after birth, and infant feeding. Multivariable logistic regression was used to examine associations between characteristics and newborn COVID-19 infection. Results: The proportion of newborns infected with COVID-19 was relatively low (6.4%). Maternal age was associated with infection risk, with newborns of mothers aged 20-34 years (adjusted odds ratio: AOR = 0.60, 95%CI: 0.43-0.81) and ≥ 35 years (AOR = 0.64, 95%CI: 0.44-0.93) having a lower likelihood of infection compared to the youngest age group. Newborns of mothers known of infection during postpartum had a higher likelihood of infection (AOR = 3.75, 95% CI: 2.16-6.51). The severity of COVID-19 infection in mothers was inversely associated with newborn infection risk (AOR = 0.67, 95% CI: 0.47-0.96). Term newborns had a lower likelihood of being infected with COVID-19 (AOR = 0.49, 95% CI: 0.29-0.84) compared to preterm newborns. Complete separation of mother and newborn after birth was associated with the lowest likelihood of infection (AOR = 0.18, 95% CI: 0.11-0.30). Newborns who were fed breast milk substitutes, or a combination of substitutes and maternal milk had a higher likelihood of infection (AOR = 4.16, 95% CI: 2.32-7.45) compared to those directly breastfed or fed with expressed breastmilk. Conclusion: This study contributes to the understanding of newborn COVID-19 infection and its risk factors in Thailand. The relatively low proportion of infected newborns and the identified factors provide guidance for preventive measures and optimizing care during the pandemic. Continued research is needed to further explore these factors and address knowledge gaps for effective prevention and management strategies.


location: , 'Thailand year: 2008 source: HSRI

title: Factors Related to Blood Pressure Controls in Patients with Hypertension of Thabsakae Hospital

abstract: This descriptive research aimed at studying factors related to blood pressure
  controls in patients with hypertension attending Thabsakae Hospital, Prachuap Kiri Khan
  Province. The subjects comprised 340 patients with hypertension who continuously attended
  the outpatient department of Thabsakae Hospital in the period October 1 to December 30,
  2007. Simple random sampling was conducted by using an interview questionnaire. The  method for analyzing the data were frequency, percentage, mean and standard deviation.
  A chi-square test was employed to determine the factors associated with blood pressure
  controls.
       The factors were identified as age, sex, marital status, education, occupation,
  income, knowledge about hypertension, self-care behavior, body mass index, period of
  illness and presence of other co-morbidities, by compliant hypertensive patient care control
  groups, that is, those with a blood pressure of less than 140/90 mm Hg (at least 3 SD),
  and accepting those with a diastolic blood pressure of more than 140/90 mm Hg (only 1
  SD); however, those with a diastolic blood pressure equal to or more than 92 mm
  Hg were those considered as having high blood pressure that could not be controlled
  (at least 5 SD), The research results show that occupation, self-care behavior and body
  mass index were statistically significant with blood pressure controls in patients with
  hypertension (p<0.05). This finding can be applied to plan and develop an appropriate
  method for controlling blood pressure in patients with hypertension.


location: , 'Thailand year: 2008 source: HSRI

title: Good Governance in the Health Systems Management

abstract: Good governance in the health system generally refers to the exercise of political authority and the
use of institutional resources to manage health problems and affairs. There are eight dimension of governance:
participation, rule of law, transparency, responsiveness, consensus orientation, equity and inclusiveness,
effectiveness and efficiency, and accountability. The enhancement of stewardship functions and
the improvement of management support systems of the government in terms of collective responsibility
for overall performance of the health system are aspects of good governance. In addition, good governance
is the responsibility of other stakeholders outside of the public sector. Therefore, the principles of
good governance will be used by the National Health Organization to enhance accessibility to care, the
quality to care, equity rights, and stakeholder participation.


location: , 'Thailand year: 2003 source: HSRI

title: Synthesizing Knowledge Underlying the Development of Position Paper on the Definitions of Levels in Health Service System in Thailand

abstract: Synthesizing Knowledge Underlying the Development of Position Paper on the Definitions of Levels in Health Service System in ThailandThis research aims at synthesizing knowledge underlying the development of position paper on the definitions of levels in health service system in Thailand by exploring service systems in 7 countries including; South Korea, Japan, New Zealand, Malaysia, Singapore, Australia, and Thailand.  The study identified scope and functions of each level in the system and analyzed factors that differentiated all levels of health services and other supportive systems.  Documents analysis was conducted priori to interviews with experts in health system designs and forums of academics and researchers in health system.  Reflections from National Forum on the National Health Act were analyzed.  Results indicate the following.  	1. Lessons learned from other countries indicate that 1)factors influencing health service system design included; population structure and illness pattern, health care expenditures, social demands on quality health services; 2) two concepts defining levels, scopes, functions, and levels referrals were technical and professional explanation through levels of sophistication of treatment, severity of illness, and specialization of care; and management concept of ownership and networking, and 3)health insurance played a major role in making the health service system able to be implemented as planned.  Roles and scopes of the health services at each level would be functioning well upon the regulations stated in the health insurance system and others related such as financial, health manpower development, and health promotion systems.   	2. Concepts explaining scopes of care in the health service system of Thailand must be based on technical and professional and management reasons.  “High Touch-High Tech” is the principle of the technical and professional concept of which “High Touch” be used when social and humanistic knowledge are vital and “High Tech” be used when medical treatment and cure are central to the services.  Health services could be differentiated into two types; community care and institutionalized care.  The institutionalized care could be ranged in four levels, which are; primary, secondary, tertiary, and specialized care.  Supportive mechanism must be designed accordingly especially health insurance system, hospital accreditation system, and technology appraisal system.  Through management concept, the emphasis is on ownership and networking, which community care could be governed by the local authorities and the community.  While the institutionalized care should be governed by own board and controlled by the health insurance system.  Networking relationships among authorities and service units must be equal on contractual basis of which benefits could be shared.  Health services on this management basis include 1)individual and family care, 2)community care, 3)primary care and 4)hospital treatment.  	3. It is suggested that the involving parties including the local authorities, the government, and the health professions play vital roles in managing all factors influencing the design of health services system.


