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Satchanawakul N, Liangruenrom N, Thang LL, Satchanawakul N. Systematic scoping review of ageing in place strategies in Japan, Singapore and Thailand: A comparative analysis. Australas J Ageing 2024. [PMID: 39367639 DOI: 10.1111/ajag.13378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 08/28/2024] [Accepted: 09/01/2024] [Indexed: 10/06/2024]
Abstract
OBJECTIVE Given the differing cultural contexts and service needs of older persons in the west and the east, programs or policies should be thoughtfully redesigned to accommodate these diverse societies. This paper presents a systematic scoping review of ageing in place (AIP) strategies in Japan, Singapore and Thailand, emphasising how they are tailored to address the unique challenges of ageing populations in Asia. METHODS A systematic literature search was conducted through seven databases. Empirical, peer-reviewed studies in English that discussed AIP-related programs or policies involving aged populations in the target countries were included. Themes were identified using the policy triangle framework, allowing for a comprehensive comparison of AIP across the countries. RESULTS Three key components of AIP, place, support network and workforce, were identified from 44 included studies. Each country exhibits distinctive approaches to implementing these components. Japan has extensive AIP systems with comprehensive services and strong community and family support. Singapore offers innovative aged care with significant government involvement, though on a smaller scale. Thailand's localised initiatives focus on community health care and age-friendly city assessments, with a less developed AIP infrastructure. CONCLUSIONS The study proposes a comprehensive framework for developing ageing policies in Asia, emphasising the need for a person-centred approach in developing AIP strategies that cater to the diverse needs of ageing populations, and underscores the importance of integrating health-care services, community support and home environment modifications. The three AIP elements advocate for a person-centred approach, providing valuable insights for policymakers to effectively manage challenges of rapidly ageing populations.
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Affiliation(s)
| | | | - Leng Leng Thang
- Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
| | - Napaphat Satchanawakul
- United Nations Economic and Social Commission for Asia and the Pacific, Bangkok, Thailand
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Liu K, Prommawin B, Schroyen F. Health insurance, agricultural production and investments. JOURNAL OF HEALTH ECONOMICS 2024; 97:102918. [PMID: 39180871 DOI: 10.1016/j.jhealeco.2024.102918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/26/2024] [Accepted: 08/03/2024] [Indexed: 08/27/2024]
Abstract
We study the effects of health insurance coverage on agricultural production decisions, examining the causal relationships by exploiting a health care reform and providing a theoretical framework to elucidate underlying mechanisms. We find that the reform led to long-run increases in total cultivation investments and output, accompanied by a shift in households' cultivation portfolio towards riskier crops. We explain these findings using a model of agricultural investment, highlighting the important roles of health insurance in mitigating background medical expenditure risks and enhancing health. We also find that the reform improved households' financial well-being through reduced debts and defaults on loans.
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Affiliation(s)
- Kai Liu
- Faculty of Economics, University of Cambridge, Cambridge, United Kingdom; IZA Institute of Labor Economics, Bonn, Germany.
| | - Benjapon Prommawin
- Faculty of Economics, University of Cambridge, Cambridge, United Kingdom; Faculty of Economics, Chiang Mai University, Chiang Mai, Thailand.
| | - Fred Schroyen
- Department of Economics, Norwegian School of Economics, Bergen, Norway.
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Sudnawa KK, Yeepae J, Photia A, Rujkijyanont P, Traivaree C, Monsereenusorn C. Health-related quality of life and its determinant factors in Thai children with cancer: parents vs. children perspectives. BMC Pediatr 2024; 24:531. [PMID: 39164706 PMCID: PMC11334399 DOI: 10.1186/s12887-024-05010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 08/13/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQOL) is a vital assessment to demonstrate the achievement in pediatric cancer care parallels that of medical treatment. The Pediatric Quality of Life Inventory (PedsQL) 3.0 Cancer Module in the Thai Version has become a standard tool to access the HRQOL among Thai children with cancer and their families. This study aimed to explore the HRQOL and factors related to HRQOL among pediatric oncology patients using the PedsQL 3.0 Cancer Module. METHODS In 2018-2019, a single-institution, cross-sectional study was conducted among children with cancer and their families in Bangkok, Thailand. A paired-sample t-test was performed to evaluate the differences between the HRQOL scores of the child and parents' reports. Linear regression was used to evaluate factors associated with HRQOL and which particular domains of the PedsQL 3.0 Cancer Module were influenced. RESULTS Eighty-five children with cancer and their families were enrolled. The patients' mean age was 10.82 ± 5.48 years. The most common cancer types included acute lymphoblastic leukemia (n = 32, 67%), central nervous system tumors (n = 13, 15%), osteosarcoma (n = 10, 27%) and neuroblastoma (n = 9, 24%), in rank. The mean HRQOL scores in child and parent reports were 74.37 ± 15.7 and 70.42 ± 17.15, respectively (p = 0.034). Factors negatively correlated to HRQOL in parent reports were the number of outpatient visits (p = 0.019) and hospital admissions (p = 0.002). The number of hospitalizations was the only independent factor that affected HRQOL (p = 0.044). The number of outpatient visits and/or hospital admissions was influenced by pain and hurt, nausea, procedural anxiety and communication domains (p < 0.05). Only the number of hospitalizations was an independent factor influencing the procedural anxiety domain in HRQOL (p = 0.005). CONCLUSION HRQOL among Thai children with cancer was desirable from both children's and parent's perspectives. Differences between child and parent HRQOL scores were observed. The number of outpatient visits and hospital admissions affected HRQOL, particularly in the procedural anxiety aspect. TRIAL REGISTRATION Thai Clinical Trials Registry (TCTR) Number: TCTR20200904001 (04/09/2020), https://www.thaiclinicaltrials.org/ .
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Affiliation(s)
- Khemika K Sudnawa
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Jitthip Yeepae
- Phayao Hospital, Ministry of Public Health, Phayao, Thailand
| | - Apichat Photia
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 315 Ratchawithi Rd. Ratchathewi, Bangkok, 10400, Thailand
| | - Piya Rujkijyanont
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 315 Ratchawithi Rd. Ratchathewi, Bangkok, 10400, Thailand
| | - Chanchai Traivaree
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 315 Ratchawithi Rd. Ratchathewi, Bangkok, 10400, Thailand
| | - Chalinee Monsereenusorn
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 315 Ratchawithi Rd. Ratchathewi, Bangkok, 10400, Thailand.
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Julian GS, Shau WY, Chou HW, Setia S. Bridging Real-World Data Gaps: Connecting Dots Across 10 Asian Countries. JMIR Med Inform 2024; 12:e58548. [PMID: 39026427 PMCID: PMC11362708 DOI: 10.2196/58548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/17/2024] [Accepted: 07/19/2024] [Indexed: 07/20/2024] Open
Abstract
The economic trend and the health care landscape are rapidly evolving across Asia. Effective real-world data (RWD) for regulatory and clinical decision-making is a crucial milestone associated with this evolution. This necessitates a critical evaluation of RWD generation within distinct nations for the use of various RWD warehouses in the generation of real-world evidence (RWE). In this article, we outline the RWD generation trends for 2 contrasting nation archetypes: "Solo Scholars"-nations with relatively self-sufficient RWD research systems-and "Global Collaborators"-countries largely reliant on international infrastructures for RWD generation. The key trends and patterns in RWD generation, country-specific insights into the predominant databases used in each country to produce RWE, and insights into the broader landscape of RWD database use across these countries are discussed. Conclusively, the data point out the heterogeneous nature of RWD generation practices across 10 different Asian nations and advocate for strategic enhancements in data harmonization. The evidence highlights the imperative for improved database integration and the establishment of standardized protocols and infrastructure for leveraging electronic medical records (EMR) in streamlining RWD acquisition. The clinical data analysis and reporting system of Hong Kong is an excellent example of a successful EMR system that showcases the capacity of integrated robust EMR platforms to consolidate and produce diverse RWE. This, in turn, can potentially reduce the necessity for reliance on numerous condition-specific local and global registries or limited and largely unavailable medical insurance or claims databases in most Asian nations. Linking health technology assessment processes with open data initiatives such as the Observational Medical Outcomes Partnership Common Data Model and the Observational Health Data Sciences and Informatics could enable the leveraging of global data resources to inform local decision-making. Advancing such initiatives is crucial for reinforcing health care frameworks in resource-limited settings and advancing toward cohesive, evidence-driven health care policy and improved patient outcomes in the region.
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Affiliation(s)
| | - Wen-Yi Shau
- Pfizer Corporation Hong Kong Limited, Hong Kong, China (Hong Kong)
| | | | - Sajita Setia
- Executive Office, Transform Medical Communications Limited, Wanganui, New Zealand
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Wang Y, Wang R, Jiang M, Ying X. Provincial inequality of China's progress towards universal health coverage: An empirical analysis in 2016-21. J Glob Health 2024; 14:04122. [PMID: 38939928 PMCID: PMC11211969 DOI: 10.7189/jogh.14.04122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Background Achieving universal health coverage (UHC) is a crucial target shared by the Sustainable Development Goals (SDGs). As UHC levels are influenced by factors such as the regional economy and resource allocation, subnational evidence in China is urgently needed. This study aimed to monitor provincial progress from 2016 to 2021, thereby informing the development of region-specific strategies. Methods Based on the UHC monitoring framework proposed by the World Health Organization, a UHC index was constructed comprising the service coverage dimension (16 indicators) and financial protection dimension (four indicators). In this observational study, routinely collected health data from 25 provinces (autonomous regions and municipalities) in mainland China were obtained from statistical yearbooks, relevant literature, and nationally representative surveys. The indices were calculated using geometric means. Socioeconomic inequalities among provinces were quantified using the slope index of inequality (SII) and relative index of inequality (RII). Results From 2016 to 2021, China made laudable progress towards achieving UHC, with the index rising from 56.94 in 2016 to 63.03 in 2021. Most provinces demonstrated better performance in service coverage. Western provinces generally presented faster rates of progress, which were attributed to more substantial increases in financial protection. Despite significant disparities, with the UHC index ranging from 77.94 in Shanghai to 54.61 in Fujian in 2021, the overall equity of UHC has improved across the 25 provinces. SII decreased from 17.78 (95% confidence interval (CI) = 11.64, 23.93) to 12.25 (95% CI = 5.86, 18.63) and RII from 1.38 (95% CI = 1.29, 1.46) to 1.22 (95% CI = 1.16, 1.29). However, the non-communicable disease (NCD) domain experienced a drop in both index score and equity, underscoring the need for prioritised attention. Conclusions In the context of SDGs and the 'Healthy China 2030' initiative, China has made commendable progress towards UHC, and inter-provincial equity has improved. However, substantial differences persisted. The equitable realisation of UHC necessitates prioritising the enhancement of service capacity and financial protection in less developed regions, particularly by addressing shortages in the general practitioner workforce and mitigating catastrophic payments. Developed regions should focus on preventing NCDs through effective interventions targeting key risk factors. This study provides insights for other countries to adopt comprehensive monitoring frameworks, identify subnational disparities, and introduce targeted policy initiatives.
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Affiliation(s)
- Yining Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Ruixin Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Mingzhu Jiang
- School of Public Health, Fudan University, Shanghai, China
| | - Xiaohua Ying
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Shanghai, China
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Samant S, Pawaskar M, Chaisavaneeyakorn S, Kamolratanakul S, Limpadanai S, Jackson B, Stephens J, Sukarom I, Chokephaibulkit K. Economic burden of varicella in Bangkok, Thailand: A multicenter medical chart review study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003099. [PMID: 38865316 PMCID: PMC11168696 DOI: 10.1371/journal.pgph.0003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/17/2024] [Indexed: 06/14/2024]
Abstract
Our multicenter, medical chart review, cost-of-illness study used a micro-costing approach to evaluate the economic burden associated with varicella in Bangkok, Thailand, from a societal perspective. We reviewed medical charts of adults and children with a primary diagnosis of varicella (2014-2018) from 4 hospitals in Bangkok. Reported healthcare resource utilization and missed school or workdays were extracted from medical charts. Mean direct, indirect, and total costs per patient were estimated for overall, adult, and pediatric patients (2020 USD). Of the 200 children and 60 adults, 99.6%, 5.4%, and 5.4% had a varicella-related outpatient visit, emergency department visit, and hospitalization, respectively. The mean direct medical cost was 33 USD for pediatric and adult patients. The mean cost of outpatient visits (8 vs 13 USD, P<0.001) and medications (7 vs 9 USD, P<0.001) was significantly lower among pediatric patients. Forty-eight children reported a mean of 5.8 school days lost, and 32 adult patients reported a mean of 7.4 workdays lost. The mean total cost per varicella patient was 89 USD, with the mean total cost higher for adult than pediatric patients (145 vs 72 USD, P<0.001). Indirect cost accounted for 63% of the total cost per patient (54% for pediatric patients and 77% for adult patients). There is a substantial economic burden associated with patients seeking varicella-related healthcare in Thailand, including considerable indirect costs.
