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1.
BMC Public Health ; 19(1): 1449, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684951

RESUMO

BACKGROUND: Road traffic injuries (RTIs) have been one of the most critical public health problems in Thailand for decades. The objective of this study was to examine to what extent provincial economy was associated with RTIs, road traffic deaths and case fatality rate in Thailand. METHODS: A secondary data analysis on time-series data was applied. The unit of analysis was a panel of 77 provinces during 2012-2016. Data were obtained from relevant public authorities, including the Ministry of Public Health. Descriptive statistics and econometric models, using negative binomial (NB) regression, negative binomial regression with random-effects (RE) model, and spatial Durbin model (SDM) were employed. The main predictor variable was gross domestic product (GDP) per capita and the outcome variables were incidence proportion of RTIs, traffic deaths and case fatality rate. The analysis was adjusted for key covariates. RESULTS: The incidence proportion of RTIs rose from 449.0 to 524.9 cases per 100,000 population from 2012 till 2016, whereas the incidence of traffic fatalities fluctuated between 29.7 and 33.2 deaths per 100,000 population. Case fatality rate steadily stood at 0.06-0.07 deaths per victim. RTIs and traffic deaths appeared to be positively correlated with provincial economy in the NB regression and the RE model. In the SDM, a log-Baht increase in GDP per capita (equivalent to a growth of GDP per capita by about 2.7 times) enlarged the incidence proportion of injuries and deaths by about a quarter (23.8-30.7%) with statistical significance. No statistical significance was found in case fatality rate by the SDM. The SDM also presented the best model fitness relative to other models. CONCLUSION: The incidence proportion of traffic injuries and deaths appeared to rise alongside provincial prosperity. This means that RTIs-preventive measures should be more intensified in economically well-off areas. Furthermore, entrepreneurs and business sectors that gain economic benefit in a particular province should share responsibility in RTIs prevention in the area where their businesses are running. Further studies that explore others determinants of road safety, such as patterns of vehicles used, attitudes and knowledge of motorists, investment in safety measures, and compliance with traffic laws, are recommended.


Assuntos
Acidentes de Trânsito/mortalidade , Acidentes de Trânsito/estatística & dados numéricos , Desenvolvimento Econômico/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Análise de Dados , Feminino , Produto Interno Bruto/estatística & dados numéricos , Humanos , Incidência , Masculino , Modelos Econométricos , Análise Espacial , Tailândia/epidemiologia , Ferimentos e Lesões/mortalidade , Adulto Jovem
2.
Risk Manag Healthc Policy ; 12: 41-55, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30881160

RESUMO

Introduction: In 2017 the Thai Ministry of Public Health proposed a new financing mechanism to promote day surgery under the Universal Coverage Scheme - the main public insurance arrangement for Thais. The key feature of the policy is health facilities performing day surgery can claim the treatment expense based on relative weight (RW) instead of adjusted RW (adjRW). Procedures for 12 diseases (so-called "candidate procedures") are eligible for the new reimbursement. The objective of this study was to assess the current day surgery situation in Thailand and analyze potential budget impact from the new policy. Methods: A quantitative cross-section design was employed. Individual inpatient records of the Universal Coverage Scheme during 2014-2016 were analyzed. Descriptive statistics and simulation analyses were applied. The analyses were divided into three subtopics: 1) case volume and expense claim, 2) utilization across facilities, and 3) case mix index and budget impact. Results: Overall, day surgery accounted for 4.8% of admissions with candidate procedures. Inguinal hernias, hemorrhoids, and common bile duct stones caused the largest sum of admission numbers and admission days. Currently, the annual reimbursement for candidate procedures treated as inpatient cases is around 290.8 million Baht (US$ 8.8 million), with about 12.4 million Baht (US$ 0.38 million) for day surgery cases. If all candidate procedures were performed as day surgery and diagnostic-related groups (DRG) version 6 was applied, the incremental budget would amount to 1.9 million Baht (US$ 58,903). Conclusions: The new reimbursement policy will likely lead to minimal budget burden. Even in the case of maximal uptake of the policy, the needed budget would increase by just 15%. The marginal budget increment was explained by the infinitesimal RW-adjRW difference. Apart from the financial measure, other qualitative aspects of the policy, such as infrastructure and health staff readiness, should be explored.