location: , 'Thailand year: 2017 source: HSRI

title: Labor Price Index for Physicians in Thailand

abstract: This research aimed to formulate and develop the labor price index (LPI) for physicians in Thailand in both public and private health service sectors. LPI was developed and used extensively in the US, Australia, New Zealand and Canada to enable the monitoring of labor cost in the healthcare market and planning wage policies in public and private sectors. However, LPI is new and has not been comprehensively studied and developed in Thailand. Physician compensation in this study included salaries and benefit or welfare. The total physician compensation in public and private hospitals was estimated from the annual budget and the survey by the National Statistical Office (NSO). The weight was calculated by the ratio of share for labor expenditure in a base year. The LPIs of 2008 to 2011 were calculated. The Laspeyres LPI was used in this study, and LPI of 2010 was defined as the base year. It was found that between 2008 and 2011, the average of physician compensation in private hospitals was higher than public hospitals. On the contrary, the average growth rate of physician compensation in public hospitals was higher than private hospitals. The results showed that the LPI of public hospitals increased approximately 1.5-1.6% annually while the LPI of private hospitals declined approximately 1.4-1.5%. This study recommended that surveys to represent physician populations should be undertaken. Moreover, LPIs for other professional groups such as nurses, dentists, pharmacists, other medical workers working at back offices should also be studied.


location: , 'Thailand year: 2023 source: HSRI

title: KhunLook Application Platform for Healthcare Data Analytics

abstract: The critical period for growth and development is during childhood and adolescence. In Thailand, the number of children 0-5 years with delayed development is an important issue tracked annually by the Ministry of Public Health. If appropriate health promotion is provided during this critical period, children will grow up to be happy adults, able to realize their full potential, and become strong contributors to society. Health care providers, parents, and teachers all have important roles in providing health care supervision. Notably, amongst these three groups, parents spend the most time with their children. If parents are equipped with information on how to support and promote healthy physical, mental, emotional, and behavioral development, they can track their children’s development and detect problems earlier. Since 2013, we have set on a mission to research and development a mobile and web application called KhunLook that serves this purpose with funding from the Healthcare Systems Research Institute (HSRI) and the National Research Council of Thailand (NRCT). KhunLook provides up-to-date information and healthcare assessments based on standard best practice and clinical guidelines in an easy-to-use and convenient mobile and web application. More than 500,000 people have downloaded the mobile application on iOS and Android operating systems, and more than 3,000 people have registered and used the web application www.khunlook.com. The KhunLook mobile application’s key strength when released was its ability to work completely offline, disconnected from the Internet, which was required in 2013 because the majority of users at that time could not afford Internet access on their mobile phones. Today, Thailand is amongst the top countries in the world with mobile Internet access. Therefore, in this project, we have updated the KhunLook mobile application to be an online application that can work in both online and offline mode. With users’ consent, we store user data on the KhunLook Platform and use that data to provide healthcare data analytics. After the first six months of deployment, we have access to more than a million healthcare-related records that can be used for healthcare data analytics, such as data on development, growth, vaccination, and oral health. If KhunLook were to be promoted widely, there could be a large amount of data comparable to the data collected by the Ministry of Public Health to track their KPI’s, leading to valuable data-driven insights that could influence health care policy. Furthermore, the granularity of data in the KhunLook platform is more fine-grained than data tracked by healthcare service providers, so there is potential to leverage KhunLook data to perform in-depth health assessment of individuals. Lastly, the KhunLook platform can be used to broaden the reach of healthcare innovations by adding such innovations into the mobile application. We have conducted a pilot study to leverage the KhunLook platform to support parents of children with delayed development by providing them access to the Department of Mental Health’s Thai Early Developmental Assessment for Intervention (TEDA4I). Parents can use the KhunLook mobile application to stimulate and track their children’s development. As future work, other innovative assessments may be added, and their usage may be tracked through the KhunLook platform.


location: , 'Thailand year: 2017 source: HSRI

title: Capacity Building of Community Volunteers to be Case Manager of Community Dwelling Elderly with Disabilities

abstract: This research aims to 1) propel the handicapped elderly care in the community to
receive rehabilitation properly. 2.) developments in public health volunteers, a case
manager in the care of older people with disabilities in the community effectively 3) Create
a list of cases of people with disabilities. The cooperative research (PAR) of the research
team with the Nakean community in Nakhon-si-thammarat province using the AIC technique, which has the creation of knowledge, development guidelines, practice and evaluation. The sample are 32 village health volunteers who jointly take care of 50 elderly people with disabilities in the community. The data were collected using pre-post test. Data analysis by content analysis, mean and percentages. The study found that: The management pattern can be summarized as follows: 1) sub-district health promotion hospital explore elderly with disabilities 2) Clarify the role of case manager with public health volunteers. 3) Training course “Capacity Building of Community Volunteers to be Case Manager of Community Dwelling Elderly with Disabilities.” 4) Organize teams to take care of elderly with disabilities people in the community. 5) Record visit and sent to sub-district health promotion hospitals every month. 6) Sub-district health promotion hospitals monitor the performance of public health volunteers 7) coordinate with external agencies involved in helping and caring for the elderly disabled. Public health volunteers are trained in both theoretical and practical subjects pass 100 percent. After the training they have increased in all aspects. In terms of basic knowledge on the rights of elderly with disabilities people (97.34%), knowledge on health assessment and screening (95.78%). Thus The Department of Health Service ,Support Local administration and Subdistrict Health Promotion Hospital should a role in the health of people in the area. Especially bedside patients and should provide services that facilitate access to older with disabilities people. And should provide training for public health volunteers.


location: , 'Thailand year: 2004 source: HSRI

title: Strategies for the enactment of the National Health Draft Bill

abstract: This Research paper presents the findings of a study on strategies for the enactment of the National Health draft Bill by applying the concept of strategic management and TOWS Matrix technique. It suggests four strategic options to enact the National Health draft Bill: 1) pushing the National Health draft Bill  through the parliament by collecting the signature of 50,000 people to support the Bill 2) modifying the draft of the Bill before pushing it through the parliament 3) change the Bill to be a policy or master plan and 4) social movement. The last option can be implemented along with other strategies. Lastly, the strengths and limitations of each strategy for implementation are discussed as well.