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Affiliation(s)
- Salome Samant
- Merck & Co., Inc., Rahway, New Jersey, United States of America
| | | | | | | | | | - Bianca Jackson
- OPEN Health, Bethesda, Maryland, United States of America
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Auimekhakul T, Suttajit S, Suwannaprom P. Pharmaceutical public health competencies for Thai pharmacists: A scoping review with expert consultation. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 14:100444. [PMID: 38712325 PMCID: PMC11070631 DOI: 10.1016/j.rcsop.2024.100444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
Background Thai pharmacists' roles have increasingly shifted to a system-focused role in providing public health services. A competency framework in this area is essential to workforce development. Objective This study aimed to summarize and synthesize the literature on pharmaceutical public health competencies of Thai pharmacists. Methods The Scopus, MEDLINE, and Web of Science (Clarivate) databases were searched. The search criteria included "public health", "health promotion", "primary care", "community pharmacy", "pharmacy" and "pharmacist". Documents published in English and Thai between January 2011 and December 2020 were also examined. Unpublished documents were included. A 3-step inductive coding technique was used to develop the competency framework. To validate the findings, a 2-round, modified Delphi method was employed with 20 Thai pharmaceutical specialists between August 2022 and January 2023. The Scale-level Content Validity Index (S-CVI) was used to assess validity. Results The database search yielded 1429 articles. Fifty-seven articles were selected. The analysis identified 5 competency domains. The domains, along with their related competency elements and behavioral statements, were provided for expert assessment. The S-CVI scores in the first and second rounds were 0.78 and 0.93, respectively. The terminology and categories of competencies have been improved. This outcome resulted in a pharmaceutical public health competency framework for Thai pharmacists. The framework consists of 5 competency domains: 1) individual and family health promotion (3 competency elements with 10 behavioral statements), 2) community empowerment for well-being communities (6 competency elements with 23 behavioral statements), 3) information management and evidence-based practice (3 competency elements with 10 behavioral statements), 4) communication for health promotion (3 competency elements with 6 behavioral statements), and 5) pharmacoepidemiology and support for public health emergencies and epidemics (2 competency elements with 5 behavioral statements). Conclusion Pharmaceutical public health competencies for Thai pharmacists were developed through extensive literature review and expert consultation.
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Affiliation(s)
- Thanayut Auimekhakul
- Consumer Health Protection and Pharmaceutical Public Health, Chiang Mai Provincial Public Health Office, Chiang Mai 50200, Thailand
- Master's Degree Program in Pharmacy Management, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Siritree Suttajit
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Puckwipa Suwannaprom
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
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Youngkong S, Kamolwat P, Wongrot P, Thavorncharoensap M, Chaikledkaew U, Nateniyom S, Pungrassami P, Praditsitthikorn N, Mahasirimongkol S, Jittikoon J, Nishikiori N, Baena IG, Yamanaka T. Catastrophic costs incurred by tuberculosis affected households from Thailand's first national tuberculosis patient cost survey. Sci Rep 2024; 14:11205. [PMID: 38755216 PMCID: PMC11099064 DOI: 10.1038/s41598-024-56594-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/08/2024] [Indexed: 05/18/2024] Open
Abstract
Tuberculosis (TB) causes an economic impact on the patients and their households. Although Thailand has expanded the national health benefit package for TB treatment, there was no data on out-of-pocket payments and income losses due to TB from patients and their household perspectives. This national TB patient cost survey was conducted to examine the TB-related economic burden, and assess the proportion of TB patients and their households facing catastrophic total costs because of TB disease. A cross-sectional TB patient cost survey was employed following WHO methods. Structured interviews with a paper-based questionnaire were conducted from October 2019 to July 2021. Both direct and indirect costs incurred from the patient and their household perspective were valued in 2021 and estimated throughout pre- and post-TB diagnosis episodes. We assessed the proportion of TB-affected households facing costs > 20% of household expenditure due to TB. We analyzed 1400 patients including 1382 TB (first-line treatment) and 18 drug-resistant TB patients (DR-TB). The mean total costs per TB episode for all study participants were 903 USD (95% confident interval; CI 771-1034 USD). Of these, total direct non-medical costs were the highest costs (mean, 402 USD, and 95%CI 334-470 USD) incurred per TB-affected household followed by total indirect costs (mean, 393 USD, and 95%CI 315-472 USD) and total direct medical costs (mean, 107 USD, and 95%CI 81-133 USD, respectively. The proportion of TB-affected households facing catastrophic costs was 29.5% (95%CI 25.1-34.0%) for TB (first-line), 61.1% (95%CI 29.6-88.1%) for DR-TB and 29.9% (95%CI 25.6-34.4%) overall. This first national survey highlighted the economic burden on TB-affected households. Travel, food/nutritional supplementation, and indirect costs contribute to a high proportion of catastrophic total costs. These suggest the need to enhance financial and social protection mechanisms to mitigate the financial burden of TB-affected households.
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Affiliation(s)
- Sitaporn Youngkong
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand.
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
| | - Phalin Kamolwat
- Division of Tuberculosis, Department of Disease Control, Ministry of Public Health, Bangkok, Thailand
| | - Phichet Wongrot
- Faculty of Nursing, Mahidol University, Nakhon Pathom, Thailand
| | - Montarat Thavorncharoensap
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Sriprapa Nateniyom
- Division of Tuberculosis, Department of Disease Control, Ministry of Public Health, Bangkok, Thailand
| | - Petchawan Pungrassami
- Division of Tuberculosis, Department of Disease Control, Ministry of Public Health, Bangkok, Thailand
| | | | | | - Jiraphun Jittikoon
- Department of Biochemistry, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Nobuyuki Nishikiori
- World Health Organization Global Tuberculosis Programme, Geneva, Switzerland
| | - Ines Garcia Baena
- World Health Organization Global Tuberculosis Programme, Geneva, Switzerland
| | - Takuya Yamanaka
- World Health Organization Global Tuberculosis Programme, Geneva, Switzerland
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Damrongplasit K, Melnick G. Utilisation, out-of-pocket payments and access before and after COVID-19: Thailand's Universal Health Coverage Scheme. BMJ Glob Health 2024; 9:e015179. [PMID: 38740495 PMCID: PMC11097804 DOI: 10.1136/bmjgh-2024-015179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
The goal of Universal Health Coverage (UHC) is that everyone needing healthcare can access quality services without financial hardship. Recent research covering countries with UHC systems documents the emergence, and acceleration following the COVID-19 pandemic of unapproved informal payment systems by providers that collect under-the-table payments from patients. In 2001, Thailand extended its '30 Baht' government-financed coverage to all uninsured people with little or no cost sharing. In this paper, we update the literature on the performance of Thailand's Universal Health Coverage Scheme (UCS) with data covering 2019 (pre-COVID-19) through 2021. We find that access to care for Thailand's UCS-covered population (53 million) is similar to access provided to populations covered by the other major public health insurance schemes covering government and private sector workers, and that, unlike reports from other UHC countries, no evidence that informal side payments have emerged, even in the face of COVID-19 related pressures. However, we do find that nearly one out of eight Thailand's UCS-covered patients seek care outside the UCS delivery system where they will incur out-of-pocket payments. This finding predates the COVID-19 pandemic and suggests the need for further research into the performance of the UHC-sponsored delivery system.
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Affiliation(s)
- Kannika Damrongplasit
- Faculty of Economics and Center of Excellence for Health Economics, Chulalongkorn University, Bangkok, Thailand
| | - Glenn Melnick
- Sol Price School of Public Policy and Center for Health Financing, Policy and Management, University of Southern California, Los Angeles, California, USA
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Pinsuwan C, Santong C, Chainansamit SO, Komvilaisak P, Sirikarn P, Phimha S, Suwannaying K. Trends in incidence and survival of childhood cancers in Khon Kaen, Thailand (2000-2019): a population-based Khon Kaen Cancer Registry study. BMC Public Health 2024; 24:1255. [PMID: 38714963 PMCID: PMC11077803 DOI: 10.1186/s12889-024-18742-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND In Thailand, the national health care system and nationwide standard treatment protocols have evolved over time, potentially influencing the trends in the incidence and survival rates of childhood cancers. However, further investigations are required to comprehensively study these trends in Khon Kaen, Thailand. METHODS Childhood cancer patients aged 0-14 years (n = 541) who were diagnosed with one of the five most common cancers between 2000 and 2019 from the population-based Khon Kaen Cancer Registry were enrolled. Descriptive statistics were used to analyse the demographic data, which are presented as numbers, percentages, means, and standard deviations. The trends in incidence between 2000 and 2019, including age-standardized incidence rates (ASRs) and annual percent changes (APCs), were analysed using the Joinpoint regression model. Survival analysis was performed for 5-year relative survival rates (RSRs) according to the Pohar Perme estimator and Kaplan-Meier survival curves. RESULTS The ASRs of the overall top 5 childhood cancer groups were 67.96 and 106.12 per million person-years in 2000 and 2019, respectively. Overall, the APC significantly increased by 2.37% each year for both sexes. The overall 5-year RSRs were 60.5% for both sexes, 58.2% for males, and 63.9% for females. The highest 5-year RSR was for germ cell tumours (84.3%), whereas the lowest 5-year RSR was for neuroblastoma (29.1%). CONCLUSIONS The incidence and survival rates of childhood cancers in Khon Kaen, Thailand, varied according to sex. The incidence trends increased over time, meanwhile, the relative survival rates rose to satisfactory levels and were comparable to those of other nations with similar financial status. The implementation of national health policies and adherence to national treatment guidelines have improved cancer diagnosis and treatment outcomes.
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Affiliation(s)
- Chanaporn Pinsuwan
- Doctor of Public Health Program, Faculty of Public Health, Khon Kaen University, 123 Mittraphap road, Muang Khon Kaen, Khon Kaen, 40002, Thailand
| | - Chalongpon Santong
- Khon Kaen Cancer Registry, Cancer unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, 123 Mittraphap road, Muang Khon Kaen, Khon Kaen, 40002, Thailand
| | - Su-On Chainansamit
- Department of Pediatrics, Khon Kaen Hospital, 54 Sri Chant road, Muang Khon Kaen, Khon Kaen, 40000, Thailand
| | - Patcharee Komvilaisak
- Department of Pediatrics, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, 123 Mittraphap road, Muang Khon Kaen, Khon Kaen, 40002, Thailand
| | - Prapassara Sirikarn
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, 123 Mittraphap road, Muang Khon Kaen, Khon Kaen, 40002, Thailand
| | - Surachai Phimha
- Department of Public Health Administration, Health Promotion, and Nutrition, Faculty of Public Health, Khon Kaen University, 123 Mittraphap road, Muang Khon Kaen, Khon Kaen, 40002, Thailand
| | - Kunanya Suwannaying
- Department of Pediatrics, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, 123 Mittraphap road, Muang Khon Kaen, Khon Kaen, 40002, Thailand.
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Wang P, Wang Z, Qiu S. Universal, school-based transdiagnostic interventions to promote mental health and emotional wellbeing: a systematic review. Child Adolesc Psychiatry Ment Health 2024; 18:47. [PMID: 38600562 PMCID: PMC11007989 DOI: 10.1186/s13034-024-00735-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE This systematic review aims to evaluate the effectiveness of universal school-based transdiagnostic interventions in promoting the mental health of children and adolescents. It compares and discusses interventions targeting the prevention of mental disorders versus the promotion of mental health. Additionally, the roles of teachers and psychologists as intervention conductors are examined. METHODS A comprehensive search of the Psycinfo, Pubmed, and Web of Science databases was conducted without any time restrictions to identify relevant literature on universal school-based transdiagnostic interventions promoting children and adolescents' mental health. RESULTS AND DISCUSSION The findings reveal that universal school-based transdiagnostic promotion/prevention programs have a small to medium overall effect size. These interventions demonstrate a broad coverage of different aspects of children and adolescents' mental health. However, the relative effectiveness of teacher-led versus psychologist-led interventions remains unclear. Interventions focused on preventing mental disorders exhibit a higher effect size, albeit on a narrower range of mental health aspects for children and adolescents. SIGNIFICANCE This study enhances our understanding of universal school-based transdiagnostic interventions and their impact on children and adolescents' mental health. Further research is needed to elucidate the comparative efficacy of teacher-led and psychologist-led interventions and to explore the specific dimensions of mental health targeted by these interventions.
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Affiliation(s)
- Peng Wang
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK.
- Department of Language, Literature and Communication, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands.
| | - Zhaoqi Wang
- School of Foreign Studies, China University of Petroleum, Qingdao City, China
| | - Shuiwei Qiu
- Department of Cardiothoracic Surgery, Quzhou People's Hospital, Quzhou City, China
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Lemon CA, Svob C, Bonomo Y, Dhungana S, Supanya S, Sittanomai N, Diatri H, Haider II, Javed A, Chandra P, Herrman H, Hoven CW, Sartorius N. Priorities for research promoting mental health in the south and east of Asia. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 23:100287. [PMID: 38404519 PMCID: PMC10884971 DOI: 10.1016/j.lansea.2023.100287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 02/27/2024]
Abstract
Progress in promoting mental health, preventing mental illness, and improving care for people affected by mental illness is unlikely to occur if efforts remain separated from existing public health programs and the principles of public health action. Experts met recently to discuss integrating public health and mental health strategies in the south and east of Asia, especially in low- and middle-income countries. Areas of research identified as high priority were: 1) integrating mental health into perinatal care; 2) providing culturally-adjusted support for carers of people with mental and physical disorders; 3) using digital health technologies for mental health care in areas with limited resources and 4) building local research capacity. Selection of these areas was informed by their relative novelty in the region, ease of implementation, likely widespread benefit, and potential low costs. In this article, we summarise available evidence, highlight gaps and call for collaborations with research centres, leaders and persons with lived experience within and beyond the region.
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Affiliation(s)
- Christopher A. Lemon
- NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Connie Svob
- Department of Psychiatry, College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, United States of America
| | - Yvonne Bonomo
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Victoria, Australia
- Department of Addiction Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Saraswati Dhungana
- Department of Psychiatry, Institute of Medicine, Tribhuvan University, Nepal
| | - Suttha Supanya
- Somdet Chaopraya Institute of Psychiatry, Department of Mental Health, Bangkok, Thailand
| | - Napat Sittanomai
- Division of Child and Adolescent Psychiatry, Department of Paediatrics, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Hervita Diatri
- Department of Psychiatry, Faculty Medicine Universitas Indonesia and Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | | | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | - Prabha Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christina W. Hoven
- Department of Psychiatry, College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, United States of America
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
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Sukhampha R. Diffusion of global health norms through a national medical professional movement in the universal healthcare of Thailand. Front Public Health 2024; 12:1249497. [PMID: 38515593 PMCID: PMC10956689 DOI: 10.3389/fpubh.2024.1249497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
Commonly, research investigations on social policy reform primarily examine the national processes at the core of policy formation rather than considering their global context. Concerns are raised regarding the diffusion and influence of global health norms on Thai universal health coverage policymaking. The findings demonstrate that global health ideas and actors have an impact on national policymaking and that they can share ideas in a variety of ways, including glocalization, vernacularization, policy learning, and policy entrepreneur intervention, in setting the agenda for national universal health coverage. Global and universal health coverage (UHC) concepts have existed for decades; success would not be possible without the efforts of policy entrepreneurs such as the Rural Doctor Movement, who localize and vernacularize global concepts for implementation. These concepts must be compatible with the national and local sociopolitical contexts in which they exist. The Thai case contributed to a better understanding of the influences of global ideas and actors on transnational health policy transfer, as well as the intervention of the national medical professional movement as policy entrepreneurs in healthcare policymaking and policy change for equity in health.
