Effective coverage of diabetes and hypertension: an analysis of Thailand's national insurance database 2016-2019.

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.

Thailand Prevalence and Profile of Food Insecurity in Households with under Five Years Children: Analysis of 2019 Multi-Cluster Indicator Survey.

This study aimed to estimate the prevalence and profile of food insecurity in households with children under 5 years old using the Food Insecurity Experience Scale (FIES) in Thailand. We integrated FIES into the 2019 Multiple Indicator Cluster Surveys (MICS). A total of 861 households were successfully interviewed with FIES. The Rasch model was applied to examine the validity and reliability. Multiple logistic regression was used to assess the association between socio-economic status and prevalence of food insecurity, adjusting for geographical regions and characteristics of households. We found that FIES measurement is valid as Infit falls within the normal range of 0.7−1.3 and is reliable (Rasch reliability value of 0.81). The overall prevalence of moderate or severe food insecurity was 2.79%. The wealthiest households were less likely to suffer from food insecurity than the poorest households (adjusted OR: 0.07; 95% CI: 0.02−0.34; p-value < 0.05). Households with children under 5 years old living in rural areas had lower food insecurity severity scores. We recommend social protection policies such as food and nutrition subsidies or conditional cash transfer to poor households with children under the age of 5.

Annual prevalence of unmet healthcare need in Thailand: evidence from national household surveys between 2011 and 2019.

BACKGROUND: Extending Universal Health Coverage (UHC) requires identifying and addressing unmet healthcare need and its causes to improve access to essential health services. Unmet need is a useful monitoring indicator to verify if low incidence of catastrophic health spending is not a result of foregone services due to unmet needs. This study assesses the trend, between 2011 and 2019, of prevalence and reasons of unmet healthcare need and identifies population groups who had unmet needs. METHOD: The unmet healthcare need module in the Health and Welfare Survey (HWS) 2011-2019 was used for analysis. HWS is a nationally representative household survey conducted by the National Statistical Office biennially. There are more than 60,000 respondents in each round of survey. The Organisation for Economic Co-operation and Development (OECD) standard questions on unmet need and reasons behind were applied for outpatient (OP), inpatient (IP) and dental services in the past 12 months. Data from samples were weighted to represent the Thai population. Univariate analysis was applied to assess unmet need across socioeconomic profiles. RESULTS: The annual prevalence of unmet need between 2011 and 2019 was lower than 3%. The prevalence was 1.3-1.6% for outpatient services, 0.9% - 1.1% for dental services, and lower than 0.2% for inpatient care. A small increasing trend was observed on dental service unmet need, from 0.9% in 2011 to 1.1% in 2019. The poor, the elderly and people living in urban areas had higher unmet needs than their counterparts. Long waiting times was the main reason for unmet need, while cost of treatment was not an issue. CONCLUSION: The low level of unmet need at less than 3% was lower than OECD average (28%), and was the result of UHC since 2002. Regular monitoring using the national representative household survey to estimate annual prevalence and reasons for unmet need can guide policy to sustain and improve access by certain population groups.

Impacts of a sugar sweetened beverage tax on body mass index and obesity in Thailand: A modelling study.

BACKGROUND: The World Health Organization (WHO) recommends sugar-sweetened beverage (SSB) taxes to address obesity. Thailand has just launched the new tax rates for SSB in 2017; however, the existing tax rate is not as high as the 20% recommended by the WHO. The objective for this study was to estimate the impacts of an SSB tax on body mass index (BMI) and obesity prevalence in Thailand under three different scenarios based on existing SSB and recommended tax rates. METHODS: A base model was built to estimate the impacts of an SSB tax on SSB consumption, energy intake, BMI, and obesity prevalence. Literature review was conducted to estimate pass on rate, price elasticity, energy compensation, and energy balance to weight change. Different tax rates (11%, 20% and 25%) were used in the model. The model assumed no substitution effects, model values were based on international data since there was no empirical Thai data available. Differential effects by income groups were not estimated. FINDINGS: When applying 11%, 20%, and 25% tax rates together with 100% pass on rate and an -1.30 own-price elasticity, the SSB consumption decreased by 14%, 26%, and 32%, respectively. The 20% and 25% price increase in SSB price tended to reduce higher energy intake, weight status and BMI, when compared with an 11% increase in existing price increase of SSB. The percentage changes of obesity prevalence of 11%, 20% and 25% SSB tax rates were estimated to be 1.73%, 3.83%, and 4.91%, respectively. CONCLUSIONS: A higher SSB tax (20% and 25%) was estimated to reduce consumption and consequently decrease obesity prevalence. Since Thailand has already endorsed the excise tax structure, the new excise tax structure for SSB should be scaled up to a 20% or 25% tax rate if the SSB consumption change does not meet a favourable goal.

Financial risk protection of Thailand's universal health coverage: results from series of national household surveys between 1996 and 2015.