location: , 'Thailand year: 2021 source: HSRI

title: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Knowledge information in scientific research of virus, diagnostic, treatment and vaccine development

abstract: There was an outbreak of SARS-CoV-2, a novel coronavirus, in late December 2019, originated in Wuhan, China. The virus causes problems with the respiratory tract. The syndrome is called "COVID-19". The number of infections and mortality has increased in China within a few weeks after the first patient was discovered. The virus quickly spread globally, including in Thailand. Fortunately, Thailand has an excellent public health policy for handling the outbreak. So we could control the first wave of the epidemic by reduced the infection rate to zero for several months. However, the health systems research institute (HSRI) is looking forward to finding the research direction of COVID-19 for the country. Therefore, this project was funded to review the essential knowledge about the COVID-19 and SARS-CoV-2 for HSRI. The review will be used as basic information for making a policy and manipulating COVID-19 granting in the future. The investigators reviewed the general knowledge of the SARS-CoV-2 that was a causative agent of the COVID-19. The report is divided into five chapters, where Chapter 1 addresses the basic biology of the SARS-CoV-2 virus, including taxonomy, virus structure, genome structure, viral proteins, and virus life cycle. Chapter 2 describes the diagnosis of infection by different test kits. The investigators have identified the key points of the different test kits, the limitations of the use of the diagnostic kits and their interpretation. Chapter 3 summarized all five major types of SARS-CoV-2 antiviral agents, which is currently used. The five grooups of antiviral drugs are (i) anti-enzyme activity of RNA Dependent RNA polymerase (RdRp), (ii) protease inhibitor, (iii) anti-fusion between the viral envelope and the host cell membrane, (iv) the antagonistic binding activity between the virus and host cell surface and receptors, and (v) anti-interleukine-6 receptor. Chapter 4 is focused on the immune system responding to SARS-CoV-2 virus infection. Chapter 5 will address the opinions of researchers, who are working on COVID-19 research over time of outbreak. The investigators wish the information of this report would be helpful for HSRI to be used in country policy-making for COVID-19 funding.


location: , 'Thailand year: 2000 source: HSRI

title: Sexual knowledge, attitude and behavior of primary and secondary education school students

abstract: Sexual knowledge, attitude and behavior of primary and secondary education school studentsThis survey aimed to explore knowledge, attitude and behavior of primary and secondary education school students.  The sampled population was the students from  "pathom"  or  "po"  5 (late primary school-about 11 years old) through "matayom" or "mo" 6 (late secondary school-about 18 years old) at Phanomphrai district, Roi-Et province, Northeast of Thailand,  in academic year 1999. The subjects were stratified into 3 groups, according to education levels, i.e. po 5-6, mo 1-3 and mo 4-6. Two multiple-choice questionaries were, after approved by 4 experts in sexology and in education, used separately, one for po 5-6 and another for mo 1-6 group, for quantitative survey. Three discussion guidelines were developed and used for each group. Among a total of 5956 students, 1073 (18.0) : 	The result of attitude towards who is the most suitable for teaching sexual education reveals that most po 5-6 group prefered a doctor or a nurse. This result corresponds to mo 1-3 (62.1%, 95%Cl: 55.2-69.0)and mo 4-6Z56.9%, 95%Cl:51.5-62.2), and 62.5%Z95%Cl: 58.8-66.3) of all students think so.The attitude towards should school reproductive health services be provided, survey only among mattayom students (mo 1-6), reveals that 53.2 % of mo 1-3, 59.2 % of mo 4-6 and 56.1 % of all mattayom students did not agree. On the other hand, 18.0 % of mo 1-3, 23.6 % of mo 4-6 and 20.7 % of all mattayom students agreed. Most of the students agree that counselling clinic in school by a doctor or nurse or health personnel would be most suitable (64.1 %, 95%CI: 60.5-67.7). The attitude towards what to do first if unwanted pregnancy occurs, survey only among mo 1-6, reveals that 49.7 % of mo 1-3 group would tell their parents and 25.5 % would consult a doctor or a nurse. The same attitude was found among mo 4-6 group, 58.6 % would tell their parents and 23.0 % would consult a doctor or a nurse. For the total of mo 1-6 students, 54.0 % would tell their parents and 24.3 % would consult a doctor or a nurse. The sexual experience was 1.1 % among po 5-6 students, 1.1 % among mo 1-3 and 5.2 % among mo 4-6, and the overall experience was 2.4 %. This study suggests sexual education in school be adjusted according to the student needs. School reproductive health services by means of counselling clinic may be appropriate and there should be a survey for parental readiness in counselling an adolescent with unplanned pregnancy.


location: , 'Thailand year: 2008 source: HSRI

title: Effectiveness of a psychiatric patient care system developed in a community in Sangkom district, Udon Thani province

abstract: This evaluation research was aimed at assessing the effectiveness of the psychiatric
patient care system of Sangkom Hospital in a community of Sangkom district, Udon Thani
province, i.e., whether it could encourage the community participating in providing con-tinuity of care for psychiatric patients, families and communities having knowledge and
a positive attitude and supporting the patients to live within the community, reducing
readmission rates, suicide and referral to higher institutions. A qualitative method was
applied for data collection, including document research, in-depth interviews, small group
meetings and participatory and non-participatory observations. Data were collected between
September 1, 2007 and January 30, 2008.
The study revealed that the psychiatric patient care system in the community was
established with community participation. Changes were noted from the time when there
were no services in the communities, poor drug compliance and no continuity of care, all
of which resulted in readmission, to a time when a community participation psychiatric
patient care system had been established. The development process included increased
community awareness and understanding of the situation and facilitation of all community
sectors to participate in identifying problems and causes of the problems, planning
for appropriate interventions to help psychiatric patients, families and communities in
line with a proactive policy for continuity of care. A community health committee was
established with the financial support of the local administration organization. The committee
organized a training workshop for volunteers to improve their knowledge, attitudes
and skills in caring for and counseling those with special needs. These volunteers
made monthly home visits to support the psychiatric patients and identify new cases.
Capacity-building training for patients and their families was organized. Both patients
and their families were helped and supported in joining community activities. The development
resulted in reducing drug non-compliance; there were no suicides and the number
of patients referred to specialized hospitals was reduced. As a resalt, the volunteers
as well as the community had knowledge and better attitudes towards psychiatric patients.