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Affiliation(s)
- Rangsan Sukhampha
- Faculty of Sociology, Bielefeld University, Bielefeld, Germany
- Department of Public Administration, Faculty of Humanities and Social Sciences, Valaya Alongkorn Rajabhat University, Pathum Thani, Thailand
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Sukrong M, Prapaisilp P, Juntamongkol T, Siranart N, Phoolcharoen N, Assavapokee N, Sirisabya N, Santibenchakul S. Knowledge regarding human papillomavirus and cervical cancer prevention among medical students from Chulalongkorn University in Thailand. BMC Womens Health 2024; 24:129. [PMID: 38373946 PMCID: PMC10877815 DOI: 10.1186/s12905-024-02933-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Cervical cancer is one of the leading causes of death among women in Thailand. General practitioners, within their primary healthcare role, play a vital role in the cervical cancer screening program, as they are the healthcare professionals most easily accessible to the general population. This study aims to determine the level of knowledge of cervical cancer and human papillomavirus (HPV) infection, HPV vaccination, and cervical cancer screening among last-year medical students. METHODS A cross-sectional study was conducted among sixth-year medical students using an electronic self-administered questionnaire. The two-part questionnaire comprised demographic data and 12 true/false questions that assessed knowledge regarding HPV infection, HPV vaccination, and cervical cancer screening recommendations. Pilot testing revealed a high Cronbach's alpha and test-retest reliability coefficient. RESULTS A 67% response rate was achieved. Among the 198 respondents, only one (0.5%) student correctly answered over 80% of the questions while most respondents (172, 71.7%) correctly answered less than 60% of the questions. Less than half of the respondents correctly identified crucial aspects such as the primary cause of cervical cancer, recommended vaccination age, cytology sensitivity compared to HPV testing, and the recommended screening frequency for average-risk women. CONCLUSIONS This study highlights a significant lack of comprehension among Thai medical students concerning HPV infection, vaccination, and cervical cancer screening guidelines. Encouraging educational enhancement, effective communication, and heightened awareness of these crucial topics within the medical school curriculum are imperative.
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Affiliation(s)
- Monchada Sukrong
- Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Peerapong Prapaisilp
- Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Tunchanok Juntamongkol
- Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Noppachai Siranart
- Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Natacha Phoolcharoen
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Nicha Assavapokee
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Nakarin Sirisabya
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Somsook Santibenchakul
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
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Sakboonyarat B, Rangsin R. Characteristics and clinical outcomes of people with hypertension receiving continuous care in Thailand: a cross-sectional study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 21:100319. [PMID: 38361594 PMCID: PMC10866948 DOI: 10.1016/j.lansea.2023.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/27/2023] [Accepted: 10/27/2023] [Indexed: 02/17/2024]
Abstract
Background Hypertension (HT) is a major global health concern, including in Thailand. The present study aimed to identify the characteristics and clinical outcomes of people with HT receiving continuous care in Thailand in 2018. Methods We conducted a nationwide cross-sectional study in 2018. People with HT aged 20 years and older receiving medical care at outpatient clinics in the targeted hospitals for at least 12 months were included. Findings A total of 36,557 people with HT nationwide were enrolled in the current study. 61.5% of the participants were women, and the average age of the participants was 64.7 years. Most participants (53.3%) required two or more antihypertensive medications to control blood pressure (BP). The overall prevalence of BP control (systolic BP, <140 mmHg; diastolic BP, <90 mmHg) was 66.6% and 49.4% at the latest visit and the latest two consecutive times, respectively. BP control rate was lower for people with HT residing in the southern region compared to other regions. The prevalence of achieving the target goal of LDL cholesterol level (<100 mg/dL) was 39.9%, and that of BMI ≥ 25 kg/m2 was 47.6%. Only 15.2% of participants received a 12-lead electrocardiogram (ECG) screening; among them, 2.8% had atrial fibrillation and 2.2% had left ventricular hypertrophy. The prevalence of the history of cerebrovascular, cardiovascular, and renal complications was 4.2%, 4.3%, and 13.1%, respectively, among people with HT. Interpretation The findings indicated a potential for further improvement in the quality of HT care in Thailand. Accessibility to continuous care among males with HT requires additional responsiveness. BP control rate should be enhanced, especially in the southern region. A coverage of 12-lead ECG screening in people with HT should be increased. Weight management and reduction of LDL cholesterol levels should be encouraged to prevent cardiovascular complications. Funding National Health Security Office (NHSO) in Thailand.
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Affiliation(s)
- Boonsub Sakboonyarat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
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Tienthavorn V, Chuenkongkaew W, Tanvatanakul V, Charoensuk S, Poltana P, Thepaksorn P. Policies and practices to attract, retain, support, and reskill health and care workers during the COVID-19 pandemic and future workforce development in Thailand. J Glob Health 2023; 13:03046. [PMID: 37971944 PMCID: PMC10653341 DOI: 10.7189/jogh.13.03046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Affiliation(s)
- Vichai Tienthavorn
- President Office, Praboromarajchanok Institute, Royal Thai Ministry of Public Health
| | - Wanicha Chuenkongkaew
- President Office, Praboromarajchanok Institute, Royal Thai Ministry of Public Health
| | - Vasuton Tanvatanakul
- President Office, Praboromarajchanok Institute, Royal Thai Ministry of Public Health
| | - Sukjai Charoensuk
- Boromarajonani College of Nursing, Chonburi, Faculty of Nursing, Praboromarajchanok Institute, Royal Thai Ministry of Public Health
| | - Pisit Poltana
- Boromarajonani College of Nursing, Suphanburi, Faculty of Nursing, Praboromarajchanok Institute, Royal Thai Ministry of Public Health
| | - Phayong Thepaksorn
- Sirindhorn College of Public Health, Trang, Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute, Royal Thai Ministry of Public Health
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Viriyathorn S, Sachdev S, Suwanwela W, Wangbanjongkun W, Patcharanarumol W, Tangcharoensathien V. Procedural fairness in benefit package design: inclusion of pre-exposure prophylaxis of HIV in Universal Coverage Scheme in Thailand. Health Policy Plan 2023; 38:i36-i48. [PMID: 37963082 PMCID: PMC10645053 DOI: 10.1093/heapol/czad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/09/2023] [Accepted: 07/29/2023] [Indexed: 11/16/2023] Open
Abstract
Since 2002, Thailand's Universal Coverage Scheme (UCS) has adopted a comprehensive benefits package with few exclusions. A positive-list approach has gradually been applied, with pre-exposure prophylaxis (PrEP) of HIV recently being included. Disagreements resulting from competing values and diverging interests necessitate an emphasis on procedural fairness when making any decisions. This qualitative study analyses agenda setting, policy formulation and early implementation of PrEP from a procedural fairness lens. Literature reviews and in-depth interviews with 13 key stakeholders involved in PrEP policy processes were conducted. Civil society organizations (CSOs) and academia piloted PrEP service models and co-produced evidence on programmatic feasibility and outcomes. Through a broad stakeholder representation process, the Department of Disease Control proposed PrEP for inclusion in UCS benefits package in 2017. PrEP was shown to be cost-effective and affordable through rigorous health technology assessment, peer review, use of up-to-date evidence and safe-guards against conflicts of interest. In 2021, Thailand's National Health Security Board decided to include PrEP as a prevention and promotion package, free of charge, for the populations at risk. Favourable conditions for procedural fairness were created by Thailand's legislative provisions that enable responsive governance, notably inclusiveness, transparency, safeguarding public interest and accountable budget allocations; longstanding institutional capacity to generate local evidence; and implementation capacity for realisation of procedural fairness criteria. Multiple stakeholders including CSOs, academia and the government deliberated in the policy process through working groups and sub-committees. However, a key lesson from Thailand's deliberative process concerns a possible 'over interpretation' of conflicts of interest, intended to promote impartial decision-making, which inadvertently limited the voices of key populations represented in the decision processes. Finally, this case study underscores the value of examining the full policy cycle when assessing procedural fairness, since some stages of the process may be more amenable to certain procedural criteria than others.
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Affiliation(s)
- Shaheda Viriyathorn
- International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Saranya Sachdev
- International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Waraporn Suwanwela
- National Health Security Office (NHSO), The Government Complex Commemorating His Majesty the King's 80th Birthday Anniversary 5th December, B.E.2550 (2007) Building B 120 Moo 3 Chaengwattana Road, Lak Si District, Bangkok 10210, Thailand
| | - Waritta Wangbanjongkun
- International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Walaiporn Patcharanarumol
- International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Viroj Tangcharoensathien
- International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand
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Yunus RM, Johar H, Katiman D. In Search for a Sustainable and Equitable Long-Term Care for Malaysia. J Aging Soc Policy 2023; 35:743-755. [PMID: 35290173 DOI: 10.1080/08959420.2022.2049575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/05/2021] [Indexed: 10/18/2022]
Abstract
Like many other countries across the globe, Malaysia is rapidly graying. It is projected that older adults will comprise 10-15% of the country's total population in the next decade. Despite the surge in chronic diseases and a rise in dependency in daily living activities among Malaysian elders, formal support and long-term care services (LTC) have not been adequately developed. The existing tax-funded health care system - currently under huge financial strain - has no systematic or comprehensive LTC provision in place. This paper highlights the need for sustainable and equitable LTC services in Malaysia while drawing insight from existing LTC provision and financing arrangements in neighboring countries. It offers several recommendations to move forward in LTC planning using an approach that is unique to the Malaysian context.
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Affiliation(s)
- Raudah Mohd Yunus
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - Hamimatunnisa Johar
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500 Selangor, Malaysia
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Ingolstädter Landstraße 1, 85764, München, German
| | - Diana Katiman
- Department of Medicine, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia
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Wongsingha N, Widyastari DA, Chokthananukoon B, Rasri N, Katewongsa P. Assessing physical activity promotion in different settings and how its associated with public participation during COVID-19 epidemic: evidence from national policy evaluation. BMC Public Health 2023; 23:1775. [PMID: 37700247 PMCID: PMC10496167 DOI: 10.1186/s12889-023-16690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Various interventions, programs and policies have been implemented to improve physical activity (PA) levels worldwide. However, countries continue to face barriers and challenges in achieving their targets. To date, there is a lack of study on the evaluation of physical activity (PA) promotion and how it's associated with public participation. METHODS This study assessed PA promotion in eight different settings in terms of policy availability, policy implementation, and public participation in PA programs. Policy availability was assessed by reviewing 384 policy and strategy documents, rules, regulations, legislation, and guidelines on PA. We scored the documents by using the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework. Data to assess policy implementation and public participation were taken from the Thailand Report Card Survey 2021 (TRC2021), and the Thailand Surveillance on Physical Activity (SPA) 2021. Both surveys comprised over 5,000 nationally-representative samples from on-screen, face-to-face interviews, and an online self-administered survey. We scored the policy implementation and public participation based on respondents' response towards policy implementation and participation indicators. A grading scheme was applied to indicate how successful an investment has been made. RESULTS Public education and mass media received the highest average score in policy availability, implementation and public participation in PA program (67.9%, grade B), followed by active urban design (66.1%, grade B-) and active transport (63.7%, grade B-). Workplace, whole-of-school, and community-wide initiatives were the investments with the lowest scores, implying low availability, limited implementation, and less accessibility to public. Females were less likely to participate in active transport, active urban design, sports/recreation for all, workplace activity, and community-wide initiatives. Age and educational attainment were consistent predictors of utilization in all investments. CONCLUSIONS With varying degrees of policy availability and accessibility, public participation in PA investments is likely to be constrained by biological and socioeconomic inequality. Future investments should aim at providing generalized or tailored interventions to ensure equal access and participation for all segments of the population.
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Affiliation(s)
- Narakorn Wongsingha
- Thailand Physical Activity Knowledge Development Centre (TPAK), Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
| | - Dyah Anantalia Widyastari
- Thailand Physical Activity Knowledge Development Centre (TPAK), Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
- Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
| | - Burathep Chokthananukoon
- Thailand Physical Activity Knowledge Development Centre (TPAK), Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
- Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
| | - Niramon Rasri
- Thai Health Promotion Foundation, Thung Maha Mek, Sathorn, Bangkok, 10120 Thailand
| | - Piyawat Katewongsa
- Thailand Physical Activity Knowledge Development Centre (TPAK), Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
- Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
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Khamnil Y, Kao-Iean S, Pisarnturakit PP. Scale development to measure the patient perception of patient-centered care of dentists in primary care settings of Thailand: a measurement invariance test. BMC Oral Health 2023; 23:626. [PMID: 37660040 PMCID: PMC10474778 DOI: 10.1186/s12903-023-03331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Patient-centered care is essential for providing quality services thoroughly at the primary care level, but it is unclear and lacks measurement. This study aimed to develop a reliable and valid instrument to measure patient perception of patient-centered care in primary dental care in Thailand and test the measurement invariance between large and small community hospitals. METHODS The initial set of 45 items for the patient perception of Patient-Centered Care of Dentist Scale (PCCDS-P version) was developed using a mixed-method approach, which included a literature review, a content validity test, cognitive interviews, and a pre-test. A multistage sampling strategy was used to recruit dental patients or their parents or caregivers from community hospitals across Thailand. Validity was examined through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability was assessed using Cronbach's alpha coefficient and the intraclass correlation coefficient. Furthermore, a multi-group analysis was conducted to compare the responses of patients from large and small community hospitals. RESULTS Three hundred thirty-six and One thousand one hundred sixty-seven samples were randomized for EFA and CFA, respectively. The final PCCDS-P version consists of 7 factors with satisfactory reliability and validity and is composed of 42 items: dentist-patient relationship, disease-illness, integrated care, communication, shared information and decision-making, holistic, and empathy and anxiety management. The CFA showed the model fit was consistent with the entire sample. The metric invariance analysis showed that the factor loadings were invariant across patient groups. Overall, Cronbach's alpha coefficient and intraclass correlation coefficient were satisfactory. CONCLUSIONS The newly developed PCCDS-P version is composed of seven domains with 42 items with good reliability and validity, and it indicated measurement invariance across patients in large and small community hospitals.
