District division administrative disaggregation data framework for monitoring leaving no one behind in the National Health Insurance Fund of Sudan: achieving sustainable development goals in 2030.

BACKGROUND: The aim of this study is to monitor the concept of 'leaving no one behind' in the Sustainable Development Goals (SDGs) to track the implications of the mobilization of health care resources by the National Health Insurance Fund (NHIF) of Sudan. METHODS: A cross-sectional study was used to monitor 'leaving no one behind' in NHIF by analyzing the secondary data of the information system for the year 2016. The study categorized the catchment areas of health care centers (HCCS) according to district administrative divisions, which are neighborhood, subdistrict, district, and zero. The District Division Administrative Disaggregation Data (DDADD) framework was developed and investigated with the use of descriptive statistics, maps of Sudan, the Mann-Whitney test, the Kruskal-Wallis test and health equity catchment indicators. SPSS ver. 18 and EndNote X8 were also used. RESULTS: The findings show that the NHIF has mobilized HCCs according to coverage of the insured population. This mobilization protected the insured poor in high-coverage insured population districts and left those living in very low-coverage districts behind. The Mann-Whitney test presented a significant median difference in the utilization rate between catchment areas (P value < 0.001). The results showed that the utilization rate of the insured poor who accessed health care centers by neighborhood was higher than that of the insured poor who accessed by more than neighborhood in each state. The Kruskal-Wallis test of the cost of health care services per capita in each catchment area showed a difference (P value < 0.001) in the median between neighborhoods. The cost of health care services in low-coverage insured population districts was higher than that in high-coverage insured population districts. CONCLUSION: The DDADD framework identified the inequitable distribution of health care services in low-density population districts leaves insured poor behind. Policymakers should restructure the equation of health insurance schemes based on equity and probability of illness, to distribute health care services according to needs and equity, and to remobilize resources towards districts left behind.

Assessing system-based trainings for primary care teams and quality-of-life of patients with multimorbidity in Thailand: patient and provider surveys.

BACKGROUND: Strengthening primary care is considered a global strategy to address non-communicable diseases and their comorbidity. However, empirical evidence of the longer-term benefits of capacity building programmes for primary care teams contextualised for low- and middle-income countries is scanty. In Thailand, a series of system-based capacity building programmes for primary care teams have been implemented for a decade. An analysis of the relationship between these systems-based trainings in diverse settings of primary care and quantified patient outcomes was needed. METHODS: Facility-based and community-based cross-sectional surveys were used to obtain data on exposure of primary care team members to 11 existing training programmes in Thailand, and health profiles and health-related quality of life of their patients measured in EuroQol-5 Dimension (EQ-5D) scale. Using a multilevel modelling, the associations between primary care provider's training and patient's EQ-5D score were estimated by a generalized linear mixed model (GLMM). RESULTS: While exposure to training programmes varied among primary care teams nationwide, District Health Management Learning (DHML) and Contracting Unit of Primary Care (CUP) Leadership Training Programmes, which put more emphasis on bundling of competencies and contextualising of applying such competencies, were positively associated with better health-related quality of life of their multimorbid patients. CONCLUSIONS: Our report provides systematic feedback to a decade-long investment on system-based capacity building for primary care teams in Thailand, and can be considered as new evidence on the value of human resource development in primary care systems in low- and middle-income countries. Building multiple competencies helps members of primary care teams collaboratively manage district health systems and address complex health problems in different local contexts. Coupling contextualised training with ongoing programme implementation could be a key entity to the sustainable development of primary care teams in low and middle income countries which can then be a leverage for improving patients outcomes.

Copayment and recommended strategies to mitigate its impacts on access to emergency medical services under universal health coverage: a case study from Thailand.

BACKGROUND: Although bodies of evidence on copayment effects on access to care and quality of care in general have not been conclusive, allowing copayment in the case of emergency medical conditions might pose a high risk of delayed treatment leading to avoidable disability or death. METHODS: Using mixed-methods approach to draw evidence from multiple sources (over 40,000 records of administrative dataset of Thai emergency medical services, in-depth interviews, telephone survey of users and documentary review), we are were able to shed light on the existence of copayment and its related factors in the Thai healthcare system despite the presence of universal health coverage since 2001. RESULTS: The copayment poses a barrier of access to emergency care delivered by private hospitals despite the policy proclaiming free access and payment. The copayment differentially affects beneficiaries of the major 3 public-health insurance schemes hence inducing inequity of access. CONCLUSIONS: We have identified 6 drivers of the copayment i.e., 1) perceived under payment, 2) unclear operational definitions of emergency conditions or 3) lack of criteria to justify inter-hospital transfer after the first 72 h of admission, 4) limited understanding by the service users of the policy-directed benefits, 5) weak regulatory mechanism as indicated by lack of information systems to trace private provider's practices, and 6) ineffective arrangements for inter-hospital transfer. With demand-side perspectives, we addressed the reasons for bypassing gatekeepers or assigned local hospitals. These are the perception of inferior quality of care and age-related tendency to use emergency department, which indicate a deficit in the current healthcare systems under universal health coverage. Finally, we have discussed strategies to address these potential drivers of copayment and needs for further studies.