3.
BMC Pediatr ; 18(1): 395, 2018 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-30591029

RESUMO

BACKGROUND: Childhood stunting, defined as the height-for-age standardized score lower than minus two, is one of the key indicators for assessing well-being and health of a child; and can be used for monitoring child health inequalities. Thailand has been successful in improving health and providing financial protection for its population. A better understanding of the determinants of stunting will help fill both knowledge and policy gaps which promote children's health and well-being. This study assesses the factors contributing to stunting among Thai children aged less than five years. METHODS: This study obtained data from the Multiple Indicator Cluster Survey Round 4 (MICS4), conducted in Thailand in 2012. Data analysis consisted of three steps. First, descriptive statistics provided an overview of data. Second, a Chi-square test determined the association between each covariate and stunting. Finally, multivariable logistic regression assessed the likelihood of stunting from all independent variables. Interaction effects between breastfeeding and household economy were added in the multivariable logistic regression. RESULTS: In the analysis without interaction effects, while the perceived size of children at birth as 'small' were positively associated with stunting, children in the well-off households were less likely to experience stunting. The analysis of the interactions between 'duration of breastfeeding' and 'household's economic level' found that the odds of stunting in children who were breastfed longer than 12 months in the poorest household quintile were 1.8 fold (95% Confidence interval: 1.3-2.6) higher than the odds found in mothers from the same poorest quintiles, but without prolonged breastfeeding. However prolonged breastfeeding in most well-off households (those between the second quintile and the fifth wealth quintile) did not show a tendency towards stunting. CONCLUSIONS: Childhood stunting was significantly associated with several factors. Prolonged breastfeeding beyond 12 months when interacting with poor economic status of a household potentiated stunting. Children living in the least well-off households were more prone to stunting than others. We recommend that the MICS survey questionnaire be amended to capture details on quantity, quality and practices of supplementary feeding. Multi-sectoral nutrition policies targeting poor households are required to address stunting challenges.


Assuntos
Aleitamento Materno , Transtornos do Crescimento/epidemiologia , Pobreza , Peso ao Nascer , Pré-Escolar , Abastecimento de Alimentos , Inquéritos Epidemiológicos , Humanos , Lactente , Prevalência , Tailândia/epidemiologia , Fatores de Tempo
4.
Lung Cancer ; 120: 91-97, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29748023

RESUMO

OBJECTIVES: Tyrosine kinase inhibitors (TKIs) have shown to be better for progression-free survival than chemotherapy as the first-line treatment for advanced, non-small cell lung cancer (NSCLC), especially in patients with epidermal growth factor receptor mutation (EGFR M+). This study evaluates under the Thai health system context, cost-effectiveness of (A) the use of platinum doublets for all without EGFR testing, and (B) an EGFR test followed by TKIs or platinum doublets conditional on test results. MATERIALS AND METHODS: A decision analysis model was constructed to estimate quality-adjusted life years (QALYs) and total cost for each option. Cancer progression and death were pooled from randomized, controlled trials. Quality of life was obtained from patient interview, using the European Quality-of-Life, 5-Dimension questionnaire. Costs associated with treatment outcomes were derived from patient chart reviews. RESULTS: Combining the EGFR test with each TKI, gefitinib, erlotinib and afatinib if M+ or otherwise platinum doublets, resulted in higher effectiveness than the use of platinum doublets for all by 0.15, 0.19 and 0.21 QALYs, respectively. Among the three TKIs, gefitinib was dominated economically by erlotinib, which incurred an incremental cost-effectiveness ratio (ICER) of $46,783/QALY over the platinum doublets for all. Moving to the next best, afatinib resulted in the ICER of $198,961/QALY over erlotinib. Probabilities for any TKIs being cost-effective when compared with platinum doublets over a wide range of willingness to pay were modest. CONCLUSION: In Thailand, the first-line treatment for advanced NSCLC with TKIs conditional on EGFR test results was not cost-effective as compared with platinum doublets for all.