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Affiliation(s)
- Yutthana Khamnil
- Graduate Program in Dental Public Health, Faculty of Dentistry, Chulalongkorn University, Patumwan, Bangkok, 10330, Thailand
| | - Surasak Kao-Iean
- Research Unit of CYD and Department of Educational Research and Psychology, Faculty of Education, Chulalongkorn University, Patumwan, Bangkok, 10330, Thailand
| | - Pagaporn Pantuwadee Pisarnturakit
- Department of Community Dentistry, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Road, Patumwan, Bangkok, 10330, Thailand.
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Lim MY, Kamaruzaman HF, Wu O, Geue C. Health financing challenges in Southeast Asian countries for universal health coverage: a systematic review. Arch Public Health 2023; 81:148. [PMID: 37592326 PMCID: PMC10433621 DOI: 10.1186/s13690-023-01159-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Universal Health Coverage (UHC) has received much attention and many countries are striving to achieve it. The Southeast Asian region, in particular, comprises many developing countries with limited resources, exacerbating challenges around attaining UHC. This paper aims to specifically explore the health financing challenges these countries face in achieving UHC via a systematic review approach and formulate recommendations that will be useful for policymakers. METHODS The systematic review followed the guidelines as recommended by PRISMA. The narrative synthesis approach was used for data synthesis, followed by identifying common themes. RESULTS The initial search returned 160 articles, and 32 articles were included after the screening process. The identified challenges in health financing towards achieving UHC in the Southeast Asian region are categorised into six main themes, namely (1) Unsustainability of revenue-raising methods, (2) Fragmented health insurance schemes, (3) Incongruity between insurance benefits and people's needs, (4) Political and legislative indifference, (5) Intractable and rapidly rising healthcare cost, (6) Morally reprehensible behaviours. CONCLUSIONS The challenges identified are diverse and therefore require a multifaceted approach. Regional collaborative efforts between countries will play an essential role in the progress towards UHC and in narrowing the inequity gap. At the national level, individual countries must work towards sustainable health financing strategies by leveraging innovative digital technologies and constantly adapting to dynamic health trends. REGISTRATION This study is registered with PROSPERO, under registration number CRD42022336624.
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Affiliation(s)
- Ming Yao Lim
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK.
| | - Hanin Farhana Kamaruzaman
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
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Feng Y, Maimaitiming M, Shi J, Wang M, Li N, Jin Y, Zheng ZJ. Inequity of maternal-child health services in ASEAN member states from 1993 to 2021. Int J Equity Health 2023; 22:149. [PMID: 37550702 PMCID: PMC10408145 DOI: 10.1186/s12939-023-01974-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Inequity in maternal-child health services is a challenge to global health as it hinders the achievement of Sustainable Development Goals (SDGs) and Universal Health Coverage. Though the Association of Southeast Asian Nations (ASEAN) has made remarkable achievements in maternal-child health, there remain gaps in reaching global goals. This study aimed to compare and investigate the inequity in maternal-child health (MCH) services in ASEAN member states to help guide policy decisions to improve equitable health services in the SDG era and beyond. METHODS Using the WHO Health Inequality Monitor, we identified inequity summary measures for five MCH services in ASEAN member states from 1993 to 2021: antenatal care, births attended by skilled health personnel, diphtheria, tetanus and pertussis (DTP3) immunization, measles immunization, and polio immunization. We divided the analysis dimension of inequity into urban-rural inequity, economic status inequity, and sub-regional inequity. Trends of absolute and relative inequity in every dimension of MCH services in ASEAN member states were examined with the principal component analysis (PCA). RESULTS The mean coverages of MCH services are 98.80% (Thailand), 86.72% (Cambodia), 84.54% (Viet Nam), 78.52 (Indonesia), 76.94% (Timor-Leste), 72.40% (Lao PDR), 68.10% (Philippines) and 48.52% (Myanmar) in 2021. Thailand have the lowest MCH services absolute inequity indexes of -1.945, followed by Vietnam (-1.449). Lao PDR and Myanmar have relatively higher MCH services absolute inequity indexes of 0.852 and 0.054 respectively. The service in Cambodia, Indonesia, and the Philippines is pro-specific regions (with subnational region absolute inequity indexes of -0.02, 0.01, and 1.01 respectively). The service in Myanmar is pro-rich (with economic status absolute inequity index of 0.43). The service in Lao PDR and Timor-Leste is pro-urban areas, pro-rich, and pro-specific regions. CONCLUSION The inequity of MCH services in ASEAN persists but is in a declining trend. Thailand and Vietnam have performed well in ensuring MCH services equity, while Laos and Myanmar are still facing serious inequity dilemmas. The progress of MCH service equity in Myanmar, Cambodia, the Philippines, and Indonesia is uneven. It is acceptable to learn from the successful experiences of Thailand and Vietnam to improve the equities in other ASEAN countries. Policies should be developed according to the specific types of MCH inequity in member states to improve equity levels.
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Affiliation(s)
- Yikai Feng
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Mailikezhati Maimaitiming
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Junyi Shi
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Minmin Wang
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Na Li
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
- Institute for Global Health and Development, Peking University, Beijing, China.
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
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Kaikeaw S, Punpuing S, Chamchan C, Prasartkul P. Socioeconomic inequalities in health outcomes among Thai older population in the era of Universal Health Coverage: trends and decomposition analysis. Int J Equity Health 2023; 22:144. [PMID: 37533003 PMCID: PMC10399069 DOI: 10.1186/s12939-023-01952-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/06/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Thailand's Universal Health Coverage (UHC) has been achieved since 2002 when the entire population are covered by three main public health security schemes: (1) Civil Servant Medical Benefit Scheme (CSMBS); (2) Social Security Scheme (SSS); and (3) Universal Coverage Scheme (UCS). Citizens have access to healthcare services at all life stages and are protected from catastrophic expenditure and medical impoverishment. However, there are health inequalities in both health outcomes and access to healthcare among older Thais. This study aims to: (1) assess the degrees of socioeconomic inequalities in health outcomes among the older Thai population during the period of Thailand's UHC implementation (2003-2019), and (2) explain socioeconomic inequalities in health outcomes through decomposition of the contributions made by Thailand's UHC policy and other health determinants. METHODS Data sets come from a four-year series of the National Health and Welfare Survey (HWS) between 2003 and 2019. The health outcome of interest was obtained from the Thai EQ-5D index. The Erreygers' concentration index (CI) was used to calculate the socioeconomic inequality in health outcomes. Multivariate methods were employed to decompose inequalities. RESULTS Findings indicated Thai older adults (aged 50 and older) are healthier during the UHC implementation. Better health outcomes remain concentrated among the wealthier groups (pro-rich inequality). However, the degree of socioeconomic inequalities in health outcomes significantly declined by almost a factor-of-three (from CI = 0.061 in 2003 to CI = 0.024 in 2019) after the roll-out of the UHC. Decomposed results reported that Thailand's UHC, urban residence, and household wealth were major contributors in explaining pro-rich inequalities in health outcomes among Thai older adults. CONCLUSIONS Older persons in Thailand have better health while health inequalities between the rich and the poor have substantially decreased. However, there is inequalities in health outcomes within all three national health security schemes in Thailand. Minimizing differences between schemes continues to be a crucial cornerstone to tackling health inequalities among the older population. At the same time, making Thailand's UHC sustainable is necessary through preparing financial sustainability and developing health resources to better serve an ageing society.
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Affiliation(s)
- Sirinya Kaikeaw
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand.
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
| | - Chalermpol Chamchan
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
| | - Pramote Prasartkul
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
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Kaiser AH, Rotigliano N, Flessa S, Ekman B, Sundewall J. Extending universal health coverage to informal workers: A systematic review of health financing schemes in low- and middle-income countries in Southeast Asia. PLoS One 2023; 18:e0288269. [PMID: 37432943 DOI: 10.1371/journal.pone.0288269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/23/2023] [Indexed: 07/13/2023] Open
Abstract
Achieving universal health coverage (UHC) is a priority of most low- and middle-income countries, reflecting governments' commitments to improved population health. However, high levels of informal employment in many countries create challenges to progress toward UHC, with governments struggling to extend access and financial protection to informal workers. One region characterized by a high prevalence of informal employment is Southeast Asia. Focusing on this region, we systematically reviewed and synthesized published evidence of health financing schemes implemented to extend UHC to informal workers. Following PRISMA guidelines, we systematically searched for both peer-reviewed articles and reports in the grey literature. We appraised study quality using the Joanna Briggs Institute checklists for systematic reviews. We synthesized extracted data using thematic analysis based on a common conceptual framework for analyzing health financing schemes, and we categorized the effect of these schemes on progress towards UHC along the dimensions of financial protection, population coverage, and service access. Findings suggest that countries have taken a variety of approaches to extend UHC to informal workers and implemented schemes with different revenue raising, pooling, and purchasing provisions. Population coverage rates differed across health financing schemes; those with explicit political commitments toward UHC that adopted universalist approaches reached the highest coverage of informal workers. Results for financial protection indicators were mixed, though indicated overall downward trends in out-of-pocket expenditures, catastrophic health expenditure, and impoverishment. Publications generally reported increased utilization rates through the introduced health financing schemes. Overall, this review supports the existing evidence base that predominant reliance on general revenues with full subsidies for and mandatory coverage of informal workers are promising directions for reform. Importantly, the paper extends existing research by offering countries committed to progressively realizing UHC around the world a relevant updated resource, mapping evidence-informed approaches toward accelerated progress on the UHC goals.
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Affiliation(s)
- Andrea Hannah Kaiser
- Department of Clinical Sciences Malmö, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Improving Social Protection and Health Project, Phnom Penh, Cambodia
| | - Niccolò Rotigliano
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Improving Social Protection and Health Project, Phnom Penh, Cambodia
| | - Steffen Flessa
- Department of Health Care Management, University of Greifswald, Greifswald, Germany
| | - Björn Ekman
- Department of Clinical Sciences Malmö, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
| | - Jesper Sundewall
- Department of Clinical Sciences Malmö, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
- HEARD, University of KwaZulu-Natal, Durban, South Africa
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25
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Wang Y, Luangasanatip N, Pan-Ngum W, Isaranuwatchai W, Prawjaeng J, Saralamba S, Painter C, Briones JR, Teerawattananon Y. Assessing the cost-effectiveness of COVID-19 vaccines in a low incidence and low mortality setting: the case of Thailand at start of the pandemic. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:735-748. [PMID: 35951243 PMCID: PMC9366779 DOI: 10.1007/s10198-022-01505-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 07/26/2022] [Indexed: 05/20/2023]
Abstract
OBJECTIVE This study aimed to assess the cost-effectiveness of COVID-19 vaccines, preferred COVID-19 vaccine profiles, and the preferred vaccination strategies in Thailand. METHODS An age-structured transmission dynamic model was developed based on key local data to evaluate economic consequences, including cost and health outcome in terms of life-years (LYs) saved. We considered COVID-19 vaccines with different profiles and different vaccination strategies such as vaccinating elderly age groups (over 65s) or high-incidence groups, i.e. adults between 20 and 39 years old who have contributed to more than 60% of total COVID-19 cases in the country thus far. Analyses employed a societal perspective in a 1-year time horizon using a cost-effectiveness threshold of 160,000 THB per LY saved. Deterministic and probabilistic sensitivity analyses were performed to identify and characterize uncertainty in the model. RESULTS COVID-19 vaccines that block infection combined with social distancing were cost-saving regardless of the target population compared to social distancing alone (with no vaccination). For vaccines that block infection, the preferred (cost-effective) strategy was to vaccinate the high incidence group. Meanwhile, COVID-19 vaccines that reduces severity (including hospitalization and mortality) were cost-effective when the elderly were vaccinated, while vaccinating the high-incidence group was not cost-effective with this vaccine type. Regardless of vaccine type, higher vaccination coverage, higher efficacy, and longer protection duration were always preferred. More so, vaccination with social distancing measures was always preferred to strategies without social distancing. Quarantine-related costs were a major cost component affecting the cost-effectiveness of COVID-19 vaccines. CONCLUSION COVID-19 vaccines are good value for money even in a relatively low-incidence and low-mortality setting such as Thailand, if the appropriate groups are vaccinated. The preferred vaccination strategies depend on the type of vaccine efficacy. Social distancing measures should accompany a vaccination strategy.
