ABSTRACT
Background: Thailand HIV/AIDS epidemics have been driven in specific populations from homo/bisexuals through pregnant women, youths and mobile population. Strategic actions for impact mitigation on people living with HIV/AIDS and their households are needed. Methodology: Economic impact of HIV/AIDS morbidity on case (with HIV/AIDS)/ control households in rural Thailand and coping mechanisms was conducted in two districts of Phayao province in Northern Thailand: among 300 households in Mueng district (or active villages) and 300 households in Pong district (or less active villages). Main economic indicators from the historical and alternative simulation with 20 percent decrease and increase in health care to change of historical-alternative simulation was performed. Results: Main economic indicators from the historical simulation showed that total income, consumption and saving per capita in case respectively was 69, 47 and 265 percent lower than in control. From alternative simulation with 20 percent decrease in health care showed negative percentage change of historical-alternative simulation while alternative simulation with 20 percent increase in health care showed positive change. From follow-up studies, action to minimize distress was followed and mobilization of control to case household was demonstrated. Scope of accessibility was created and sustained such as medical services e.g. VCT, OI prophylaxis, ART and specific laboratory support including CD4 and viral load. Conclusion: The studies showed that total income, consumption and saving per capita in case was lower than in control households and increase in health care support was an important mechanism to mitigate the impact of HIV/AIDS to households. Strengthening the partnership between the communities, governments, donor agencies, NGO, private sectors in mitigating the impacts of HIV/AIDS are potential focus areas for strategic mainstreaming at the household level. The remaining questions are how social networks affect the impact, vulnerability and responses to HIV/AIDS and poverty. The extension of studies beyond rural economy and dissemination of information are essential further actions.
ABSTRACT
This study aims to analyze the cost-effectiveness of Hypertensive Elderly Service in the OPD and the PCU of Hua Hin Hospital, Prachuap Khiri Khan Province. The 12 weeks cohort study from June to September 2007 was designed to evaluate the outcome of hypertensive elderly services at the two settings. By purposive selection of new hypertensive elderly patients age 60 years and above, the study included 54 patients from the OPD and 36 from the PCU. Both provider and patient perspective of cost analysis were taken into account. The provider costs data was collected from hospital records while the patient costs data was collected by interview and structured questionnaire. The effectiveness was measured as the average reduction in the systolic blood pressure. Both cost and outcome data were analyzed using descriptive and analytical statistics. The results showed that hypertensive elderly service at PCU was more cost-effective than the OPD of Hua Hin Hospital. The cost-effectiveness ratio was 75.05 Bt/mmHg for the hypertensive elderly service in the OPD and 32.60 Bt/mmHg for the PCU. The total costs of the OPD were 1,223.27 Baht while the total costs of the PCU was only 444.69 Baht. The sensitivity analysis of the service costs indicated that unit costs vary with the time used for the stage of patient screening. The study suggested that it is necessary to strengthening the capability of PCU in providing chronic care service in order to reduce the burden of costs to the hospital and to the patients. Health promotion and prevention programs should be encouraged and implemented to people of all ages though there is costs incurred from health promotion programs but it is worth in the long run in term of quality of life and reduction in the costs of treatment.