Effective coverage of diabetes and hypertension: an analysis of Thailand's national insurance database 2016-2019.
BMJ Open
; 12(12): e066289, 2022 12 01.
Article
em En
| MEDLINE
| ID: mdl-36456029
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
11_ODS3_cobertura_universal
/
1_ASSA2030
/
2_ODS3
Base de dados:
MEDLINE
Assunto principal:
Diabetes Mellitus
/
Hipertensão
/
Seguro
Tipo de estudo:
Prognostic_studies
/
Qualitative_research
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
País/Região como assunto:
Asia
Idioma:
En
Revista:
BMJ Open
Ano de publicação:
2022
Tipo de documento:
Article