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Affiliation(s)
- Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Nantasit Luangasanatip
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wirichada Pan-Ngum
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.
| | - Juthamas Prawjaeng
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Sompob Saralamba
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Christopher Painter
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Jamaica Roanne Briones
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
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Freeman T, Baum F, Musolino C, Flavel J, McKee M, Chi C, Giugliani C, Falcão MZ, De Ceukelaire W, Howden-Chapman P, Nguyen TH, Serag H, Kim S, Carlos AD, Gesesew HA, London L, Popay J, Paremoer L, Tangcharoensathien V, Sundararaman T, Nandi S, Villar E. Illustrating the impact of commercial determinants of health on the global COVID-19 pandemic: Thematic analysis of 16 country case studies. Health Policy 2023; 134:104860. [PMID: 37385156 DOI: 10.1016/j.healthpol.2023.104860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
Previous research on commercial determinants of health has primarily focused on their impact on non-communicable diseases. However, they also impact on infectious diseases and on the broader preconditions for health. We describe, through case studies in 16 countries, how commercial determinants of health were visible during the COVID-19 pandemic, and how they may have influenced national responses and health outcomes. We use a comparative qualitative case study design in selected low- middle- and high-income countries that performed differently in COVID-19 health outcomes, and for which we had country experts to lead local analysis. We created a data collection framework and developed detailed case studies, including extensive grey and peer-reviewed literature. Themes were identified and explored using iterative rapid literature reviews. We found evidence of the influence of commercial determinants of health in the spread of COVID-19. This occurred through working conditions that exacerbated spread, including precarious, low-paid employment, use of migrant workers, procurement practices that limited the availability of protective goods and services such as personal protective equipment, and commercial actors lobbying against public health measures. Commercial determinants also influenced health outcomes by influencing vaccine availability and the health system response to COVID-19. Our findings contribute to determining the appropriate role of governments in governing for health, wellbeing, and equity, and regulating and addressing negative commercial determinants of health.
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Affiliation(s)
- Toby Freeman
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005 Australia.
| | - Fran Baum
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005 Australia
| | - Connie Musolino
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005 Australia
| | - Joanne Flavel
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005 Australia
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London WC1H 9SH, United Kingdom
| | - Chunhuei Chi
- Center for Global Health, Oregon State University, Corvallis, OR 7331, USA
| | - Camila Giugliani
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2400 CEP 90035-003, Porto Alegre, Brazil
| | - Matheus Zuliane Falcão
- University of São Paulo, Brazil, Av. Dr. Arnaldo, 715 - 211 - Cerqueira César, São Paulo - SP, 01246-904, Brazil
| | | | | | - Thanh Huong Nguyen
- Faculty of Social Science and Behavior, Hanoi University of Public Health, 1A Duc Thang Road, Duc Thang Ward, North Tu Liem District, Hanoi, Vietnam
| | - Hani Serag
- University of Texas Medical Branch (UTMB), 301 University Blvd., Galveston, Texas, 77555, USA
| | - Sun Kim
- People's Health Institute, 36 Sadang-ro 13-gil, Dongjak-gu, Seoul 07004, South Korea
| | - Alvarez Dardet Carlos
- CIBERESP, Center for Research in Epidemiology and Public Health, University of Alicante, 03560 Spain
| | - Hailay Abrha Gesesew
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, 5000 AUSTRALIA & College of Health Sciences, Mekelle University, Mekelle, 231 Ethiopia
| | - Leslie London
- School of Public Health, University of Cape Town, South Africa
| | - Jennie Popay
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Bailrigg, Lancaster LA1 4YW, United Kingdom
| | - Lauren Paremoer
- Political Studies, University of Cape Town, Cape Town, South Africa
| | | | | | | | - Eugenio Villar
- Universidad Peruana Cayetano Heredio, San Martín de Porres 15102, Peru
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27
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Frieden TR, Lee CT, Lamorde M, Nielsen M, McClelland A, Tangcharoensathien V. The road to achieving epidemic-ready primary health care. Lancet Public Health 2023; 8:e383-e390. [PMID: 37120262 PMCID: PMC10139016 DOI: 10.1016/s2468-2667(23)00060-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 05/01/2023]
Abstract
Millions of avoidable deaths arising from the COVID-19 pandemic emphasise the need for epidemic-ready primary health care aligned with public health to identify and stop outbreaks, maintain essential services during disruptions, strengthen population resilience, and ensure health worker and patient safety. The improvement in health security from epidemic-ready primary health care is a strong argument for increased political support and can expand primary health-care capacities to improve detection, vaccination, treatment, and coordination with public health-needs that became more apparent during the pandemic. Progress towards epidemic-ready primary health care is likely to be stepwise and incremental, advancing when opportunity arises based on explicit agreement on a core set of services, improved use of external and national funds, and payment based in large part on empanelment and capitation to improve outcomes and accountability, supplemented with funding for core staffing and infrastructure and well designed incentives for health improvement. Health-care worker and broader civil society advocacy, political consensus, and bolstering government legitimacy could promote strong primary health care. Epidemic-ready primary health-care infrastructure that is able to help prevent and withstand the next pandemic will require substantial financial and structural reforms and sustained political and financial commitment. Governments, advocates, and bilateral and multilateral agencies should seize this window of opportunity before it closes.
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Affiliation(s)
| | | | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
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Nuampa S, Ratinthorn A, Lumbiganon P, Rungreangkulkij S, Rujiraprasert N, Buaboon N, Jampathong N, Dumont A, Hanson C, de Loenzien M, Bohren MA, Betrán AP. "Because it eases my Childbirth Plan": a qualitative study on factors contributing to preferences for caesarean section in Thailand. BMC Pregnancy Childbirth 2023; 23:280. [PMID: 37095449 PMCID: PMC10124050 DOI: 10.1186/s12884-023-05576-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Although caesarean section (CS) rates have increased rapidly in Thailand, the upward trend is not supported by significant maternal or perinatal health benefits. The appropriate use of CS through QUALIty DECision-making by women and providers (QUALI-DEC project) aims to design and implement a strategy to optimize the use of CS through non-clinical interventions. This study aimed to explore the factors influencing women's and health professionals' preferences for CS delivery in Thailand. METHODS We conducted a formative qualitative study by using semi-structured in-depth interviews with pregnant and postpartum women, and healthcare staff. Purposive sampling was used to recruit participants from eight hospitals across four regions of Thailand. Content analysis was used to develop the main themes. RESULTS There were 78 participants, including 27 pregnant and 25 postpartum women, 8 administrators, 13 obstetricians, and 5 interns. We identified three main themes and seven sub-themes of women and healthcare providers' perceptions on CS: (1) avoiding the negative experiences from vaginal birth (the pain of labor and childbirth, uncertainty during the labor period); (2) CS is a safer mode of birth (guarantees the baby's safety, a protective shield for doctors); and (3) CS facilitates time management (baby's destiny at an auspicious time, family's management, manage my work/time). CONCLUSIONS Women mentioned negative experiences and beliefs about vaginal delivery, labor pain, and uncertain delivery outcomes as important factors influencing CS preferences. On the other hand, CS is safer for babies and facilitates multiple tasks in women's lives. From health professionals' perspectives, CS is the easier and safer method for patients and them. Interventions to reduce unnecessary CS, including QUALI-DEC, should be designed and implemented, taking into consideration the perceptions of both women and healthcare providers.
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Affiliation(s)
- Sasitara Nuampa
- Department of Obstetrics and Gynaecological Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Ameporn Ratinthorn
- Department of Obstetrics and Gynaecological Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Somporn Rungreangkulkij
- Centre for Research and Training on Gender and Women's Health, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Nilubon Rujiraprasert
- Centre for Research and Training on Gender and Women's Health, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Natthapat Buaboon
- Department of Family of Nursing and Midwifery, Faculty of Nursing, Thammasat University, Prathumthani, Thailand
| | | | - Alexandre Dumont
- Université Paris Cité, IRD, Inserm, F-75006, Paris, Ceped, France
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Saepoo J, Pangsomboon K, Tianviwat S. Awareness of HLA-B* 15:02 screening in trigeminal neuralgia and the gene screening policy among dentists in Southern Thailand. SPECIAL CARE IN DENTISTRY 2023; 43:286-293. [PMID: 35973978 DOI: 10.1111/scd.12768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/26/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the factors associated with public hospital dentists' awareness of HLA-B*15:02 screening in trigeminal neuralgia (TN) and the national gene screening policy in Thailand. METHODS Cross-sectional study. A validated questionnaire was distributed to public hospital dentists with at least 1 year of practice in Southern Thailand (n = 760) to assess their knowledge of TN, carbamazepine (CBZ) use, awareness of HLA-B*15:02 screening, and the gene screening policy. RESULTS A total of 385 dentists participated (50.7% response rate); 81.3% of respondents were aware of HLA-B*15:02 screening. However, 18.7% of dentists were not aware of the importance of gene testing. Furthermore, dentists who were aware of gene screening had significantly better knowledge of TN diagnosis and CBZ use than "unaware" dentists. Awareness of HLA-B*15:02 screening was also significantly associated with dental specialty. Moreover, 80.5% of respondents were not aware of the gene screening policy. The primary problems related to the policy were its inefficient publication, poor implementation, and lack of clinical practice guidelines (CPGs) to encourage dentists to follow the policy and prescribe gene tests. CONCLUSION While most hospital dentists were aware of the necessity of HLA-B*15:02 screening prior to prescribing CBZ in TN, the majority were unaware of the national gene screening policy. Dental specialty and knowledge were associated with awareness of HLA-B*15:02 screening.
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Affiliation(s)
- Jirayu Saepoo
- Section of Oral Medicine, Department of Oral Diagnostic Sciences, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Kanokporn Pangsomboon
- Section of Oral Medicine, Department of Oral Diagnostic Sciences, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Sukanya Tianviwat
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, Thailand
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Sukmanee J, Butchon R, Karunayawong P, Saeraneesopon T, Boonma C, Teerawattananon Y, Isaranuwatchai W. Pattern of OPD utilisation during the COVID-19 pandemic under the Universal Coverage Scheme in Thailand: what can 850 million records tell us? BMC Health Serv Res 2023; 23:116. [PMID: 36737787 PMCID: PMC9897880 DOI: 10.1186/s12913-023-09121-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Out-patient department (OPD) is a crucial component of the healthcare systems in low- and middle-income countries including Thailand. A considerable impact of coronavirus disease 2019 (COVID-19) pandemic and its control measures, especially the lockdown, on utilisation of OPD services was expected. This study thus aims to estimate the pattern of OPD utilisation during the COVID-19 pandemic in Thailand including overall utilisation and within each sub-groups including diagnostic group, age group, and health region. METHODS This study was a secondary data analysis of aggregated outpatient data from patients covered under the Universal Coverage Scheme (UCS) in Thailand over a 4-year period (2017-2020). Interrupted time series analyses and segmented Quasi-Poisson regression were used to examine the impact of COVID-19 on the overall OPD utilisation including the impact on each diagnostic group, age groups, health regions, and provinces. RESULTS Analysis of 845,344,946 OPD visits in this study showed a seasonal pattern and increasing trend in monthly OPD visits before the COVID-19 pandemic. A 28% (rate ratio (RR) 0.718, 95% confidence interval (CI): 0.631-0.819) and 11% (RR 0.890, 95% CI: 0.811-0.977) reduction in OPD visits was observed during the lockdown and post-lockdown periods, respectively, when compared to the pre-lockdown period. Diseases of respiratory system were most affected with a RR of 0.411 (95% CI: 0.320-0.527), while the number of visits for non-communicable diseases (ICD-10: E00-E90, I00-I99) and elderly (> 60 years) dropped slightly. The post-lockdown trend in monthly OPD visits gradually increased to the pre-pandemic levels in most groups. CONCLUSIONS Thailand's OPD utilisation rate during the COVID-19 lockdown decreased in some diseases, but the service for certain group of patients appeared to remain available. After the COVID-19 lockdown, the rate returned to the pre-pandemic level in a timely manner. Equipped with a knowledge of OPD utilisation pattern during COVID-19 based on a national real-world database could aid with a better preparation of healthcare system for future pandemics.
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Affiliation(s)
- Jarawee Sukmanee
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Rukmanee Butchon
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Picharee Karunayawong
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Thanayut Saeraneesopon
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Chulathip Boonma
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Yot Teerawattananon
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand ,grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore ,grid.415836.d0000 0004 0576 2573Health Administration Division, Office of the Permanent Secretary of the Ministry of Public Health, Nonthaburi, Thailand
| | - Wanrudee Isaranuwatchai
- Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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Tangcharoensathien V, Vandelaer J, Brown R, Suphanchaimat R, Boonsuk P, Patcharanarumol W. Learning from pandemic responses: Informing a resilient and equitable health system recovery in Thailand. Front Public Health 2023; 11:1065883. [PMID: 36761120 PMCID: PMC9906810 DOI: 10.3389/fpubh.2023.1065883] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. The third quarter of 2022 saw COVID-19 cases and deaths in Thailand reduced significantly, and high levels of COVID-19 vaccine coverage. COVID-19 was declared an "endemic" disease, and economic activities resumed. This paper reviews pre-pandemic health systems capacity and identifies pandemic response strengths, weaknesses and lessons that guided resilient and equitable health system recovery. Robust health systems and adaptive strategies drive an effective pandemic response. To support health system recovery Thailand should (1) minimize vulnerability and extend universal health coverage to include migrant workers and dependents; (2) sustain provincial primary healthcare (PHC) capacity and strengthen PHC in greater Bangkok; (3) leverage information technology for telemedicine and teleconsultation; (4) enhance and extend case and event-based surveillance of notifiable diseases, and for public health threats, including pathogens with pandemic potential in wildlife and domesticated animals. This requires policy and financial commitment across successive governments, adequate numbers of committed and competent health workforce at all levels supported by over a million village health volunteers, strong social capital and community resilience. A strengthened global health architecture and international collaboration also have critical roles in establishing local capacities to develop and manufacture pandemic response products through transfer of technology and know-how. Countries should engage in the ongoing Inter-government Negotiating Body to ensure a legally binding instrument to safeguard the world from catastrophic impacts of future pandemics.