location: , 'Thailand year: 2017 source: HSRI

title: Development of Integrated Care Model for Children with Attention Deficit Hyperactivity Disorder among Health Care Professionals, Parents, and Teachers in in Northern Thailand

abstract: Background: ADHD is the most prevalent brain disorder in children in elementary school
compared with other diseases that interferes functions and development. Integrated care
among parents, teachers, and healthcare providers might improve positive behaviors and
increase chances to succeed in academic performances. Objectives: 1) To develop and test parent training curriculum and manuals to screen and provide behavioral adjustment for children with ADHD symptoms; 2) To develop and test elementary school teacher training curriculum and manuals on screening and classroom adjustment for children with ADHD symptoms; and 3) Draft an integrated care model among parents, teacher, and healthcare providers for children with ADHD symptoms. Methods: We applied one-group pre-post test design to test knowledge and attitudes of parents and teachers before and after the training based on the curriculum and manuals. Subjects were 1) parents of children age 6-7 years, studying in elementary school level, and agreed to participate in this study, and 2) elementary school teachers who are willing to participate in this study. Both groups of subjects were recruited from 2 elementary schools in Chiang Mai Province and 1 in Lamphun Province, Thailand. Parents were trained based on the curriculum and manuals for 2 days. Elementary school teachers were trained by the teacher specialized in children with special needs for 2 days based on the curriculum and manuals. Knowledge and attitudes towards children with ADHD symptoms and behavioral adjustment were assessed before and after using questionnaires developed for this study. Feasibility data of behavioral adjustment by parents was collected using focus group interview after 1 month. Teacher skills on behavioral and classroom adjustment were assessed using self-report on report form after 1 month. Results: We trained 78 parents. Most parents were female, age of 30-39 years, married, twothird were high school or college educated, and 37.2% had no experience in caring children with ADHD symptoms. Most parents relied on books or websites to search for information about ADHD. After training, parent’s knowledge and attitudes improved significantly on children with ADHD and behavioral adjustment (p<0.01). From focus group interview, parents reported of feasible use of behavioral adjustment techniques at home, mostly time management and emotional control techniques. We trained 144 elementary school teachers on ADHD screening and behavioral/classroom adjustment. Most teachers were female; half of them were 50-59 years of age; two-third had experience in caring children with ADHD symptoms for 1-5 years. Knowledge and attitudes of teachers on ADHD symptoms, behavioral adjustment, classroom adjustment, and ADHD medication treatment increased significantly after the training (p<0.01). After 1 month of follow-up, 32 teachers reported the skills and practices that they encouraged parents to screen and monitor the symptoms, using SNAP-IV and behavioral adjustment by at home. In case on children with ADHD symptoms were assessed, teachers encouraged parents to take the child to see the doctor. Teachers reported of positive feedback from parents after the interventions. This study also drafted an ADHD integrated care model using healthcare providers at primary or secondary care settings as center of referral and monitoring with the ADHD Refer database systems to assist the referral and monitoring along with parents and teachers. Conclusion: The ADHD children screening and behavioral adjustment for parents and the ADHD children screening and behavioral/classroom adjustment for elementary school teachers significantly improved knowledge and attitudes of both groups on children with ADHD symptoms and behavioral adjustment. Behavioral adjustment techniques provided in both curriculum and manuals were feasible to practice at home and at schools. Test of the proposed integrated care model should be further conducted.


location: , 'Thailand year: 2009 source: HSRI

title: Management Experiences of the Provincial Public Health Offices

abstract: The project “Management Experiences of the Provincial Public Health Offices” has four main objectives: 1) to enhance the understanding related to the Public Sector Management Quality Award (PMQA); 2) to increase the opportunity to exchange knowledge and experiences among the Provincial Public Health Offices (PHOs); 3) to obtain lessons learned from the PHOs relevant to the PMQA; 4) to publicize PMQA knowledge and experiences learned from the Provincial Public Health Offices.
The methodology used in this project consists of qualitative methods using focus groups, seminar meeting, document reviews, work-visits, and in-depth interviews.  Content analysis is used for analyzing the data.  There are seven PHOs participating in this project, namely Nakhon Ratchasima, Lop Buri, Ang Thong, Sukhothai, Nakhon Pathom, Ubon Ratchathani, and Krabi.
The results of the study found that the participants from the PHOs are very enthusiastic in joining this project.  Most of them have good attitude towards PMQA in terms of helping them to do more systematic works and to develop the potential of their staffs and organizations.  However, they also think that PMQA is a new management tool which is quite complicated and difficult to implement in some areas.   Below are the results of the experiences learned from the PHO regarding the seven categories of PMQA implementation.
The first category is related to organizational leadership and social responsibility.  It is found that many PHOs have systematic planning, communication, implementation, and review processes.  However, the problematic issues include the translation of value to the policy implementation, inefficient linkage between decentralization and innovation caused by unclear guidelines, inadequate feedback process, and unclear prioritization criteria. The flowchart of this category is suggested to link all steps for the convenience of practice. The key success factors include top management support, understanding of staff, commitment with the shared values, good attitude of top management and staff toward PMQA, and PMQA evaluation.
The result of the second category is related with strategic planning.  It is found that the problems of this category are limited understanding of the concept and the criteria of this category, inadequate involvement of participants, and inefficient deployment process. The process for this category is also suggested.  The key success factors of this category are the alignment among factors in the planning process, the knowledge and understanding of personnel, the learning mechanisms, information technology in supporting the planning process, and top management support.
The third category is related to the stakeholders of the PHOs. The problems are related to the techniques to classify the stakeholders, and the unclear definition of customer and stakeholder.  The key success factors are the concept and techniques to classify the stakeholders, satisfaction and dissatisfaction measurement, and the readiness of databases.
The fourth category is relevant with the measurement, information systems, and knowledge management.  From this study, it is found that the PHOs have systematic processes in selecting, collecting, and improving data. They can communicate these data through different channels. Lessons learned from this category include knowledge selection to manage first, the criteria for checking knowledge validity, and knowledge management evaluation.  The key success factors are top management support, supporting culture, the knowledge and understanding of staff, supporting infrastructure, and continuous evaluation.
The fifth category focuses on human resource systems, learning and motivation, and personnel happiness and satisfaction.  Many PHOs have both formal and informal systems for human resource planning. However, how to bring culture and the thoughts of personnel and community into the systems is still problematic for most PHOs.  The communication systems in PHOs are very well established by using both formal and informal channels. The personnel evaluation systems followed the government regulations. The reward and motivation systems are for creating the awareness among people. Key success factors include top-management commitment, personnel participation, experience exchange, continuous improvement, and the fairness treatments for both at organization and personnel levels.
	The sixth category emphasizes on process management, including value processes  (most important processes relating to agency mission or creating values or benefits to stakeholders) and supporting processes. Lessons learned from this category are the differences in interpreting the roles and functions of PHOs, unclear criteria to define the important processes, no standards for selecting value processes, and ambiguous definition of customers and stakeholders. The suggestions are that the organizations should simultaneously implement this category in conjunction with other categories, i.e. organization profile, the second category (strategic planning) and the third category (customers and stakeholders).  Guidelines for process management include 4 stages, i.e. process planning, designing, controlling, and improvement.  Key success factors are management commitment, experience sharing, stakeholder participation, process standardization, good evaluation, and other category integration.
	The seventh category	 is relevant with the results of performance by using four dimensions: effectiveness, service quality, efficiency, and organization development.  Since there are much data involved with this category, PHOs need a good computer program to deal with these data. In addition, to reduce the workload in data collection, the common data sets used by many sources should be organized. Key success factors include indentifying the clear indicators, accessible data base, simultaneously implementation with other categories. Finally, policy and practical recommendations are provided, together with the future research suggestions.


