Value of pharmacy services for common illness symptoms covered by universal coverage at drugstore compared to outpatient services at a hospital in Thailand.

Background: Drug stores is an option that people can receive health care services for their common illnesses. This is the first study aims to estimate cost savings for 16 common illness symptoms to the Thailand's health system. Method: This study gathered retrospective secondary data from several studies and surveyed the median cost of medicines. Cost savings of care provided by pharmacists at drug stores in comparison to out-patient department (OPD) services at hospitals were quantified using cost of illness approach. Results: The average number of hospital visits for treatment for 16 common illness symptoms was 2,356 visits per month. The estimation of the cost savings per visit from three perspectives, including government, patient, and societal, at tertiary care hospitals were 12.7-19.4, 12.7-25.6, and 18.9-25.6 USD, and at secondary care hospitals were 6.0-12.7, 6.0-18.9, and 12.2-18.9 USD. Every $1 reimbursed at drug stores will save additional costs in Thailand's health system, ranging from $0.04 to $0.24 and $0.02 to $0.16 at tertiary care hospitals and secondary hospitals, respectively. Conclusion: Pharmacy services for 16 common illness symptoms can clearly save costs.

Effects of a national policy advocating rational drug use on decreases in outpatient antibiotic prescribing rates in Thailand.

OBJECTIVE: This study examined the effects of a national policy advocating rational drug use (RDU), namely, the 'RDU Service Plan', starting in fiscal year 2017 and implemented by the Thai Ministry of Public Health (MOPH), on trends in antibiotic prescribing rates for outpatients. The policy was implemented subsequent to a voluntary campaign involving 136 hospitals, namely, the 'RDU Hospital Project', which was implemented during fiscal years 2014-2016. METHODS: Hospital-level antibiotic prescribing rates in fiscal years 2014-2019 for respiratory infections, acute diarrhea, and fresh wounds were aggregated for two hospital groups using equally weighted averages: early adopters of RDU activities through the RDU Hospital Project and late adopters under the RDU Service Plan. Pre-/post-policy annual changes in the prescribing levels and trends were compared between the two groups using an interrupted time-series analysis. RESULTS: In fiscal years 2014-2016, decreases in antibiotic prescribing rates for respiratory infections and acute diarrhea in both groups reflected a trend that existed before the RDU Service Plan was implemented. The immediate effect of the RDU Service Plan policy occurred in fiscal year 2017, when the prescribing level among the late adopters dropped abruptly for all three conditions with a greater magnitude than in the decrease among the early adopters, despite nonsignificant differences. The medium-term effect of the RDU Service Plan was identified through a further decreasing trend during fiscal years 2017-2019 for all conditions in both groups, except for acute diarrhea among the early adopters. CONCLUSIONS: The national policy on rational drug use effectively reduced antibiotic prescribing for common but questionable outpatient conditions.

Effects of restrictive reimbursement on the prescribing and expenditures on non-essential lipid-lowering drugs.

BACKGROUND: The rapid cost escalation of the government employee scheme in Thailand was driven by the overprescription of non-essential drugs (NEDs), which were not listed in the National Lists of Essential Medicines. A restrictive reimbursement policy implemented in October 2012 required prescribers to base the prescription of NEDs on six criteria, including A and B for safety, C for effectiveness, D for availability, and E and F for costs, hence known as the A-F policy. OBJECTIVE: The A-F policy was examined in terms of its outcomes regarding the prescription volume and reimbursement expenditure for lipid-lowering drugs (LLDs). METHODS: Data on LLD prescription in 2012-2015 from outpatient settings in 29 public hospitals were standardized using quantities based on the World Health Organization's Anatomical, Therapeutic and Chemical (ATC) classification and the defined daily dose (DDD) system. The policy effects were estimated using an interrupted time-series analysis. RESULTS: The restrictive reimbursement policy decreased both the prescription volume and the reimbursement value of non-essential LLDs. Within the first month of policy implementation, the percentage of NEDs, as defined by DDDs and reimbursement expenditure, immediately decreased by 15.1 and 15.2% points in provincial hospitals and by 8.3 and 4.4% points in military hospitals, respectively. The prescription of NEDs continued to decrease thereafter, despite there being no statistically significant changes in the trend of decreased prescribing compared with the prepolicy period. The decrease in the prescription of NEDs resulted in the declining reimbursed amount per day and stable expenditure of LLDs as a whole. CONCLUSION: The effectiveness on the A-F restrictive reimbursement on NED prescribing helped stabilize the expenditure on LLDs.

Long-Term Projections of Patients Undertaking Renal Replacement Therapy Under the Universal Coverage Scheme in Thailand.