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Affiliation(s)
- Viroj Tangcharoensathien
- International Health Policy Programme, Ministry of Public Health, Nonthaburi, Thailand,*Correspondence: Viroj Tangcharoensathien ✉
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Chhim S, Te V, Buffel V, van Olmen J, Chham S, Long S, Yem S, Van Damme W, Wouters E, Por I. Healthcare usage and expenditure among people with type 2 diabetes and/or hypertension in Cambodia: results from a cross-sectional survey. BMJ Open 2023; 13:e061959. [PMID: 36635032 PMCID: PMC9843177 DOI: 10.1136/bmjopen-2022-061959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To assess usage of public and private healthcare, related healthcare expenditure, and associated factors for people with type 2 diabetes (T2D) and/or hypertension (HTN) and for people without those conditions in Cambodia. METHODS A cross-sectional household survey. SETTINGS Five operational districts (ODs) in Cambodia. PARTICIPANTS Data were from 2360 participants aged ≥40 years who had used healthcare services at least once in the 3 months preceding the survey. PRIMARY AND SECONDARY OUTCOME The main variables of interest were the number of healthcare visits and healthcare expenditure in the last 3 months. RESULTS The majority of healthcare visits took place in the private sector. Only 22.0% of healthcare visits took place in public healthcare facilities: 21.7% in people with HTN, 37.2% in people with T2D, 34.7% in people with T2D plus HTN and 18.9% in people without the two conditions (p value <0.01). For people with T2D and/or HTN, increased public healthcare use was significantly associated with Health Equity Fund (HEF) membership and living in ODs with community-based care. Furthermore, significant healthcare expenditure reduction was associated with HEF membership and using public healthcare facilities in these populations. CONCLUSION Overall public healthcare usage was relatively low; however, it was higher in people with chronic conditions. HEF membership and community-based care contributed to higher public healthcare usage among people with chronic conditions. Using public healthcare services, regardless of HEF status reduced healthcare expenditure, but the reduction in spending was more noticeable in people with HEF membership. To protect people with T2D and/or HTN from financial risk and move towards the direction of universal health coverage, the public healthcare system should further improve care quality and expand social health protection. Future research should link healthcare use and expenditure across different healthcare models to actual treatment outcomes to denote areas for further investment.
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Affiliation(s)
- Srean Chhim
- Technical Office, National Institute of Public Health, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phonm Penh, Cambodia
| | - Vannarath Te
- Technical Office, National Institute of Public Health, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phonm Penh, Cambodia
- Department of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerpen, Belgium
| | - Veerle Buffel
- Centre for Population, Family & Health, University of Antwerp, Antwerpen, Antwerp
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Savina Chham
- Technical Office, National Institute of Public Health, Phnom Penh, Cambodia
- Department of Social Sciences, University of Antwerp, Antwerpen, Belgium
| | - Sereyraksmey Long
- School of Public Health, National Institute of Public Health, Phonm Penh, Cambodia
| | - Sokunthea Yem
- Technical Office, National Institute of Public Health, Phnom Penh, Cambodia
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Gerontology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Edwin Wouters
- Centre for Population, Family & Health, University of Antwerp, Antwerpen, Antwerp
| | - Ir Por
- Management team, National Institute of Public Health, Phonm Penh, Cambodia
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Phattharapornjaroen P, Carlström E, Holmqvist LD, Sittichanbuncha Y, Khorram-Manesh A. Assessing Thai Hospitals’ Evacuation Preparedness Using the Flexible Surge Capacity Concept and Its Collaborative Tool. INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE 2023; 14:52-63. [PMCID: PMC9930065 DOI: 10.1007/s13753-023-00468-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 08/16/2023]
Abstract
According to the concept of “flexible surge capacity,” hospitals may need to be evacuated on two occasions: (1) when they are exposed to danger, such as in war; and (2) when they are contaminated, such as during the Covid-19 pandemic. In the former, the entire hospital must be evacuated, while in the latter, the hospital becomes a pandemic center necessitating the transfer of its non-contaminated staff, patients, and routine activities to other facilities. Such occasions involve several degrees of evacuation—partial or total—yet all require deliberate surge planning and collaboration with diverse authorities. This study aimed to investigate the extent of hospital evacuation preparedness in Thailand, using the main elements of the flexible surge capacity concept. A mixed method cross-sectional study was conducted using a hospital evacuation questionnaire from a previously published multinational hospital evacuation study. The tool contained questions regarding evacuation preparedness encompassing surge capacity and collaborative elements and an open-ended inquiry to grasp potential perspectives. All 143 secondary care, tertiary care, and university hospitals received the questionnaire; 43 hospitals provided responses. The findings indicate glitches in evacuation protocols, particularly triage systems, the inadequacies of surge planning and multiagency collaboration, and knowledge limitations in community capabilities. In conclusion, the applications of the essential components of flexible surge capacity allow the assessment of hospital preparedness and facilitate the evaluation of guidelines and instructions through scenario-based training exercises.
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Affiliation(s)
- Phatthranit Phattharapornjaroen
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 40100 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- USN School of Business, University of South-Eastern Norway, 3603 Kongsberg, Norway
| | - Lina Dahlén Holmqvist
- Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska University Hospital, 40530 Gothenburg, Sweden
| | - Yuwares Sittichanbuncha
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 40100 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
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Marshall AI, Witthayapipopsakul W, Chotchoungchatchai S, Wangbanjongkun W, Tangcharoensathien V. Contracting the private health sector in Thailand's Universal Health Coverage. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000799. [PMID: 37115744 PMCID: PMC10146570 DOI: 10.1371/journal.pgph.0000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 03/20/2023] [Indexed: 04/29/2023]
Abstract
Private sector plays an import role in health service provision, therefore the engagement of private health facilities is important for ensuring access to health services. In Thailand, two of the three public health insurance schemes, Universal Coverage Scheme and Social Health Insurance, contract with private health facilities to fill gaps of public providers for the provision of health services under Universal Health Coverage. The National Health Security Office (NHSO) and Social Security Office (SSO), which manage the schemes respectively, have designed their own contractual agreements for private facilities. We aim to understand the current situation of contracting private health facilities within UHC of the two purchasing agencies. This qualitative descriptive case study was conducted through document review and in-depth interviews with key informants to understand how they contract private primary care facilities, service types, duration of contract, standard and quality requirement and renewal and termination of contracts. Private providers make a small contribution to the service provision in Thailand as a whole but they are important actors in Bangkok. The current approaches used by two purchasers are not adequate in engaging private sector to fill the gap of public provision in urban cities. One important reason is that large private hospitals do not find public contracts financially attractive. NHSO classifies contracts into 3 categories: main contracting units, primary care units, and referral units; while SSO only contracts main contracting units. Both allows subcontracting by the main contractors. Contractual agreements are effective in ensuring mandatory infrastructure and quality standards. Both purchasers have established technical capacities to enforce quality monitoring and financial compliance although there remains room for improvement especially on identifying fraud and taking legal actions. Contracting private healthcare facilities can fill the gap of public healthcare facilities, especially in urban settings. Purchasers need to balance the right level of incentives and accountability measures to ensure access to quality of care. In contracting private-for-profit providers, strong regulatory enforcement and auditing capacities are necessary. Further studies may explore various aspects contracting outcomes including access, equity, quality and efficiency impacts.
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Affiliation(s)
- Aniqa Islam Marshall
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Woranan Witthayapipopsakul
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
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Greer RC, Kanthawang N, Roest J, Wangrangsimakul T, Parker M, Kelley M, Cheah PY. Vulnerability and agency in research participants' daily lives and the research encounter: A qualitative case study of participants taking part in scrub typhus research in northern Thailand. PLoS One 2023; 18:e0280056. [PMID: 36696400 PMCID: PMC9876277 DOI: 10.1371/journal.pone.0280056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 12/20/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Researchers have a responsibility to protect all participants, especially vulnerable participants, from harm. Vulnerability is increasingly understood to be context specific, yet limited guidance is available regarding the vulnerability and agency of research participants in different cultural settings. This study aims to explore research participants' daily vulnerability and agency, and how these interact with participants' research experiences in their own words. Researchers' views and responses were also explored. METHODS A qualitative study was conducted around two scrub typhus research studies in northern Thailand. A thematic analysis was carried out on 42 semi-structured interviews with research participants, their families, researchers and key informants. RESULTS The majority of the research participants belonged to a hill tribe ethnic minority group. Common challenges were related to Thai language barriers, travel difficulties, uncertain legal status, unstable employment, lack of education and healthcare. We did not identify new vulnerabilities but we found that the extent of these vulnerabilities might be underestimated or even hidden from researchers in some cases. Despite these challenges people demonstrated agency in their daily lives and were often motivated and supported in this by family members. The majority of perceived research benefits were related to healthcare and gaining knowledge, while attending follow-up visits could be a burden for some. CONCLUSIONS Our approach to research in culturally and socioeconomically diverse settings should be more responsive to participants' specific vulnerabilities and abilities evidenced in their daily life, rather than attributing vulnerability on the basis of membership of pre-defined 'vulnerable groups'. Researchers need to be aware and responsive towards the challenges participants face locally in order to minimise the burdens of research participation whilst allowing participants to benefit from research.
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Affiliation(s)
- Rachel C. Greer
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Nipaphan Kanthawang
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jennifer Roest
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Tri Wangrangsimakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Michael Parker
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Maureen Kelley
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Thongpaeng S, Sorncharoen P, Preechasuk L, Santiprabhob J. Dietary Intake and Physical Activity of Thai Children and Adolescents with Type 1 Diabetes Mellitus. Nutrients 2022; 14:nu14235169. [PMID: 36501199 PMCID: PMC9738333 DOI: 10.3390/nu14235169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Appropriate dietary intake and physical activity (PA) are essential for glycemic control and optimal growth in youth with type 1 diabetes (T1D). Thus, this study aimed to compare dietary intake and PA between youth with T1D and healthy controls. One hundred Thai youth with T1D and 100 age-matched healthy participants were recruited. A 3-day food record was completed and converted into nutrient intake data. PA data were collected via interview. Participants with T1D had a significantly higher mean ± SD carbohydrate (50.8 ± 6.8% vs. 46.2 ± 7.5%, p < 0.01), lower fat (32.4 ± 5.9% vs. 35.9 ± 6.4%, p < 0.01), and lower protein (16.8 ± 2.6% vs. 17.9 ± 3.5%, p = 0.01) intake compared to controls. Fifty percent of T1D participants and 41% of control participants consumed saturated fat more than recommendations (p = 0.20). Participants with T1D had a higher median (IQR) calcium intake compared to controls (474 (297−700) vs. 328 (167−447) mg/day, p < 0.01). Both groups consumed less fiber and more sodium compared to recommendations. Both groups had inadequate PA. Participants with T1D had significantly less PA compared to controls (25 (13−48) vs. 34 (14−77) minutes/day, p = 0.04). In addition to the need for counseling that promotes consumption of more dietary fiber and calcium and less saturated fat and sodium, the benefits of performing regular exercise need to be emphasized among youth with T1D.
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Affiliation(s)
- Sriwan Thongpaeng
- Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Preeyarat Sorncharoen
- Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Lukana Preechasuk
- Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Jeerunda Santiprabhob
- Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- Correspondence: ; Tel.: +66-2-419-5676
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Rajatanavin N, Witthayapipopsakul W, Vongmongkol V, Saengruang N, Wanwong Y, Marshall AI, Patcharanarumol W, Tangcharoensathien V. Effective coverage of diabetes and hypertension: an analysis of Thailand's national insurance database 2016-2019. BMJ Open 2022; 12:e066289. [PMID: 36456029 PMCID: PMC9716924 DOI: 10.1136/bmjopen-2022-066289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study assesses effective coverage of diabetes and hypertension in Thailand during 2016-2019. DESIGN Mixed method, analysis of National health insurance database 2016-2019 and in-depth interviews. SETTING Beneficiaries of Universal Coverage Scheme residing outside Bangkok. PARTICIPANTS Quantitative analysis was performed by acquiring individual patient data of diabetes and hypertension cases in the Universal Coverage Scheme residing outside bangkok in 2016-2019. Qualitative analysis was conducted by in-depth interview of 85 multi-stakeholder key informants to identify challenges. OUTCOMES Estimate three indicators: detected need (diagnosed/total estimated cases), crude coverage (received health services/total estimated cases) and effective coverage (controlled/total estimated cases) were compared. Controlled diabetes was defined as haemoglobin A1C (HbA1C) below 7% and controlled hypertension as blood pressure below 140/90 mm Hg. RESULTS Estimated cases were 3.1-3.2 million for diabetes and 8.7-9.2 million for hypertension. For diabetes, all indicators have shown slow improvement between 2016 and 2019 (67.4%, 69.9%, 71.9% and 74.7% for detected need; 38.7%, 43.1%, 45.1% and 49.8% for crude coverage and 8.1%, 10.5%, 11.8% and 11.7% for effective coverage). For hypertension, the performance was poorer for detection (48.9%, 50.3%, 51.8% and 53.3%) and crude coverage (22.3%, 24.7%, 26.5% and 29.2%) but was better for effective coverage (11.3%, 13.2%, 15.1% and 15.7%) than diabetes. Results were better for the women and older age groups in both diseases. Complex interplays between supply and demand side were a key challenge. Database challenges also hamper regular assessment of effective coverage. Sensitivity analysis when using at least three annual visits shows slight improvement of effective coverage. CONCLUSION Effective coverage was low for both diseases, though improving in 2016-2019, especially among men and ัyounger populations. The increasing rate of effective coverage was significantly smaller than crude coverage. Health information systems limitation is a major barrier to comprehensive measurement. To maximise effective coverage, long-term actions should address primary prevention of non-communicable disease risk factors, while short-term actions focus on improving Chronic Care Model.