location: , 'Thailand year: 2020 source: HSRI

title: Unit Cost of Thasongyang Hospital, Tak Province

abstract: The objective of this study was to estimate unit cost of Thasongyang Hospital, Tak province from
provider perspective. Retrospective study was conducted in fiscal year 2018 and cost was obtained during
1 October 2017 and 30 September 2018. The hospital cost and service cost were analyzed using standard
top-down method and cost-per-patient was analyzed using bottom-up method. Cost centers were divided
by department types into two main groups: absorbing cost center and transient cost center. Costs
were distributed from transient cost centers to absorbing cost centers using simultaneous equation
method. The allocation criteria used data from absorbing cost centers together with information from
hospital database, and data were processed by (Hospital Service Cost Estimate: HSCE) computer program.
The study found that in fiscal year 2018, total service cost of Thasongyang Hospital was 159,909,496
baht. The proportion of labor cost, material cost and capital cost was 56.7:32.4:10.9 respectively. An
average outpatient cost per visit was 615 baht. An average outpatient cost per visit of each scheme including
the civil servant medical benefit scheme, social security scheme, universal coverage scheme,
stateless people, non-Thai resident with health insurance, non-Thai resident, road accident victims and
other was 747, 613, 599, 629, 617, 581, 1,175 and 459 baht, respectively. An average inpatient cost per
adjusted relative weight was 13,945 baht. An average inpatient cost per adjusted relative weight of each
scheme including the civil servant medical benefit scheme, social security scheme, universal coverage
scheme, stateless people, non-Thai resident with health insurance, non-Thai resident, road accident
victims and other was 15,330, 12,888, 13,792, 13,263, 14,429, 14,488, 10,840 and 22,967 baht, respectively.
Service cost of Thasongyang Hospital was higher than the service charge and labor cost was the
highest cost. Hospital administrators, therefore, should apply the results from this study for better management.
Further studies should examine cost recovery in each scheme.


location: , 'Thailand year: 2023 source: HSRI

title: Detection of Viral Genome, Nonstructural Protein 1 (NS1) and Anti-Dengue Antibodies in Oral Fluid Specimen of Suspected Pediatric Dengue Patients (First-Year)

abstract: Dengue disease is an important problem in global public health. Annually, 390 people are infected with dengue virus. The majority of infections results in asymptomatic cases. For symptomatic cases, patients will develop either mild dengue fever (DF) or severe dengue hemorrhagic fever (DHF). DF is a self-limiting disease meaning the patients will recover within 4-7 days without any significant intervention. However, DHF patients will eventually develop plasma leakage which may progress into potentially fatal hypovolemic shock known as dengue shock syndrome (DSS) without prompt and adequate fluid management. Dengue disease is caused by dengue virus which belongs to the genus Flavivirus. There are four serotypes of the virus including dengue virus 1, 2, 3 and 4. The virus is transmitted by Aedes mosquitoes. There is no antiviral drug against dengue virus and the only available vaccine has limited efficacy and elevates the risk of hospitalization from dengue disease in seronegative vaccines. Dengue infection is usually confirmed by assaying patient’s blood obtained by invasive procedures, such as venipuncture or fingertip pricking. Qualified personnel are required to effectively and safely collect and process blood specimen. In addition, the blood specimen processing is usually costly in terms of budget and personnel. However, previous studies reported the presence of dengue virus, NS1 protein, and anti-dengue virus antibodies in non-invasively obtained clinical specimens such as saliva and urine. Recently, oral fluid was interestingly used for detecting anti-virus antibodies and virus genomes for HIV, hepatitis viruses (HAV, HBV, HCV). We believe oral fluid specimen could be an alternative for study dengue virus. Oral fluid is non-invasively obtained so the specimen collection and processing are inexpensive and simple. Minimally trained personnel should be able to collect, handle and process oral fluid specimen safely and effectively. In addition, oral fluid could be obtained from people in the household or workplace of the index case to capture asymptomatic dengue cases. Therefore, we tested whether oral fluid specimen could be used to detect virus genome, NS1 protein and anti-dengue IgM/IgG. We also compared the accuracy for assaying oral fluid specimen to that of blood specimen. Consequently, we evaluated whether oral fluid could be an alternative to blood specimen. We found that although viral genome and NS1 antigen were rarely detected in oral fluid, anti-dengue IgM and IgG were dramatically detected for 3 day of illness and still completely detected until 1 -2 months after illness. Efficiency of anti-dengue IgM and IgG detection in oral fluid specimens was not statistically different with plasma specimens after analyzed by Fisher’s exact test. Thus, oral fluid could be a suitable specimen for screening of asymptomatic infection in dengue season or screening of immune response after vaccination.


location: , 'Thailand year: 2012 source: HSRI

title: Development of Capacity Building Model for Organizations Working on Monitoring and Evaluation

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


location: , 'Thailand year: 2008 source: HSRI

title: Health Research Expenditures of the Health Systems Research Institute

abstract: The objectives of this study encompassed three elements to study: (1) the financial resources of the
Health Systems Research Institute (HSRI); (2) the budgetary allocation of HSRI; and (3) the relationship
between budget allocation and outcomes of HSRI. Data were collected from existing documents and studies on health research in Thailand and from financial data and activity reports of HSRI. The results showed
that (1) in the period 2002 and 2007, HSRI received 1,445 million Baht for health systems research, and
budgets from other sources dominated the government budget;  (2) the major research themes involved
data systems and knowledge generation;  and (3) the outcomes of HSRI activities, in terms of social movement and policy linkage, were related to the themes of research that received funds. The author recommends the following: (1) the private sector should play a greater role in supporting the national health
research system;  (2) the efficiency of a research funding agency should be measured by the proportion of
administrative costs to the total expenditures, and the real practices of staff of that agency compared with
the agency’s existing protocol on funding and terminating a project;  and (3) the effectiveness of a research
funding agency should be measured through total outcomes of that agency compared with the targets
mentioned in strategies rather than the figure of unit costs per program/project.