Assuntos
Antineoplásicos/economia , Carcinoma Pulmonar de Células não Pequenas/economia , Neoplasias Pulmonares/economia , Compostos de Platina/uso terapêutico , Inibidores de Proteínas Quinases/uso terapêutico , Idoso , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Estudos de Coortes , Análise Custo-Benefício , Custos de Medicamentos , Receptores ErbB/genética , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Mutação/genética , Estadiamento de Neoplasias , Anos de Vida Ajustados por Qualidade de Vida , Análise de Sobrevida , Tailândia
5.
JAMA Ophthalmol ; 136(7): 796-802, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29800002

RESUMO

Importance: Uptake of cataract surgery in developing countries is much lower than that in developed countries. Cataract unawareness and financial barriers have been cited as the main causes. Under the Universal Coverage Scheme (UCS), Thailand introduced a central reimbursement (CR) system for cataract surgery. It is unknown if this financial arrangement could incentivize service provision (private or public) in areas that are hard to reach. Objective: To examine the association between the CR policy and access to cataract surgery in Thailand. Design, Setting, and Participants: Using time series analysis, hospitalization data during 2005 to 2015 for UCS members were analyzed for time trends and subnational variations in the cataract surgery rate (CSR) before and after the CR implementation. Main Outcomes and Measures: The annual growth in access was estimated using segmented regression. The CSR gap across regions was determined by the slope index of inequality (SII). Unequal access across districts was represented by the gap between the top and bottom quintiles. Results: During 2005 to 2015, a total of 0.98 million UCS members (mean [SD] age, 67.4 [11.2] years; 58.7% female) received cataract surgery. The number of cases increased from 77 897 in 2005 to 192 290 in 2015. At the national level, the CSR per 100 000 population increased from 352.0 to 378.7 cases in 2005 to 2008, to 716.3 cases in 2013, and then to 765.3 cases in 2015. With the use of mobile services through an exclusive CR, 3 private hospitals took the lead in service growth, sharing 79.2% of cases in the private sector in 2009. From 2010, the number of cases in public hospitals grew yearly by 12.6% to 13.6% until 2012, rose 21.7% in 2013, and then the rate of increase declined to that of 8.2% to 8.3% in 2014-2015. During the periods of an increase in overall access, the CSR gap across regions widened as indicated by the SII of 755.4 cases per 100 000 population in 2010 because of rapid uptake in areas with mobile services. When the national CSR became adequately large and mobile services were discouraged in 2013, the gap in 2014-2015 narrowed. Conclusions and Relevance: This study found that the appropriate payment and service designs helped reduce the cataract surgery backlog. With an adequately high CSR, Thailand is on track to reach the VISION 2020 goal, aiming for blindness elimination by the year 2020, which has been achieved by most developed countries.


Assuntos
Extração de Catarata/estatística & dados numéricos , Tabela de Remuneração de Serviços/estatística & dados numéricos , Financiamento Governamental/estatística & dados numéricos , Política de Saúde/tendências , Acesso aos Serviços de Saúde/estatística & dados numéricos , Sistema de Pagamento Prospectivo/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Catarata/epidemiologia , Extração de Catarata/economia , Países em Desenvolvimento , Feminino , Financiamento Governamental/economia , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Tailândia/epidemiologia , Cobertura Universal do Seguro de Saúde/economia
6.
Health Policy Plan ; 33(3): 436-444, 2018 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-29346547

RESUMO

Financing incidence analysis (FIA) assesses how the burden of health financing is distributed in relation to household ability to pay (ATP). In a progressive financing system, poorer households contribute a smaller proportion of their ATP to finance health services compared to richer households. A system is regressive when the poor contribute proportionately more. Equitable health financing is often associated with progressivity. To conduct a comprehensive FIA, detailed household survey data containing reliable information on both a cardinal measure of household ATP and variables for extracting contributions to health services via taxes, health insurance and out-of-pocket (OOP) payments are required. Further, data on health financing mix are needed to assess overall FIA. Two major approaches to conducting FIA described in this article include the structural progressivity approach that assesses how the share of ATP (e.g. income) spent on health services varies by quantiles, and the effective progressivity approach that uses indices of progressivity such as the Kakwani index. This article provides some detailed practical steps for analysts to conduct FIA. This includes the data requirements, data sources, how to extract or estimate health payments from survey data and the methods for assessing FIA. It also discusses data deficiencies that are common in many low- and middle-income countries (LMICs). The results of FIA are useful in designing policies to achieve an equitable health system.