INTRODUCTION: The increasing number of patients with end-stage renal disease and the cost of their treatment may potentially place a large burden on overall healthcare spending and human resources for health. We projected the number of patients with end-stage renal disease to better estimate arrangements needed in the future. MATERIALS AND METHODS: We used a dataset containing information about patients who registered with the three modalities of the renal replacement therapy (RRT) program from 2009 to 2017: continuous automated peritoneal dialysis (CAPD), hemodialysis (HD) and kidney transplant (KT). An autoregressive integrated moving average model was used to predict the number of patients who would enroll in the RRT program from 2018 to 2027. RESULTS: From 2009 to 2017, there was a constant increase in the volume of CAPD patients, although a slight drop in some periods was observed. HD patients outnumbered CAPD patients during the inception period of the program. After mid-2013, the trend in HD patients accelerated to the same pace as CAPD patients. By the end of 2017, the number of patients increased to 20,000 for CAPD and 15,000 for HD. The number of KT patients was extremely small relative to CAPD and HD patients. The program enrolled patients receiving a kidney transplant at a constant rate of approximately 200 per year after 2013. The predicted numbers of patients on RRT corresponded to an annual growth rate of 7.2-7.4% for CAPD and HD and 4.8% for KT. CONCLUSION: Despite the expected increased volume of patients, the year-by-year growth rate of patients in all RRT modalities seemed to diminish over time. This phenomenon is likely explained by the intensive implementation of policies to address risk factors of non-communicable diseases among Universal Coverage Scheme (UCS) beneficiaries.

The changing patterns of access overtime to the renal replacement therapy programme in Thailand.

Based on projected numbers, approximately only 50% of those requiring renal replacement therapy (RRT) receive it. Many patients who require RRT live in low- and middle-income countries. The objective of this study was to examine the changing pattern over time of entry into the RRT programme in Thailand following RRT's inclusion in the Universal Coverage Scheme. This study was an ecological study using the age-period-cohort analysis to look at dialysis registration and kidney transplant trends during RRT programme implementation. Data from 2008 to 2016 of patients diagnosed with end-stage renal disease (ESRD) were obtained from the National Health Security Office. The study found that the numbers of new patients with ESRD, aged 20-69, registered with the dialysis programme increased over time. For patients aged 20-40 years, the dialysis programme took up to 400 new patients for every 1000 new ESRD diagnoses. For kidney transplant, the rates increased slowly. The kidney transplant programme could at best treat only around 50 cases for every 1000 new ESRD diagnoses in patients aged 20-30 years. Findings of this study highlighted the importance of promoting strategies to reduce the increasing number of patients with kidney disease, to consider conservative therapy for older/frail patients, and to improve access to kidney transplantation and live-donation.

Thailand's HIV/AIDS program after weaning-off the global fund's support.

BACKGROUND: Though 85% of financing HIV/AIDS program was domestic resources, Global Fund (GF) programs played a significant role in prevention interventions and treatment for non-Thai Key Affected Populations (KAP) and migrants. As upper-middle income country, Thailand is not eligible for GF support. This study identified the remaining challenges and funding for prevention interventions for Thai and non-Thai KAP and migrants if GF supports were to curtail. METHODS: Qualitative method was applied including document review and in-depth interviews of 21 key informants who were Principal Recipients, Sub-recipients, provincial level program implementers and policy makers in health financing agencies. A multi-stakeholder consultation workshop was convened to discuss recommendations. RESULTS: The "public financed public services model" where Principal and Agents were the same entities resulted in less accountability than the "contractual agreement" in GF programs where the Principal Recipients, as the Agents were more accountable to the GF as Principal through results based financing. If GF supports were to curtail, impacts on the current programs would be varied from low to high degree of negative consequences. Scale down the scope and targets, while keeping the most critical components were common coping mechanisms. All three, except one, Principal Recipients had difficulties in fund mobilization. Prevention among non-Thai KAP and migrants were identified as the remaining challenge. CONCLUSIONS: A pooled funding mechanism from multiple domestic sources was proposed. Replacing the conventional public-financed-public-service by a contractual model was preferable. The GF should continue funding the non-Thai KAP and migrant as transition mechanism. Multi-countries or regional programs especially at the border areas were priorities.

Attitudes toward working in rural areas of Thai medical, dental and pharmacy new graduates in 2012: a cross-sectional survey.