BACKGROUND: Thailand, an upper-middle income country, has demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country achieved full population coverage and a high level of financial risk protection since 2002, through implementing three public health insurance schemes. UHC has two explicit goals of improved access to health services and financial protection where use of these services does not create financial hardship. Prior studies in Thailand do not provide evidence of long-term UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002. METHODS: We used data from a 15-year series of annual national household socioeconomic surveys (SES) between 1996 and 2015, which were conducted by the National Statistic Office (NSO). The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payment (OOP) for health by households exceeding 10 and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by the additional number of non-poor households falling below the national and international poverty lines after making health payments. RESULTS: Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when the 25% threshold was applied from 1.8 to 0.4% during the same period. The incidence of impoverishment against the national poverty line reduced considerably from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was applied, the incidence of impoverishment was 1.4 and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low. CONCLUSION: The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design of Thailand's UHC, which provides a comprehensive benefits package and zero co-payment at point of services. The well-founded healthcare delivery system and favourable benefits package concertedly support the achievement of UHC goals of access and financial risk protection.

Antibiotic use in mandarin production (Citrus reticulata Blanco) in major mandarin-producing areas in Thailand: A survey assessment.

BACKGROUND: Antimicrobial resistance (AMR), one of the major global threats to human security, has serious negative consequences for both health and economies. Excessive and inappropriate uses of antibiotics are the main drivers of the emergence of resistant bacterial strains. In Thailand, antibiotics have been used in citrus production since 2012 to treat citrus greening disease or Huanglongbing disease, despite no antibiotics being registered for use in mandarin. This raises concerns about irrational use of antibiotics, which can cause AMR. OBJECTIVE: To assess the status of greening disease and the use of antibiotics in mandarin production. METHOD: A face-to-face interview survey in 2017 with 221 mandarin growers in two major mandarin-producing areas. FINDINGS: Greening disease is one of the most serious diseases in mandarins and farmers in the two major mandarin-producing areas in Thailand used ampicillin, amoxicillin, tetracycline and penicillin to treat it. As no antibiotics are registered for use in plants, farmers used antibiotics (registered with the Thai Food and Drug Administration) for human use, either active pharmaceutical ingredients or finished products. They commonly purchased them from retail pharmacies or agrochemical suppliers. Farmers were influenced to use antibiotics by their orchard neighbours and advice from a few academics. The farmers injected antibiotics into the tree trunks approximately three to four times a year and stopped for more than two months before harvesting for in-season fruits. CONCLUSION: Antibiotics registered for human use are being applied to control greening diseases. We recommend scaling up sustainable disease control measures and curtail the use of antibiotics through close and effective dialogue among 'One Health' partners.

Achieving the targets for universal health coverage: how is Thailand monitoring progress?

Universal health coverage (UHC) is one of the targets within the Sustainable Development Goals that the Member States of the United Nations have pledged to achieve by 2030. Target 3.8 has two monitoring indicators: 3.8.1 for coverage of essential health services, for which a compound index from 16 tracer indicators has recently been developed; and 3.8.2 for catastrophic expenditure on health. The global baseline monitoring of these two indicators in 2017 shows that the progress in many low- and middle-income countries is unlikely to be on track and achieved by 2030. The monitoring and evaluation mechanism for UHC progress is a crucial function to hold governments accountable and guide countries along their paths towards UHC. This paper outlines key monitoring and evaluation tools that Thailand uses to track UHC progress; compares the strengths and limitations of each tool; and discusses monitoring gaps and enabling factors related to development of the tools. Thailand uses several data sources to monitor three UHC dimensions: population coverage; service coverage; and financial risk protection. The four key sources are: (i) national surveys; (ii) health facility and administrative data; (iii) specific disease registries; and (iv) research. Each source provides different advantages and is used concurrently to complement the others. Despite initially being developed to track progress for national health priorities, these tools are able to monitor most of the global UHC indicators. Key enabling factors of Thai monitoring systems are a supportive infrastructure and information system; a policy requirement for routine patient data records; ownership and commitment of the key responsible organizations; multisectoral collaboration; and sustainable in-country capacities. The areas for improvement are monitoring in the non-Thai population; tracking access to essential medicines; and maximizing the use of collected data. Lessons learnt from the Thai experience could be useful for other low- and middle-income countries in developing their UHC monitoring platforms.

Food Marketing in Facebook to Thai Children and Youth: An Assessment of the Efficacy of Thai Regulations.

To assess the marketing of food on Facebook in relation to Government regulations and the industry's self-regulatory codes in Thailand, Facebook pages of 30 of the most popular food brands with young people in Thailand and consumer engagement (number of likes, shares, and comments) were recorded and had their marketing content transcribed during the month of December 2017. We coded the contents into 17 marketing techniques and conducted content analysis of these posts in relation to Government regulations and the industry's self-regulatory codes. A total 752 posts were identified in one month. Retail food brand pages had the highest figures for engagement by Facebook viewers. The most common marketing techniques were the use of pictures (632 posts), followed by branding elements (569 posts) and hashtags (438 posts). Out of a total of 228 spot advert posts, all confectionery adverts and almost all (99.5%) soft drink adverts did not display the advertising license number and none of the confectionery adverts displayed the warning messages as required by law. Confectionery, retail food, and soft drink advertising violated the industry's self-regulatory codes. The food brand Facebook pages in Thailand do not comply with Government regulations and the industry's self-regulatory codes. The Government, civil society organizations, and academia should monitor these violations and improve enforcement.