Geographical variation of mortality in Thailand.

OBJECTIVE: To examine geographical variation of mortality in Thailand. MATERIAL AND METHOD: Descriptive ecological study using the national vital registration data in 2000, age-specific mortality rate and cause-specific standardized mortality ratio (SMR) were presented at district geographic level. RESULTS: Overall mortality was highly concentrated in the middle part of the upper north, as well as mortality of the working age. Clustering of cause-specific SMR in a single region was found for liver cancer (in the upper northeast region) and chronic obstructive pulmonary disease (in the upper north region). Clustering in multiple regions was found for renal failure (in the upper north and the upper northeast regions). Dispersed pattern of mortality with no regional clustering was found for leukemia. The geographical pattern of cause-specific mortality might be explained by distribution of incidence and related risk factors. CONCLUSION: Geographical variation of mortality exists and should be used as a target for reducing mortality gap across geographical areas.

Benchmarks of Fairness for health care reform in Thailand--combining evidence with opinion of the civic group.

The concept of the Benchmarks of Fairness was tried in Thailand before the big reform of universal coverage policy in 2001. The first phase of the Benchmarks in 1999 involved the analysis of the national health reform proposal as well as the analysis of ongoing field trials of health reforms in two provinces. Though the participants were predominately health personnel, the results suggested the power of combining qualitative viewpoints of participants with the quantitative indicators within the province to move health reforms to more equitable, more efficient and more democratic directions. The second phase of the Benchmarks of Fairness, therefore, tested the possibility of involving wider participation of the civic groups related, and not-related to health, in assessing their provincial health system. The health achievements of the provinces a measured by 81 indicators, in the 9 benchmarks, were provided to the civic groups before focus group discussions in 10 selected provinces to facilitate discussions based on evidence. More qualitative data were obtained from the discussions as well as their judgements on the fairness of their provincial health system. Having completed this second phase, it was recommended that the benchmarks tool could be further endorsed as the basis for monitoring the progress of health reform by province and the effect of health care decentralization. To accomplish this monitoring, the civic groups should have continuous access to evidence, in line with the benchmarks, and they should be provided with the opportunity to express their views, which is helpful in monitoring fairness in the long run.