Assuntos
Interpretação Estatística de Dados , Características da Família , Financiamento da Assistência à Saúde , Seguro Saúde/economia , Assistência à Saúde/economia , Assistência à Saúde/organização & administração , Financiamento Pessoal , Gastos em Saúde , Humanos , Renda , Fatores Socioeconômicos , Impostos
7.
BMJ Glob Health ; 2(1): e000153, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28589000

RESUMO

BACKGROUND: To assess progress towards universal health coverage, countries like Cambodia require evidence on equity in the financing and distribution of healthcare benefits. This evidence must be based on a system-wide perspective that recognises the complex roles played by the public and private sectors in many contemporary healthcare systems. OBJECTIVE: To undertake a system-wide assessment of who pays and who benefits from healthcare in Cambodia and to understand the factors influencing this. METHODS: Financing and benefit incidence analysis will be used to calculate the financing burden and distribution of healthcare benefits across socioeconomic groups. Data on healthcare usage, living standards and self-assessed health status will be derived from a cross-sectional household survey designed for this study involving a random sample of 5000 households. This will be supplemented by secondary data from the Cambodian National Health Accounts 2014 and the Cambodian Socioeconomic Survey (CSES) 2014. We will also collect qualitative data through focus group discussions and in-depth interviews to inform the interpretation of the quantitative analyses. POTENTIAL IMPACT: This study will produce previously unavailable information on who pays for, and who benefits from, health services across the entire health system of Cambodia. This evidence comes at a critical juncture in healthcare reform in South-East Asia with so many countries seeking guidance on the equity impact of their current financing arrangements that include a complex mix of public and private providers.

8.
BMJ Glob Health ; 2(2): e000200, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28589017

RESUMO

BACKGROUND: Universal health coverage (UHC) is critical to global poverty alleviation and equity of health systems. Many low-income and middle-income countries, including small island states in the Pacific, have committed to UHC and reforming their health financing systems to better align with UHC goals. This study provides the first comprehensive evidence on equity of the health financing system in Fiji, a small Pacific island state. The health systems of such states are poorly covered in the international literature. METHODS: The study employs benefit and financing incidence analyses to evaluate the distribution of health financing benefits and burden across the public and private sectors. Primary data from a cross-sectional survey of 2000 households were used to assess healthcare benefits and secondary data from the 2008-2009 Fiji Household Income and Expenditure Survey to assess health financing contributions. These were analysed by socioeconomic groups to determine the relative benefit and financing incidence across these groups. FINDINGS: The distribution of healthcare benefits in Fiji slightly favours the poor-around 61% of public spending for nursing stations and 26% of spending for government hospital inpatient care were directed to services provided to the poorest 20% of the population. The financing system is significantly progressive with wealthier groups bearing a higher share of the health financing burden. CONCLUSIONS: The healthcare system in Fiji achieves a degree of vertical equity in financing, with the poor receiving a higher share of benefits from government health spending and bearing a lower share of the financing burden than wealthier groups.