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Affiliation(s)
| | | | | | - Nithiwat Saengruang
- Health Financing, International Health Policy Program, Muang District, Thailand
| | - Yaowaluk Wanwong
- Health Financing, International Health Policy Program, Muang District, Thailand
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Maláková K, Cabasag CJ, Bardot A, Sangrajrang S, Chitapanarux I, Sripan P, Suwanrungruang K, Pongnikorn D, Thongsuksai P, Sriplung H, Soerjomataram I. Cancer survival in Thailand from 1997 to 2012: Assessing the impact of universal health coverage. J Cancer Policy 2022; 34:100353. [PMID: 36357312 DOI: 10.1016/j.jcpo.2022.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/22/2022] [Accepted: 08/14/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND In recent decades, many countries worldwide have implemented some form of Universal Health Coverage (UHC). We sought to evaluate incidence and survival trends of breast, cervical, and colorectal cancer before and after the implementation of UHC in Thailand. METHODS The age-standardized incidence rate and 1- and 5-year net survival (NS) were calculated for five Thai provinces, namely Bangkok, Chiang Mai, Khon Kaen, Lampang, and Songkhla for breast, cervix, and colorectal cancer in three study periods (1997-2012): before, during, and after the implementation of UHC. RESULTS The incidence of breast and colorectal cancer has increased over time, while the incidence of cervical cancer has decreased (17.9-29.9, 9.0-13.6, and 19.6-12.3 per 100,000, respectively). Larger proportion of breast cancer were diagnosed with localized stage after UHC implementation compared to the period prior to UHC (31.5 % vs 19.0 %). Overall, The improvement in survival by cancer site varied in magnitude with a 5-year NS increase from 61.3 % to 75.1 % for breast, 55.4-59.5 % for cervical, and 39.9-47.6 % for colorectal cancer. The amount of increase slightly differed across provinces. CONCLUSION Rising incidence for breast and colorectal, and declining cervical cancer may partly be attributable to improved awareness and early detection programs. Additionally, improvement in survival may partly be attributable to increased access to healthcare, availability of treatment, and increased access to cancer screening after UHC was implemented. Thus, continued expansion of UHC package on cancer could potentially contribute to further improvement of cancer control in Thailand. POLICY SUMMARY This study provides important evidence on the impact of UHC in cancer burden and survival for breast, cervical, and colorectal cancer in Thailand. This study serves as an example for other countries where UHC has been recently implemented and guide policymakers in allocating resources towards UHC and cancer control programs.
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Affiliation(s)
- Kateřina Maláková
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France; Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia
| | - Citadel J Cabasag
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
| | - Aude Bardot
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Imjai Chitapanarux
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Chiang Mai Cancer Registry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Patumrat Sripan
- Chiang Mai Cancer Registry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Paramee Thongsuksai
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Hutcha Sriplung
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Klinjun N, Wattanapisit A, Rodniam C, Songprasert T, Srisomthrong K, Chumpunuch P, Srivanichakorn S, Sanchaisuriya P, Pingmuangkaew P. Health promotion and disease prevention services before and during the COVID-19 pandemic: A nationwide survey from Thailand. Heliyon 2022; 8:e12014. [PMCID: PMC9705267 DOI: 10.1016/j.heliyon.2022.e12014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/03/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nuntaporn Klinjun
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- Excellence Center of Community Health Promotion, Walailak University, Nakhon Si Thammarat, Thailand
| | - Apichai Wattanapisit
- School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
- Walailak University Hospital, Nakhon Si Thammarat, Thailand
- Corresponding author.
| | - Chutima Rodniam
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- Excellence Center of Community Health Promotion, Walailak University, Nakhon Si Thammarat, Thailand
| | - Thanawan Songprasert
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- Excellence Center of Community Health Promotion, Walailak University, Nakhon Si Thammarat, Thailand
| | - Kannika Srisomthrong
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- Excellence Center of Community Health Promotion, Walailak University, Nakhon Si Thammarat, Thailand
| | - Pornchanuch Chumpunuch
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- Excellence Center of Community Health Promotion, Walailak University, Nakhon Si Thammarat, Thailand
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Sangthawan P, Klyprayong P, Geater SL, Tanvejsilp P, Anutrakulchai S, Boongird S, Gojaseni P, Kuhiran C, Lorvinitnun P, Noppakun K, Parapiboon W, Sirilak S, Tankee P, Taruangsri P, Sangsupawanich P, Sritara P, Chaiyakunapruk N, Kitiyakara C. The hidden financial catastrophe of chronic kidney disease under universal coverage and Thai "Peritoneal Dialysis First Policy". Front Public Health 2022; 10:965808. [PMID: 36311589 PMCID: PMC9606783 DOI: 10.3389/fpubh.2022.965808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Universal health coverage can decrease the magnitude of the individual patient's financial burden of chronic kidney disease (CKD), but the residual financial hardship from the patients' perspective has not been well-studied in low and middle-income countries (LMICs). This study aimed to evaluate the residual financial burden in patients with CKD stage 3 to dialysis in the "PD First Policy" under Universal Coverage Scheme (UCS) in Thailand. Methods This multicenter nationwide cross-sectional study in Thailand enrolled 1,224 patients with pre-dialysis CKD, hemodialysis (HD), and peritoneal dialysis (PD) covered by UCS and other health schemes for employees and civil servants. We interviewed patients to estimate the proportion with catastrophic health expenditure (CHE) and medical impoverishment. The risk factors associated with CHE were analyzed by multivariable logistic regression. Results Under UCS, the total out-of-pocket expenditure in HD was over two times higher than PD and nearly six times higher than CKD stages 3-4. HD suffered significantly more CHE and medical impoverishment than PD and pre-dialysis CKD [CHE: 8.5, 9.3, 19.5, 50.0% (p < 0.001) and medical impoverishment: 8.0, 3.1, 11.5, 31.6% (p < 0.001) for CKD Stages 3-4, Stage 5, PD, and HD, respectively]. In the poorest quintile of UCS, medical impoverishment was present in all HD and two-thirds of PD patients. Travel cost was the main driver of CHE in HD. In UCS, the adjusted risk of CHE increased in PD and HD (OR: 3.5 and 16.3, respectively) compared to CKD stage 3. Conclusions Despite universal coverage, the residual financial burden remained high in patients with kidney failure. CHE was considerably lower in PD than HD, although the rates remained alarmingly high in the poor. The "PD First' program" could serve as a model for other LMICs. However, strategies to minimize financial distress should be further developed, especially for the poor.
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Affiliation(s)
- Pornpen Sangthawan
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pinkaew Klyprayong
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sarayut L. Geater
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pimwara Tanvejsilp
- Department of Pharmacy Administration, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand
| | - Sirirat Anutrakulchai
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sarinya Boongird
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsathorn Gojaseni
- Department of Medicine, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand
| | - Charan Kuhiran
- Department of Medicine, Somdej Pranangchao Sirikit Hospital, Chonburi, Thailand
| | - Pichet Lorvinitnun
- Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Kajohnsak Noppakun
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Watanyu Parapiboon
- Department of Medicine, Maharat Nakhonratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Supinda Sirilak
- Department of Internal Medicine, Naresuan University Hospital, Naresuan University, Phitsanulok, Thailand
| | - Pluemjit Tankee
- Department of Medicine, Vachiraphuket Hospital, Phuket, Thailand
| | | | - Pasuree Sangsupawanich
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Piyamitr Sritara
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States,IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States,*Correspondence: Nathorn Chaiyakunapruk
| | - Chagriya Kitiyakara
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Chagriya Kitiyakara
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Shi Z, He P, Zhu D, Lu F, Meng Q. Changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes in Beijing, China. BMC Health Serv Res 2022; 22:1226. [PMID: 36192795 PMCID: PMC9528155 DOI: 10.1186/s12913-022-08602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China expanded health coverage to residents in informal economic sectors by the rural new cooperative medical scheme (NCMS) for rural population and urban resident basic medical insurance scheme (URBMI) for non-working urban residents. Fragmentation of resident social health insurance schemes exacerbated the health inequity and China started the integration of urban and rural resident medical insurance schemes since 2016. Beijing finished the insurance integration in 2017 and has been implementing a unified urban and rural resident basic medical insurance scheme (URRBMI) since the beginning of 2018. This study aims to examine changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes. METHODS We used household survey data from Beijing Health Services Survey in 2013 and 2018. Respondents who were 15 or older and covered by URBMI, NCMS or URRBMI were included in this study. Our study finally included 8,554 individuals in 2013 and 6,973 individuals in 2018, about 70% of which were rural residents in each year. Descriptive analysis was used to compare the healthcare utilization, healthcare expenditure and incidence of catastrophic health expenditure between different groups. A series of two-part regression models were used to analyze the changes of healthcare utilization, healthcare expenditure and incidence of catastrophic health expenditure. RESULTS From 2013 to 2018, urban-rural disparity in outpatient care utilization seemed widened because urban residents' utilization of outpatient care increased 131% while rural residents' utilization only increased 72%; both rural and urban residents' spending on outpatient care increased about 50%. Utilization of inpatient care changed little and poor residents still used significantly less inpatient care compared with the rich residents. Poor residents still suffered heavily catastrophic health expenditures. CONCLUSION From 2013 to 2018, residents' utilization of healthcare, especially outpatient care, increased in Beijing. Health insurance reforms increased residents' utilization of healthcare but failed to reduce their healthcare financial burden, especially for poor people. Our study advocates more pro-poor insurance policies and more efforts on the efficiency of health system.
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Affiliation(s)
- Zhenyu Shi
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Feng Lu
- Beijing Municipal Health Big Data and Policy Research Center, Beijing, China
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China.
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Tangcharoensathien V, Panichkriangkrai W, Witthyapipopsakul W, Patcharanarumol W. COVID-19 Aftermath: Direction Towards Universal Health Coverage in Low-Income Countries Comment on "Health Coverage and Financial Protection in Uganda: A Political Economy Perspective". Int J Health Policy Manag 2022; 12:7519. [PMID: 36243945 PMCID: PMC10125230 DOI: 10.34172/ijhpm.2022.7519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/14/2022] [Indexed: 11/09/2022] Open
Abstract
Progressive realization of universal health coverage (UHC) requires health systems capacity to provide quality service and financial risk protection which supports access to services without financial hardship. Government health spending in low-income countries (LICs) has been low and heavily relied on external donor resources and out-of-pocket payment. This has resulted in high prevalence of catastrophic health spending or foregone care by those who cannot afford. Under fiscal constraints posed by pandemic, reforms in LICs should focus on efficiency through health resource waste reduction. Targeting the poor even with low level of health spending can make a significant health gain. Investment in primary healthcare and health workforce is the foundation for realizing UHC which cannot be postponed. Innovative tax on health hazardous products, conditional debt relief can increase fiscal space for health; while international collaboration to accelerate coronavirus disease 2019 (COVID-19) vaccine coverage can bring LICs out of acute phase of pandemic.
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Witter S, Sheikh K, Schleiff M. Learning health systems in low-income and middle-income countries: exploring evidence and expert insights. BMJ Glob Health 2022; 7:bmjgh-2021-008115. [PMID: 36130793 PMCID: PMC9490579 DOI: 10.1136/bmjgh-2021-008115] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/16/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Learning health systems (LHS) is a multifaceted subject. This paper reviewed current concepts as well as real-world experiences of LHS, drawing on published and unpublished knowledge in order to identify and describe important principles and practices that characterise LHS in low/middle-income country (LMIC) settings. Methods We adopted an exploratory approach to the literature review, recognising there are limited studies that focus specifically on system-wide learning in LMICs, but a vast set of connected bodies of literature. 116 studies were included, drawn from an electronic literature search of published and grey literature. In addition, 17 interviews were conducted with health policy and research experts to gain experiential knowledge. Results The findings were structured by eight domains on learning enablers. All of these interact with one another and influence actors from community to international levels. We found that learning comes from the connection between information, deliberation, and action. Moreover, these processes occur at different levels. It is therefore important to consider experiential knowledge from multiple levels and experiences. Creating spaces and providing resources for communities, staff and managers to deliberate on their challenges and find solutions has political implications, however, and is challenging, particularly when resources are constrained, funding and accountability are fragmented and the focus is short-term and narrow. Nevertheless, we can learn from countries that have managed to develop institutional mechanisms and human capacities which help health systems respond to changing environments with ‘best fit’ solutions. Conclusion Health systems are knowledge producers, but learning is not automatic. It needs to be valued and facilitated. Everyday governance of health systems can create spaces for reflective practice and learning within routine processes at different levels. This article highlights important enablers, but there remains much work to be done on developing this field of knowledge.
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Affiliation(s)
- Sophie Witter
- Institute for Global Health and Development & ReBUILD Consortium, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Kabir Sheikh
- Alliance For Health Policy and System Research, Geneva, Switzerland
| | - Meike Schleiff
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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Apiyasawat S, Thongsri T, Jongpiputvanich K, Krittayaphong R. Outcome disparities in patients with atrial fibrillation based on insurance plan and educational attainment: a nationwide, multicenter and prospective cohort trial. BMJ Open 2022; 12:e053166. [PMID: 35948379 PMCID: PMC9379473 DOI: 10.1136/bmjopen-2021-053166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a complex disease. The management of AF requires continuous patient engagement and integrative healthcare. OBJECTIVES To explore the association between adverse AF-related clinical outcomes and the following two sociodemographic factors: educational attainment and insurance plan. DESIGN A nationwide, prospective, multicenter, cohort trial. SETTING National registry of 3402 patients with non-valvular AF in Thailand. PARTICIPANTS All patients enrolled in the registry, except those with missing information on educational attainment or insurance plan. Finally, data from 3026 patients (mean age 67 years, SD 11.3; 59% male sex) were analysed. PRIMARY OUTCOMES Incidences of all-cause mortality, ischaemic stroke and major bleeding during the 36-month follow-up period. Survival analysis was performed using restricted mean survival time (RMST) and adjusted for multiple covariates. The levels of the educational attainment were as follows: no formal education, elementary (grade 1-6), secondary (grade 7-12) and higher education (tertiary education). RESULTS The educational attainment of the majority of patients was elementary (N=1739, 57.4%). The predominant health insurance plans were the Civil Servant Medical Benefit Scheme (N=1397, 46.2%) and the Universal Coverage Scheme (N=1333, 44.1%). After 36 months of follow-up, 248 patients died (8.2%), 95 had ischaemic stroke (3.1%) and 136 had major bleeding (4.5%). Patients without formal education died 1.78 months earlier (adjusted RMST difference -1.78; 95% CI, -3.25 to -0.30; p=0.02) and developed ischaemic stroke 1.04 months sooner (adjusted RMST difference -1.04; 95% CI, -2.03 to -0.04; p=0.04) than those attained a level of higher education. There were no significant differences in RMSTs for all three clinical outcomes when considering the type of health insurance plan. CONCLUSION Educational attainment was independently associated with all-cause mortality and ischaemic stroke in patients with AF, but adverse clinical outcomes were not related to the types of health insurance in Thailand. TRIAL REGISTRATION NUMBER Thai Clinical Trial Registration; Study ID: TCTR20160113002.