BACKGROUND: Inequity in health workforce distribution has been a national concern of the Thai health service for decades. The government has launched various policies to increase the distribution of health workforces to rural areas. However, little is known regarding the attitudes of health workers and the factors influencing their decision to work in rural areas. This study aimed to explore the current attitudes of new medical, dental and pharmacy graduates as well as determine the linkage between their characteristics and the preference for working in rural areas. METHODS: A cross-sectional survey was conducted, using self-administered questionnaires, with a total of 1,225 medical, dental and pharmacy graduates. They were participants of the meeting arranged by the Ministry of Public Health (MOPH) on 1-2 April 2012. Descriptive statistics using mean and percentage, and inferential statistics using logistic regression with marginal effects, were applied for data analysis. RESULTS: There were 754 doctors (44.4%), 203 dentists (42.6%) and 268 pharmacists (83.8%) enrolled in the survey. Graduates from all professions had positive views towards working in rural areas. Approximately 22% of doctors, 31% of dentists and 52% of pharmacists selected 'close proximity to hometown' as the most important reason for workplace selection. The multivariable analysis showed a variation in attributes associated with the tendency to work in rural areas across professions. In case of doctors, special track graduates had a 10% higher tendency to prefer rural work than those recruited through the national entrance examination. CONCLUSIONS: The majority of graduates chose to work in community hospitals, and attitudes towards rural work were quite positive. In-depth analysis found that factors influencing their choice varied between professions. Special track recruitment positively influenced the selection of rural workplaces among new doctors attending the MOPH annual meeting for workplace selection. This policy innovation should be applied to dentists and pharmacists as well. However, implementing a single policy without supporting strategies, or failing to consider different characteristics between professions, might not be effective. Future study of attitudes and factors contributing to the selection of, and retention in, rural service of both new graduates and in-service professionals was recommended.

Thailand special recruitment track of medical students: a series of annual cross-sectional surveys on the new graduates between 2010 and 2012.

BACKGROUND: Comprehensive policies for rural retention of medical doctor and other health professional, including education strategy and mandatory service, have been implemented in Thailand since the 1970s. This study compared the rural attitudes, intention to fulfil mandatory rural service and competencies between medical graduates' from two modes of admission, normal and special tracks. METHODS: Three cross-sectional, self-administered questionnaire surveys were conducted in April 2010, 2011 and 2012. The questionnaire was distributed to all new medical graduates in the annual Ministry of Public Health meeting to allocate workplaces for the 3-year mandatory service. FINDINGS: The majority of students were recruited through the normal track (56 to 77%) from medical schools in Bangkok (56 to 66%), having mostly attended secondary schools in Bangkok. A majority of special track graduates came from secondary schools in provincial cities (76 to 79%). All three batches came from well-educated parents.A slight difference in rural attitudes was observed between tracks. Univariable analysis found statistical associations between the intention to fulfil the 3-year obligation and special track recruitment and attributes on rural exposure. Multivariable analysis showed that graduates recruited through the special track had a 10 to 15% higher probability of fulfilling the mandatory service.Special track graduates scored higher on four out of five competencies, notably procedural skills, but normal track graduates had higher competency on clinical knowledge in major clinical subjects. CONCLUSION: Since special track recruitment resulted in a higher probability of fulfilling mandatory service and competency, increasing the proportion of special track recruitment and improving the effectiveness of policies addressing physician shortage were recommended.

Prevalence and profiles of unmet healthcare need in Thailand.

BACKGROUND: In the light of the universal healthcare coverage that was achieved in Thailand in 2002, policy makers have raised concerns about whether there is still unmet need within the population. Our objectives were to assess the annual prevalence, characteristics and reasons for unmet healthcare need in the Thai population in 2010 and to compare our findings with relevant international literature. METHODS: A standard set of OECD unmet need questionnaires was used in a nationally-representative household survey conducted in 2010 by the National Statistical Office. The prevalence of unmet need among respondents with various socio-economic characteristics was estimated to determine an inequity in the unmet need and the reasons behind it. RESULTS: The annual prevalence of unmet need for outpatient and inpatient services in 2010 was 1.4% and 0.4%, respectively. Despite this low prevalence, there are inequities with relatively higher proportion of the unmet need among Universal Coverage Scheme members, and the poor and rural populations. There was less unmet need due to cost than there was due to geographical barriers. The prevalence of unmet need due to cost and geographical barriers among the richest and poorest quintiles were comparable to those of selected OECD countries. The geographical extension of healthcare infrastructure and of the distribution of health workers is a major contributing factor to the low prevalence of unmet need. CONCLUSIONS: The low prevalence of unmet need for both outpatient and inpatient services is a result of the availability of well-functioning health services at the most peripheral level, and of the comprehensive benefit package offered free of charge by all health insurance schemes. This assessment prompts a need for regular monitoring of unmet need in nationally-representative household surveys.