location: , 'Thailand year: 2009 source: HSRI

title: Reviewing the literature on governance in health system

abstract: The goal of the Thai health system development is to achieve a balanced and sustainable society in which all Thai citizens have security to live a happy life in a healthy and better condition. The objective of this research were literature review formed a foundation and knowledge of Thai good governance in health system, analyze and plan for research mapping.
In this study, the good governance in health system was divided into 10 sectors; rule of laws, ethics, transparency, participation, accountability, value for money, human resources development, knowledge organization, and information technology. These were simultaneously analyzed in macro and micro analysis system that influenced by the economic, social, political conditions as well as agency’s role.
The literature review found that there were problems in every components of health governance, if these problems were solved more effectively, it would generate a better and improved service in 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, each governance principle should be developed and adapted, and governance issues should identified at all levels. The problems of study in  health governance were that it need more research,especially in qualitative approach and comparison of the  international governance function


location: , 'Thailand year: 2001 source: HSRI

title: State of art review & practical mechanism for development of home/community care for AIDS in social-cultural context of the Central region, Thailand

abstract: This study reviews a  variety of documents and lessons on home/community care (HCC) for AIDS in the central region of Thailand, including research , thesis , NGO’s annual reports, discussions with NGOs delegates, and case studies from fieldwork observation as well as home visits. Compared to the northern region of the country, studies on HCC for AIDS in the central region are rather few. Despite of this limitation, a number of studies figures out the same problem that many HIV/AIDS patients are confronting with : community’s rejection and negative attitude towards people living with AIDS (PWA) . Besides, many patients and family care-providers still do not have adequate  knowledge and skills in self care or caring the patients at home. However, rarely few studies have deeply gone into details about the needs of these PWA, such as up-date health information about treatments and practical caring techniques for daily fife in the household setting.	The present study concludes that in the central region, most HIV/AIDS patients are normally cared for at home by their family numbers. Hospitalization is only for those in critical or terminal stage. Buddhist temples, Christian’s charity  homes and NGO’s emergency or temporary shelters are alternatives for most poor or abandoned ones. For PWA, self-help groups organized by public hospitals’ or  NGOs’ staff are crucially needed and helpful. Home visits performed by these staff  are also appreciated. These are the only two successful models of community care in the socio – cultural context of the central region. Some regional strategies are suggested for HHC development: 1). The restoration of the humane traditional Thai cultural-traits together with the acculturation of caring culture and practice in the family and community in order to promote and support HCC by “to stop AIDS by caring people with AIDS”.  2).  The empowerment of community organizations, self-help groups, voluntary groups to support PWA to get access to better health care services as will as social welfare from both public  and private sectors  3). Reformation and development of AIDS counselling service, inter-personal health education and public health education through the mass media, both in the content and technical aspects in order to transfer modest health information on AIDS and to bridge up good relations between PWA and their families/ communities.  4). The prejudice wall against PWA should be dissolved through the new nation-wide campaign, ”Living with AIDS is the way to save our families/communities and society” in order to support PWA to live with dignity as human-beings. And 5). The strengthening of collaboration among all HCC stakeholders (PWA, family ,community, NGOs and Gos) in order to improve the efficiency of the whole health care system.


location: , 'Thailand year: 2001 source: HSRI

title: The evaluation of the funeral welfare service for the improvement of quality of life of the elderly people

abstract: The  Evaluation  of The Funeral  Welfare  ServiceFor The Improvement  of Quality of Life of the Elderly  People	The study on "evaluation of the funeral welfare service for the improvement of quality of life of the elderly people" aimed to evaluate the work on the local funeral welfare, as well as to propose an appropriate operation of a local funeral welfare which will assist in the improvement of the quality of life of elderly people. The study was conducted in April - May 1999 by interviewing 383 elderly people, 81 local funeral welfare committee, and 9 responsible government officials.  The study sites covered 9 provinces which included 36 localities in 18 districts.  Below is the description of the brief results.	Local people cooperatively initiated the local funeral welfare based on the existing cultural concept. The cooperation was formed not very long ago following other localities and having believed that this would increase a financial aid for the funeral. This service was formed in most localities.	Concerning the service, there were classified into 2 categories which were official and unofficial funeral welfare. The former was established outside a locality but provided its services to cover localities, however, elderly people could not be its members. The latter was established to provide service to only members in that locality and its neighbors.   It did not have a legal form of organization but provided the service based on needs. Most organizations were in this category and mot elderly people were the members.	Regarding the location, the official funeral welfare had its organization located outside the locality, while the unofficial service had its organization located at a local welfare center and did not register legally. Its objective was to provide the funeral welfare and it had very flexible roles.	The administration structure was composed of elected committees, including at least 2 village committees, out of which most of them  were in a middle age and one fourth was the elderly. These committees had a very positive attitude toward the funeral welfare.  The committees would assign a committee to be responsible for a funeral with a team of other 2 - 4 people. The funeral procedures were based on the legal process but no clear written procedures were recorded.  However, the criteria for membership were set up clearly. There were 2 categories of members, in person and in a group. Most elderly people were in the former. The members needed to pay a membership fee of 20 Baht per person according to the law, however, this could be flexible depending on their financial status.  It could be collected varies from 5-50 Baht and when a death occurred, the money for funeral welfare will be given within a day.	After evaluating the services, it was found that the services were implemented in compliance with the legal standards. However, the local unofficial service was not in a good standard though it followed the legal procedures but the elderly people were satisfied with the services.  This was because the services were in their needs, covered the entire locality, based on equality and elderly people could participate in the services.  This service was potentially sustained.  In term of problems, there was a problem associated with the funeral welfare service in some members' opinions as well as problems with the roles of the members and service procedures.	The recommendations for the better funeral welfare service for the improvement of the quality of life of elderly people are that the quality of life of elderly people is developed by providing employment for local elderly people; that opportunity supporting a better relationship among elderly people and family is developed; and that health insurance for elderly people is thoroughly provided.	In addition, an organization providing the local funeral welfare should be improved through the development of the knowledge resource and the better service system; and a policy is formulated to ensure the insurance after death for all elderly people.