9.
Glob Health Action ; 10(sup1): 1266175, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28532308

RESUMO

The Millennium Development Goals (MDGs) triggered increased demand for data on child and maternal mortality for monitoring progress. With the advent of the Sustainable Development Goals (SDGs) and growing evidence of an epidemiological transition towards non-communicable diseases, policy makers need data on mortality and disease trends and distribution to inform effective policies and support monitoring progress. Where there are limited capacities to produce national health estimates (NHEs), global health estimates (GHEs) can fill gaps for global monitoring and comparisons. This paper draws lessons learned from Thailand's burden of disease study (BOD) on capacity development for NHEs, and discusses the contributions and limitation of GHEs in informing policies at country level. Through training and technical support by external partners, capacities are gradually strengthened and institutionalized to enable regular updates of BOD at national and sub-national levels. Initially, the quality of cause of death reporting in the death certificates was inadequate, especially for deaths occurring in the community. Verbal autopsies were conducted, using domestic resources, to determine probable causes of deaths occurring in the community. This helped improve the estimation of years of life lost. Since the achievement of universal health coverage in 2002, the quality of clinical data on morbidities has also considerably improved. There are significant discrepancies between the 2010 Global Burden of Diseases (GBD) estimates for Thailand and the 1999 nationally generated BOD, especially for years of life lost due to HIV/AIDS, and the ranking of priority diseases. National ownership of NHEs and effective interfaces between researchers and decision makers contribute to enhanced country policy responses, while sub-national data are intended to be used by various sub-national-level partners. Though GHEs contribute to benchmarking country achievement compared with global health commitments, they may hamper development of NHE capacities. GHEs should encourage and support countries to improve their data systems and develop a data infrastructure that supports the production of empirical data needed to underpin estimation efforts.


Assuntos
Causas de Morte/tendências , Mortalidade da Criança/tendências , Assistência à Saúde/organização & administração , Saúde Global , Política de Saúde , Mortalidade Materna/tendências , Objetivos Organizacionais , Adolescente , Adulto , Criança , Pré-Escolar , Tomada de Decisões , Feminino , Previsões , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Tailândia
10.
Risk Manag Healthc Policy ; 9: 261-269, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27942240

RESUMO

OBJECTIVES: This study sought to investigate the impact of the Thai "Health Insurance for People with Citizenship Problems" (HI-PCP) on access to care for stateless patients, compared to Universal Coverage Scheme patients and the uninsured, using inpatient utilization as a proxy for impact. METHODS: Secondary data analysis of inpatient records of Kraburi Hospital, Ranong province, between 2009 (pre-policy) and 2012 (post-policy) was employed. Descriptive statistics and multivariate analysis by difference-in-difference model were performed. RESULTS: The volume of inpatient service utilization by stateless patients expanded after the introduction of the HI-PCP. However, this increase did not appear to stem from the HI-PCP per se. After controlling for key covariates, including patients' characteristics, disease condition, and domicile, there was only a weak positive association between the HI-PCP and utilization. Critical factors contributing significantly to increased utilization were older age, proximity to the hospital, and presence of catastrophic illness. CONCLUSION: A potential explanation for the insignificant impact of the HI-PCP on access to inpatient care of stateless patients is likely to be a lack of awareness of the existence of the scheme among the stateless population and local health staff. This problem is likely to have been accentuated by operational constraints in policy implementation, including the poor performance of local offices in registering stateless people. A key limitation of this study is a lack of data on patients who did not visit the health facility at the first opportunity. Further study of health-seeking behavior of stateless people at the household level is recommended.

11.
Diabetes Res Clin Pract ; 109(3): 521-32, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26117686

RESUMO

OBJECTIVE: To assess the efficacy of metformin and insulin in the treatment of pregnant women with gestational diabetes mellitus (GDM). METHODS: A meta-analysis was conducted by including randomized controlled trials comparing metformin and insulin in GDM. An electronic search was conducted to identify relevant studies. Data were synthesized by a random effects meta-analysis model. A Bayesian analysis was also performed to account for uncertainties in the treatment efficacy. RESULTS: Eight clinical trials involving 1712 individuals were included in the final analysis. The pooled estimates of metformin-insulin differences were very small and statistically non-significant in fasting plasma glucose, postprandial plasma glucose and HbA1c, measured at 36-37 weeks of gestation. Notably, 14-46% of those receiving metformin required additional insulin. Compared with the insulin group, metformin treatment was associated with a lower incidence of neonatal hypoglycemia (relative risk, RR 0.74; 95% CI 0.58-0.93; P=0.01) and of neonatal intensive care admission (RR 0.76; 95% CI 0.59-0.97; P=0.03). Bayesian analysis revealed that the efficacy of metformin was consistently higher than insulin with a probability of over 98% on these two neonatal complications. Other outcomes were not significantly different between the two treatment groups. CONCLUSION: In women with gestational diabetes, metformin use and insulin therapy have comparable glycemic control profile, but metformin use was associated with lower risk of neonatal hypoglycemia.