An assessment on Thai emergency medical services performance: the patient perspective.

BACKGROUND: Emergency medical services (EMS) have been steadily developed in Thailand. However the patient perspective has not been explicitly considered in performance assessment thus far although it is a key consideration for quality improvement in public organizations. OBJECTIVE: To investigate the Thai patient experience in EMS and emergency departments (ED) and help Thai leaders guide future improvements. MATERIAL AND METHOD: The present study was a survey of selected ED of 14 public hospitals in four geographical regions. Five hundred fifty patients from each hospital were interviewed between June and July 2009. The data were collected by medical records review and face-to-face interview. RESULTS: Six thousand four hundred forty four patients [average age of 36.01 years (range: 0-98), almost 50% female, 95% local residents] participated in the survey. Ambulances staffed with paramedics or trained volunteers transported 7.28% of the patients. Of those, 80% to 95% were satisfied, rating the service as 'safe'. Volunteer transfers had lower satisfaction scores. Patients spent an average of 63.8 minutes in the ED. Almost all patients were satisfied and would recommend the services to their friends or relatives. The most common factors contributing to dissatisfaction were with waiting time for consultation and pain management. CONCLUSION: There is high patient satisfaction with emergency services in public hospitals. Nonetheless, the lower satisfaction for volunteer ambulance service, the concern about waiting time, and pain management highlights opportunity for improvement. The rapid, low-cost patient surveys combined with paper-based medical record review can yield useful information for quality improvements

Health-care data collecting, sharing, and using in Thailand, China mainland, South Korea, Taiwan, Japan, and Malaysia.

This article sought to describe the health-care data situation in six selected economies in the Asia-Pacific region. Authors from Thailand, China mainland, South Korea, Taiwan, Japan, and Malaysia present their analyses in three parts. The first part of the article describes the data-collection process and the sources of data. The second part of the article presents issues around policies of data sharing with the stakeholders. The third and final part of the article focuses on the extent of health-care data use for policy reform in these different economies. Even though these economies differ in their economic structure and population size, they share some similarities on issues related to health-care data. There are two main institutions that collect and manage the health-care data in these economies. In Thailand, China mainland, Taiwan, and Malaysia, the Ministry of Health is responsible through its various agencies for collecting and managing the health-care data. On the other hand, health insurance is the main institution that collects and stores health-care data in South Korea and Japan. In all economies, sharing of and access to data is an issue. The reasons for limited access to some data are privacy protection, fragmented health-care system, poor quality of routinely collected data, unclear policies and procedures to access the data, and control on the freedom on publication. The primary objective of collecting health-care data in these economies is to aid the policymakers and researchers in policy decision making as well as create an awareness on health-care issues for the general public. The usage of data in monitoring the performance of the heath system is still in the process of development. In conclusion, for the region under discussion, health-care data collection is under the responsibility of the Ministry of Health and health insurance agencies. Data are collected from health-care providers mainly from the public sector. Routinely collected data are supplemented by national surveys. Accessibility to the data is a major issue in most of the economies under discussion. Accurate health-care data are required mainly to support policy making and evidence-based decisions.

Universal health coverage in Thailand: ideas for reform and policy struggling.

Inequality in health between rich and poor in Thailand was well documented; millions of informal workers and their families lacked health insurance; and the poor paid more proportionately in income for health care. The universal coverage is conceived as one of the means to redress the situation. But the term 'universal coverage' may mean differently among different groups of stakeholders. This paper, based on empirical research of health policy reform, collected perceptions and ideas from stakeholders and discusses the ways and strategies that universal coverage might take shape in Thailand. Two sources of information were taken: one from the questionnaire survey (according to the Delphi technique, two rounds of survey were taken), another an in-depth interview. Obtained information for policy formulation included how best, as conceived by stakeholders, to implement the universal coverage, sources of finance, fiscal implication for Thai government, ways to prevent higher demand for unnecessary services, and involvement of local government. Recent policy move in Thailand (the so-called 30 baht for all diseases) emerged in 2001 generated hot debate nationwide. The programme is currently in its early phase and is likely to evolve overtime--i.e. whether or not this programme will be financed by certain types of taxes or from annual government expense still unclear; and budget allocation among different health providers still unsettled. Anyhow this programme may be interpreted as a policy shift away from the pro-market based toward a government-supported egalitarianism.