location: , 'Thailand year: 2023 source: HSRI

title: Safety, Immunogenicity of the 4th Booster Dose of mRNA Vaccine After Three Doses of COVID-19 Vaccine, Clinical Trial

abstract: Objective: To investigate the reactogenicity and immunogenicity of the fourth dose mRNA vaccines after different three-dose regimens, followed by a comparison between the 30 μg BNT162b2 and 50 μg mRNA-1273 groups. Methods: The prospective cohort study was performed between June and October 2022. The self-recorded reactogenicity after 7 subsequent days following a fourth booster dose was evaluated. The binding antibodies and neutralizing activity to the Omicron BA.4/5 variants were determined. Results: Overall, 292 healthy adults were enrolled and received either the BNT162b2 or mRNA-1273. The reactogenicity was mild to moderate and well-tolerated within a few days. Sixty-five individuals were excluded. A total of 227 eligible individuals received the fourth booster dose of BNT162b2 (n=109) and mRNA-1273 (n=118). Most participants, regardless of different previous three dose regimens, significantly elicited a high level of binding antibody and neutralizing activity against the Omicron BA.4/5 at 28 days after a fourth dose. The neutralizing activity against the Omicron BA.4/5 between the BNT162b2 (82.8%) and mRNA-1273 (84.2%) groups was comparable with a median ratio of 1.02. Conclusion: The findings indicated that the BNT162b2 and mRNA-1273 can be used as a fourth booster dose for individuals who were previously immunized with any mix-and-match three-dose COVID-19 vaccine.


location: , 'Thailand year: 2015 source: HSRI

title: Factors Associated with Health Behavior in Diabetic Patients with Risk of Cardiovascular Disease

abstract: The purpose of the project was to (1) conduct a baseline survey of health behavior
in type 2 diabetic patients with low risk of cardiovascular disease (CVD) (less than 10%) and
those with high risk of CVD (20% and more), according to the 10 year risk of cardiovascular
events prediction chart developed by the World Health Organization (South-East Asia: SEAR
B) and (2) explore factors associated with health behavior in type 2 diabetic patients with
risk of cardiovascular disease. The PRECEDE-PROCEED Model was used as a framework to
guide the survey development for data collection. The methods of data collection consisted
of 2 phases as follows;
The 1st Phase: The development of the survey instruments. In this phase, the data
was collected from a hospital in Samutsakorn province. At the beginning phase, focus group
was conducted in 10 type 2 diabetic patients to develop the questions, and then sent to
experts to examine how well the questions corresponded to components of The PRECEDEPROCEED
Model. The questionnaire was pilot-tested in 30 type 2 diabetic patients and
refined. To further test and refine the survey, 228 type 2 diabetic patients completed the
final version of the questionnaire. The items of the questionnaire were analyzed by using
factor analysis to determine if there were unnecessary items and identify sets of measures
reflecting different dimensions of the questionnaire. After removing or adding some items,
this process resulted in a final 60-item questionnaire for associated factors and 38-item
questionnaire for health behavior.
The 2nd Phase: The survey administration of factors related to health behavior. In this
phase, 566 type 2 diabetic patients with risk of CVD, who received treatment from a hospital
in Ayutthaya province from May to October 2014, were recruited and asked to complete the
questionnaire. These participants included 169 high risk of CVD group (20% and more) and
397 low risk of CVD group (less than 10%). The result showed that there was no significant
difference in health behavior between diabetic patients with low and high risk group. No
difference among groups in food consumption, risk behavior, and physical activity, whereas
treatment plan adherence was greater in the diabetic patients with low risk group compared
to those in the high risk group. Self-efficacy, perceived barriers, and social support were
accounted for approximately 19% of total variance in predicting health behavior. Recommendation of the study was that health service should be designed to initially
increase patients’ perception in their efficacy and reduce perception in obstacle to perform
health behavior in order to motivate their awareness in the possibility to get the
cardiovascular disease and then affect their readiness to manage their own health.
Engagement of patients’ social support should be concerned when conducting the lifestyle
modification program including family members and friends. Knowledge and health
promotion skill improvement program for health volunteer should be established due to
the findings that information availability from them was the least compared to those from
another resource.


location: , 'Thailand year: 2009 source: HSRI

title: Experience with Public Health Decentralization: The Health Center Transfer Model

abstract: Public health decentralization has been an item on the national agenda in compliance with the 1997 Constitution of Thailand. In principle, the central administration of the Ministry of Public Health was responsible for decentralizing its part of public health programs and resources to local administrative organizations according to the Decentralization Plan for Local Administration. The Ministry of Public Health established the Office for Supporting Public Health Decentralization so that it could act as a policy coordinator and a preparation facilitator for transferring public health programs and activities to local administrative organizations. In 2007, the Ministry of Public Health initiated a pilot project to transfer 22
health centers to 19 local administrative organizations in 16 provinces. The individual experiences of this project indicate that community participation was necessary. Other important factors on part of local administrative organizations were their supplementary budgets for public health activities and investment, shortened command-control line, clearer pathway of health personnel positions and leadership of
community development. Good relationship between health centers and local administrative organizations were undeniably helpful for the transferring processes. Lessons learned from this project were if the transferring would carry out for more health centers, communication of the transfer vision, processes, advantages, precaution and possible contingencies and solutions should be thoroughly made from policy
to implementation level. Human resources for transferred public health programs must be carefully planned. Administrative and Consultative Office at provincial level should be established to help solve out administrative inquiries and provide technical consultation from the starting point to monitoring and continuous evaluations. Then, the lessons learned and applications from local levels would help support the better development.