Assuntos
Diabetes Gestacional/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Peso ao Nascer/efeitos dos fármacos , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Insulina/uso terapêutico , Gravidez , Resultado da Gravidez/epidemiologia , Resultado do Tratamento
12.
Health Policy Plan ; 30(9): 1152-61, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25378527

RESUMO

Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser-provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite annual budget.


Assuntos
Assistência à Saúde , Financiamento Governamental/economia , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/economia , Metas , Humanos , Tailândia
13.
BMJ Open ; 4(12): e006806, 2014 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-25468509

RESUMO

INTRODUCTION: Equitable health financing remains a key health policy objective worldwide. In low and middle-income countries (LMICs), there is evidence that many people are unable to access the health services they need due to financial and other barriers. There are growing calls for fairer health financing systems that will protect people from catastrophic and impoverishing health payments in times of illness. This study aims to assess equity in healthcare financing in Fiji and Timor-Leste in order to support government efforts to improve access to healthcare and move towards universal health coverage in the two countries. METHODS AND ANALYSIS: The study employs two standard measures of equity in health financing increasingly being applied in LMICs-benefit incidence analysis (BIA) and financing incidence analysis (FIA). In Fiji, we will use a combination of secondary and primary data including a Household Income and Expenditure Survey, National Health Accounts, and data from a cross-sectional household survey on healthcare utilisation. In Timor-Leste, the World Bank recently completed a health equity and financial protection analysis that incorporates BIA and FIA, and found that the distribution of benefits from healthcare financing is pro-rich. Building on this work, we will explore the factors that influence the pro-rich distribution. ETHICS AND DISSEMINATION: The study is approved by the Human Research Ethics Committee of University of New South Wales, Australia (Approval number: HC13269); the Fiji National Health Research Committee (Approval # 201371); and the Timor-Leste Ministry of Health (Ref MS/UNSW/VI/218). RESULTS: Study outcomes will be disseminated through stakeholder meetings, targeted multidisciplinary seminars, peer-reviewed journal publications, policy briefs and the use of other web-based technologies including social media. A user-friendly toolkit on how to analyse healthcare financing equity will be developed for use by policymakers and development partners in the region.


Assuntos
Assistência à Saúde/economia , Acesso aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde , Financiamento da Assistência à Saúde , Seguro Saúde/economia , Cobertura Universal do Seguro de Saúde/economia , Estudos Transversais , Fiji , Humanos , Indonésia , Estudos Retrospectivos , Fatores Socioeconômicos
15.
J Med Assoc Thai ; 97 Suppl 5: S59-64, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24964700

RESUMO

To meet updated international standards, this paper revises the previous Thai guidelines for conducting sensitivity analyses as part of the decision analysis model for health technology assessment. It recommends both deterministic and probabilistic sensitivity analyses to handle uncertainty of the model parameters, which are best represented graphically. Two new methodological issues are introduced-a threshold analysis of medicines' unit prices for fulfilling the National Lists of Essential Medicines' requirements and the expected value of information for delaying decision-making in contexts where there are high levels of uncertainty. Further research is recommended where parameter uncertainty is significant and where the cost of conducting the research is not prohibitive.


Assuntos
Guias de Prática Clínica como Assunto , Avaliação da Tecnologia Biomédica/economia , Incerteza , Análise Custo-Benefício , Humanos , Probabilidade , Anos de Vida Ajustados por Qualidade de Vida , Sensibilidade e Especificidade , Tailândia
16.
J Med Assoc Thai ; 97 Suppl 5: S108-12, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24964707

RESUMO

The paper gives an overview of the four fundamental elements that should be considered when constructing a Markov model of cancers, including outcome measures, health state transition, transitional probabilities, and model calibration. The construction of any model of this kind should begin by establishing transition to the death state. The probability of this transition can be estimated using overall survival data from clinical studies. Possible health states over a cycle are defined according to the natural history of diseases and treatment pathways. Validity of the constructed model is tested against real patient data and the parameters are adjusted until the survival results are consistent.