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Affiliation(s)
- Sirin Apiyasawat
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tomon Thongsri
- Buddhachinaraj Hospital Medical School, Phitsanulok, Thailand
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Liu L, Desai MM, Fetene N, Ayehu T, Nadew K, Linnander E. District-Level Health Management and Health System Performance: The Ethiopia Primary Healthcare Transformation Initiative. Int J Health Policy Manag 2022; 11:973-980. [PMID: 33327692 PMCID: PMC9808198 DOI: 10.34172/ijhpm.2020.236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/15/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite a wide range of interventions to improve district health management capacity in low-income settings, evidence of the impact of these investments on system-wide management capacity and primary healthcare systems performance is limited. To address this gap, we conducted a longitudinal study of the 36 rural districts (woredas), including 229 health centers, participating in the Primary Healthcare Transformation Initiative (PTI) in Ethiopia. METHODS Between 2015 and 2017, we collected quantitative measures of management capacity at the district and health center levels and a primary healthcare key performance indicator (KPI) summary score based on antenatal care (ANC) coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. We conducted repeated measures analysis of variance (ANOVA) to assess (1) changes in management capacities at the district health office level and health center level, (2) changes in health systems performance, and (3) the differential effects of more vs less intensive intervention models. RESULTS Adherence to management standards at both district and health center levels improved during the intervention, and the most prominent improvement was achieved during district managers' exposure to intensive mentorship and education. We did not observe similar patterns of change in KPI summary score. CONCLUSION The district health office is a valuable entry point for primary healthcare reform, and district- and facility-level management capacity can be measured and improved in a relatively short period of time. A combination of intensive mentorship and structured team-based education can serve as both an accelerator for change and a mechanism to inform broader reform efforts.
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Affiliation(s)
- Lingrui Liu
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Mayur M. Desai
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Netsanet Fetene
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
| | - Temsgen Ayehu
- Federal Ministry of Health, Government of Ethiopia, Addis Ababa, Ethiopia
| | - Kidest Nadew
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
| | - Erika Linnander
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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Wongnuch P, Mulikaburt T, Apidechkul T, Srichan P, Tamornpark R, Udplong A, Suratana S, Kitchanapaibul S. Acceptance and accessibility to the early phase COVID-19 vaccination among the healthcare workers and hill tribe population in Thailand. Sci Rep 2022; 12:11035. [PMID: 35773315 PMCID: PMC9244445 DOI: 10.1038/s41598-022-15149-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 06/20/2022] [Indexed: 11/28/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a serious emerging disease and an extreme threat to human life. This study aimed to understand the perceptions of hill tribe people living in the border areas of Thailand-Myanmar and health workers regarding the acceptability and accessibility of the COVID-19 vaccine and health workers’ perceptions of the readiness to implement the vaccination program during the early period of national COVID-19 vaccination. A qualitative method was applied to elicit information from key informants who lived in hill tribe villages and the health professionals who served them. The study was conducted in seven hill tribe villages located along the Thailand-Myanmar borders in Mae Fah Luang District, Chiang Rai Province, Thailand. The participants were hill tribe villagers aged 20 years and over; public health care professionals working in village health centers who had primary roles in implementing disease prevention and control measures; and public health care professionals working in districts and provincial public health offices who had primary roles in policy development and implementation. A total of 63 participants (26 men and 37 women) from seven hill tribe villages provided information. Three acceptance choices regarding receiving the COVID-19 vaccine were found among the hill tribes: definite acceptance, likely acceptance, and no preference. Two factors related to obtaining access to the new COVID-19 vaccine were found: Thai citizenship and the level of literacy related to the vaccine. There was no process or protocol in place for implementing the new vaccine among health professionals working at the district, subdistrict, or community levels, but the national expanded immunization program (EPI) system was clearly demonstrated to extend throughout the health service chain in Thailand. During the early period of national COVID-19 vaccine implantation in Thailand, not all members of the hill tribes accepted the vaccine; participant acceptance depended on several factors, including a participant’s previous experience with vaccination, whether he or she required more information before making a decision, etc. While acceptance of the vaccine depended on the individual’s background, not everyone had an equal opportunity to access the vaccine. The new COVID-19 vaccine should be available at the village level, including in hill tribe villages, to reduce the systemic threat to the country.
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Affiliation(s)
- Pilasinee Wongnuch
- School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand.,Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand
| | | | - Tawatchai Apidechkul
- School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand. .,Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand.
| | - Peeradone Srichan
- School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand.,Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand
| | | | - Anusorn Udplong
- School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand
| | - Soontaree Suratana
- School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand
| | - Siwarak Kitchanapaibul
- School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand.,Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand
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Tangcharoensathien V, Sachdev S, Viriyathorn S, Sriprasert K, Kongkam L, Srichomphu K, Patcharanarumol W. Universal access to comprehensive COVID-19 services for everyone in Thailand. BMJ Glob Health 2022; 7:bmjgh-2022-009281. [PMID: 35649632 PMCID: PMC9160587 DOI: 10.1136/bmjgh-2022-009281] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/08/2022] [Indexed: 01/17/2023] Open
Abstract
Despite Thailand having had universal health coverage (UHC) with comprehensive benefit packages since 2002, services are neither listed nor budget earmarked for COVID-19 responses. Policy decisions were made immediately after the first outbreak in 2020 to fully fund a comprehensive benefit package for COVID-19. The Cabinet approved significant additional budget to respond to the unfolding pandemic. The comprehensive benefit package includes laboratory tests, contact tracing, active case findings, 14-day quarantine measures (including tests, food and lodging), field hospitals, ambulance services for referral, clinical services both at hospitals and in home and community isolation, vaccines and vaccination cost, all without copayment by users. No-fault compensation for adverse events or deaths following vaccination is also provided. Services were purchased from qualified public and private providers using the same rate, terms and conditions. The benefit package applies to everyone living in Thailand including Thai citizens and migrant workers. A standardised and comprehensive COVID-19 benefit package for Thai and non-Thai population without copayment facilitates universal and equitable access to care irrespective of capacity to pay and social status and nationality, all while aiming to supporting pandemic containment. Making essential services available, notably laboratory tests, through the engagement of qualified both public and private sectors boost supply side capacity. These policies and implementations in this paper are useful lessons for other low-income and middle-income countries on how UHC reinforces pandemic containment.
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Brown GW, Bridge G, Martini J, Um J, Williams OD, Choupe LBT, Rhodes N, Ho ZJM, Chungong S, Kandel N. The role of health systems for health security: a scoping review revealing the need for improved conceptual and practical linkages. Global Health 2022; 18:51. [PMID: 35570269 PMCID: PMC9107590 DOI: 10.1186/s12992-022-00840-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Practical links between health systems and health security are historically prevalent, but the conceptual links between these fields remain under explored, with little on health system strengthening. The need to address this gap gains relevance in light of the COVID-19 pandemic as it demonstrated a crucial relationship between health system capacities and effective health security response. Acknowledging the importance of developing stronger and more resilient health systems globally for health emergency preparedness, the WHO developed a Health Systems for Health Security framework that aims to promote a common understanding of what health systems for health security entails whilst identifying key capacities required. METHODS/ RESULTS To further explore and analyse the conceptual and practical links between health systems and health security within the peer reviewed literature, a rapid scoping review was carried out to provide an overview of the type, extent and quantity of research available. Studies were included if they had been peer-reviewed and were published in English (seven databases 2000 to 2020). 343 articles were identified, of those 204 discussed health systems and health security (high and medium relevance), 101 discussed just health systems and 47 discussed only health security (low relevance). Within the high and medium relevance articles, several concepts emerged, including the prioritization of health security over health systems, the tendency to treat health security as exceptionalism focusing on acute health emergencies, and a conceptualisation of security as 'state security' not 'human security' or population health. CONCLUSION Examples of literature exploring links between health systems and health security are provided. We also present recommendations for further research, offering several investments and/or programmes that could reliably lead to maximal gains from both a health system and a health security perspective, and why these should be explored further. This paper could help researchers and funders when deciding upon the scope, nature and design of future research in this area. Additionally, the paper legitimises the necessity of the Health Systems for Health Security framework, with the findings of this paper providing useful insights and evidentiary examples for effective implementation of the framework.
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Affiliation(s)
- Garrett Wallace Brown
- grid.9909.90000 0004 1936 8403School of Politics and International Studies (POLIS), University of Leeds, Leeds, LS2 9JT UK
| | - Gemma Bridge
- grid.4868.20000 0001 2171 1133Institute of Population Health Sciences, Centre for Clinical Trials & Methodology, Queen Mary University London, London, E1 2AD UK
| | - Jessica Martini
- grid.4989.c0000 0001 2348 0746School of Public Health, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Jimyong Um
- grid.1013.30000 0004 1936 834XDepartment of Government and International Relations, The University of Sydney, Sydney, Australia
| | - Owain D. Williams
- grid.9909.90000 0004 1936 8403School of Politics and International Studies (POLIS), University of Leeds, Leeds, LS2 9JT UK
| | | | - Natalie Rhodes
- grid.9909.90000 0004 1936 8403School of Politics and International Studies (POLIS), University of Leeds, Leeds, LS2 9JT UK
| | - Zheng Jie Marc Ho
- grid.3575.40000000121633745World Health Organisation, WHO Health Emergencies Program, 1211 Geneva, Switzerland
| | - Stella Chungong
- grid.3575.40000000121633745World Health Organisation, WHO Health Emergencies Program, 1211 Geneva, Switzerland
| | - Nirmal Kandel
- grid.3575.40000000121633745World Health Organisation, WHO Health Emergencies Program, 1211 Geneva, Switzerland
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Pitchalard K, Wimolphan P, Singkhorn O, Purkey E, Moonpanane K. Feasibility and Acceptability of the HOME Model to Promote Self-Management Among Ethnic Minority Elderly with Type 2 Diabetes Mellitus in Rural Thailand: A Pilot Study. Health Equity 2022; 6:629-637. [PMID: 36081879 PMCID: PMC9448522 DOI: 10.1089/heq.2021.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: Ethnic minority elderly (EME) people are recognized as a vulnerable group who have higher prevalence of type 2 diabetes mellitus (T2DM) than the majority of the population. The aim of this study was to explore the feasibility, acceptability, and effect of the HOME model (Home intervention; Online monitoring; Multidisciplinary approach; and Equity and education) specifically for enhancing self-management activities, glycemic control, and satisfaction of EME with T2DM in rural areas in Thailand. Methods: In this quasi-experimental study, a single group used a pre-test and post-test, which were conducted as a pilot study to examine the effect of the HOME model. Results: Overall, 23 dyads of EME with T2DM and their family caregivers completed the 12-week intervention. They reported that the HOME model was helpful and motivating, and they reported satisfaction with the service provided. EME with T2DM showed significant reduction of blood glucose level, and significant improvement in self-management activities, happiness, and satisfaction compared with baseline. Family caregivers had also significant improvements in happiness and reported satisfaction with the HOME model. Conclusion: The primary evidence suggested that the HOME model was acceptable and feasible for EME with T2DM and their families in rural Thailand.
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Affiliation(s)
| | | | | | - Eva Purkey
- School of Medicine, Queen's University, Kingston, Ontario, Canada
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50
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Janwanishstaporn S, Karaketklang K, Krittayaphong R. National trend in heart failure hospitalization and outcome under public health insurance system in Thailand 2008-2013. BMC Cardiovasc Disord 2022; 22:203. [PMID: 35488204 PMCID: PMC9052701 DOI: 10.1186/s12872-022-02629-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background There are limited data on the burden, characteristics, and outcomes of hospitalized heart failure (HF) patients in Thailand. The aim of this study was to investigate national trend in HF hospitalization rate, in-hospital and 1-year mortality rate, and rehospitalization rate in Thailand. Methods We analyzed the claims data of hospitalized patients obtained from the three major Thailand public health reimbursement systems between 2008 and 2013. Patients aged ≥ 18 years with a principal diagnosis of HF by the International Classification of Diseases, Tenth Revision, Thai modification were included. Comorbidities were identified by secondary diagnosis codes. The annual rate of HF hospitalization was calculated per 100,000 beneficiaries. Records of subsequent hospitalization of discharged patients were retrieved. For 1-year mortality rate, vital status of each patient was obtained from Thai Civil Registration of Death database. All outcomes were tested for linear trends across calendar years. Results Between 2008 and 2013, 434,933 HF hospitalizations were identified. The mean age was 65.3 years (SD 14.6), and 58.1% were female. The HF hospitalization rate increased from 138 in 2008 to 168 per 100,000 beneficiaries in 2013 (P for trend < 0.001). Nearly half (47.4%) had had a prior HF admission within 1 year. A small proportion of patients (7.4%) received echocardiography during hospitalization. The median length of hospital stay was 3 days. In-hospital mortality declined from 4.4 to 3.8% (P for trend < 0.001). The overall 30-day and 1-year rehospitalization rates were 34 and 73%, respectively, without significant trends over the study period. Most common cause of 30-day rehospitalization was HF (42%). One-year mortality decreased from 31.8% in 2008 to 28.5% in 2012 (P for trend < 0.001). Conclusion Between 2008 and 2013, HF hospitalization rate in Thailand increased. The in-hospital and 1-year mortality rates decreased slightly. However, the rehospitalization rate remained high mainly due to recurrent HF hospitalization. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02629-2.
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Affiliation(s)
- Satit Janwanishstaporn
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. .,Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road Bangkoknoi, Bangkok, 10700, Thailand.
| | - Khemajira Karaketklang
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungroj Krittayaphong
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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