location: , 'Thailand year: 2003 source: HSRI

title: Community participation in screening for diabetes mellitus

abstract: Diabetes Mellitus(DM) is a chronic disease which  needs long term care. Main problems happened to the patient are complication causing decreasing in quality of life. Early deteetion can result in controlling disease. One of the main measures used is screening for DM both at peripheral health facility, so called ‘health center’, and primary health care community center (PHCC). However, the effective of this measure would rely on the number of client attending the service which is no voluntary basis. According to low reported DM cases in comparison with others, Khun Han hospital conducted a research to investigate community participation on screening for DM from March 2001 to February 2002 which place emphasis on ‘real participation’ at all step of the intervention program including situation analysis, identifying activities, implementing identified activities and conclusion and evaluation. This program involved related organizations and units. By convening group discussion, the core participants included village leaders 2 persons, representatives of village health volunteers 3 persons, member of Tambon Administrative Organization (TAO) 1 person, representatives of villagers aged 25-60 years old 8 persons facilitating by health personnel both from health center and hospital. According to the group discussion, identified obstacles or problems of low attending screening test were insufficient or wrong perception, knowledge and understanding on DM as well as wrong attitude toward the disease. For instance, ‘DM can not be cured’ so they are afraid to know or ‘we are so strong and healthy. It’s not necessary to be tested’. Furthermore, some thought that complications of diabetes are so severe. Patient will  die soon. Regarding in-corrected knowledge, some villagers believe that some kind of herbs can cure the disease. Apart from the client side, problems on services were insufficient of urine strip for testing urine sugar in addition to villagers did not trust on the capability of the village health volunteers who provided service. Based on the findings, the group defined the necessary activities including announcement of campaign of screening for DM via person to person and broadcasting on village loud speakers. To provide knowledge and activate the awareness of the villagers, a meeting were convened at the village hall. The main contributors were village health volunteers and the one who has direct experiences on caring the diabetes patients. The session was organized as group discussion and sharing experiences among the participants and ended with ‘question & answer’. This differs from the former health education activities which was mostly done by health personnel. After being motivated the awareness, campaign of screening for DM was conducted. Out of 96 risk group, 70 villagers (72.9%) were tested for DM. There were 17 persons having positive results with urine strip. These positive cases were confirmed by fasting blood sugar determination. Out of 17 cases, one was diagnosed as DM.  After finding new case, the community was aware of DM. Following activities were identified, namely, providing weekly service on screening for DM at PHCC, organizing refreshing course on diabetes  mellitus to village health volunteer, registering DM cases living in the community, screening test for diabetes in risk group at least once a year, submitting request to TAO for blood glucose testing equipment.Being conducting research emphasizing on community participation has effects on attitude of health personnel and community regarding to health matter. The community perceive that health is their own matter not the matter for health personnel only. In addition, health personnel realize on the potentials and capacity of the community in managing problem solving.


location: , 'Thailand year: 2007 source: HSRI

title: Holistic Health Care Service for Hypertensive Patients in Primary Care Units in Bangmunnak District, Pichit Province

abstract: This qualitative research, conducted on 60 uncontrolled hypertensive volunteers,
using in-depth interviews, participant observation, group discussion and content analysis.
The aim was to study suitable forms of the holistic health-care service for hypertensive
patients available in the three primary care units at Bangmunak District, Pichit Province.
The objectives were to 1) Study the perception of hypertension disease and behavioral
self-care, 2) Study the situable health-care service for hypertensive patients in the
primary care units, 3) synthesize the situable health-care service for hypertensive patients.


location: , 'Thailand year: 2022 source: HSRI

title: Patient Journey of Type 2 Diabetes, Health Literacy and Communication Strategy for Fight to Control Diabetes

abstract: The purpose of this research was to study the patient journey, health literacy, and operations in fighting against type 2 diabetes in Thailand as well as to establish communication strategies to combat type 2 diabetes using mixed methods which consisted of: 1) an in-depth interview using selective sampling of 31 people residing in provinces with a high prevalence of type 2 diabetes from each region and Bangkok, 2) a survey research using a sample size of 1,600 people in Thailand aged 20-60 years who have type 2 diabetes or are at risk of developing type 2 diabetes, selected by simple randomization, 3) a document analysis of documents related to operations in fighting against diabetes in Thailand including reports, articles, research papers, symposium papers, and news, and 4) the research synthesis to develop communication strategies to combat type 2 diabetes in which the accuracy, appropriateness, and applications were reviewed by specialists in health campaigns, public health, and communication arts. The research findings are as follows: The patient journey of type 2 diabetes consists of 3 stages which are 1) the pre-diabetic stage, the stage before the patient meets the criteria of the disease, shows symptoms, and receives the diagnosis, 2) the treatment stage, the stage that the patient receives the diagnosis, decides to get treatments, and acknowledges lifestyle changes according to the doctors’ recommendations on how to manage the symptoms, 3) the long-term living with the disease stage, the stage in which the patient acknowledges the changing life conditions, sees the physicians regularly, and watches out for worsening symptoms, which is related to the patient’s future lifestyle. The survey findings indicated that 37.6% of the respondents started testing for diabetes when they were 41-50 years old, followed by 30.0% who started testing when they were 31-40 years old. Also, 79.1% of the respondents who have been diagnosed with diabetes were previously unaware that they were at risk. There were also more female than male respondents who have obesity (55.1%). In terms of health literacy regarding type 2 diabetes, the respondents had some skills to access to health information. Moreover, their ability to utilize health information, take actions to control and prevent the disease, and screen the information from friends and online media were moderate, while their ability to see through the advertisements on food and desserts as a cause of the disease and their skills of health communication were high. Finally, their knowledge on health is at the highest level. The document analysis results revealed that Thailand acknowledges the importance of operations in fighting against type 2 diabetes and puts an emphasis on promoting good health and fitness for Thai people. This is reflected in different levels of strategic plans including the 20-year national strategy that is linked to the plans of the public health authorities and includes the developments of policies, partnerships, databases, bodies of knowledge, communications, community capacity, health service system competency, and appropriate environments to aid the changes in behaviors of children, working adults, and senior citizens. All research findings were used to create three communication strategies to combat type 2 diabetes as follows: Strategy 1: Public campaigns to fight against type 2 diabetes. The objective of this strategy is to raise awareness and encourage changes in behaviors that will lead to the reduction in the risks of the disease. This strategy is aimed at young working adults (18-29 years old) and middle-aged working adults (30-44 years old). Strategy 2: Health education. The objective of this strategy is to raise knowledge and understanding on type 2 diabetes as well as to prevent the disease. This strategy is aimed at young children to university-aged individuals. Strategy 3: Policy advocacy to fight against type 2 diabetes. The objective of this strategy is to encourage the public to exchange ideas and engage in discussions about type 2 diabetes to contribute to the changes in policies on the fight against type 2 diabetes.


location: , 'Thailand year: 2012 source: HSRI

title: Health promotion and disease prevention policies for children aged 0-5 years in the United States of America

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