Assuntos
Cadeias de Markov , Modelos Econômicos , Neoplasias/economia , Neoplasias/terapia , Calibragem , Humanos , Probabilidade , Análise de Sobrevida
18.
Bull World Health Organ ; 91(11): 874-80, 2013 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-24347713

RESUMO

PROBLEM: In the 1970s, Thailand was a low-income country with poor health indicators and low health service coverage. The local health infrastructure was especially weak. APPROACH: In the 1980s, measures were initiated to reduce geographical barriers to health service access, improve the health infrastructure at the district level, make essential medicines more widely available and develop a competent, committed health workforce willing to service rural areas. To ensure service accessibility, financial risk protection schemes were expanded. LOCAL SETTING: In Thailand, district hospitals were practically non-existent in the 1960s. Expansion of primary health care (PHC), especially in poor rural areas, was considered essential for attaining universal health coverage (UHC). Nationwide reforms led to important changes in a few decades. RELEVANT CHANGES: Over the past 30 years, the availability and distribution of health workers, as well as their skills and competencies, have greatly improved, along with national health indicators. Between 1980 and 2000 coverage with maternal and child health services increased substantially. By 2002, Thailand had attained UHC. Overall health system development, particularly an expanded health workforce, resulted in a functioning PHC system. LESSONS LEARNT: A competent, committed health workforce helped strengthen the PHC system at the district level. Keeping the policy focus on the development of human resources for health (HRH) for an extended period was essential, together with a holistic approach to the development of HRH, characterized by the integration of different kinds of HRH interventions and the linking of these interventions with broader efforts to strengthen other health system domains.


Assuntos
Acesso aos Serviços de Saúde/organização & administração , Mão de Obra em Saúde/organização & administração , Políticas , Serviços de Saúde Rural/organização & administração , Competência Clínica , Medicamentos Essenciais/provisão & distribução , Saúde Global , Acesso aos Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde/normas , Humanos , Qualidade da Assistência à Saúde , Serviços de Saúde Rural/normas , Tailândia
19.
Hum Resour Health ; 11: 53, 2013 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-24148109

RESUMO

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.


Assuntos
Atitude do Pessoal de Saúde , Odontólogos/psicologia , Farmacêuticos/psicologia , Médicos/psicologia , Serviços de Saúde Rural , Adulto , Escolha da Profissão , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Inquéritos e Questionários , Tailândia , Adulto Jovem
20.
Lancet ; 381(9883): 2118-33, 2013 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-23574803

RESUMO

In 1985, the Rockefeller Foundation published Good health at low cost to discuss why some countries or regions achieve better health and social outcomes than do others at a similar level of income and to show the role of political will and socially progressive policies. 25 years on, the Good Health at Low Cost project revisited these places but looked anew at Bangladesh, Ethiopia, Kyrgyzstan, Thailand, and the Indian state of Tamil Nadu, which have all either achieved substantial improvements in health or access to services or implemented innovative health policies relative to their neighbours. A series of comparative case studies (2009-11) looked at how and why each region accomplished these changes. Attributes of success included good governance and political commitment, effective bureaucracies that preserve institutional memory and can learn from experience, and the ability to innovate and adapt to resource limitations. Furthermore, the capacity to respond to population needs and build resilience into health systems in the face of political unrest, economic crises, and natural disasters was important. Transport infrastructure, female empowerment, and education also played a part. Health systems are complex and no simple recipe exists for success. Yet in the countries and regions studied, progress has been assisted by institutional stability, with continuity of reforms despite political and economic turmoil, learning lessons from experience, seizing windows of opportunity, and ensuring sensitivity to context. These experiences show that improvements in health can still be achieved in countries with relatively few resources, though strategic investment is necessary to address new challenges such as complex chronic diseases and growing population expectations.


Assuntos
Assistência à Saúde/organização & administração , Política de Saúde , Acesso aos Serviços de Saúde/organização & administração , Bangladesh , Comportamento Cooperativo , Países em Desenvolvimento , Etiópia , Feminino , Governo , Humanos , Índia , Quirguistão , Masculino , Inovação Organizacional , Pobreza , Tailândia
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