General practice residency training program in Thailand: past, present, and future.

The General Practice was approved by the Thai Medical Council as a specialty in 1969. The residency training programs were revised in 1992. The first three - year rotating postgraduate residency training program was started in 1973 with a total of 9 programs by the late 1980s. Seven were in Bangkok, and the other 2 were in the North. The programs contained curricula objectives, clinical rotation in various disciplines including a general practice block in provincial or community hospitals. The weakness of the programs was the lack of a general practice department, a general practice trainer or preceptor and a general practice course organizer. Finally, the General Practitioners Association played a little role in the postgraduate general practice residency. After the revision, the general practice residency was changed to family medicine residency training in 1999. The College of Family Physicians of Thailand was established to take a central role in postgraduate education.

Medical cost and illness pattern among Ramathibodi medical students.

BACKGROUND: In Thailand, health care expenditure has increased more than three times from the 1982 to 1992. Health care of medical students does not reflect the actual costs because of the strong personal relationship between doctors and patients (ie. medical students). Many items are waived in the patient's favour. The objectives of study in medical students were analysed in unit cost, cost recovery, illness pattern and health service uses. METHOD: From May 1997 to April 1998 the prescription cost and illness pattern were retrospectively studied and analysed. There were 1,063 out-patient visits and 8 in-patient cases from 416 medical student case records of Ramathibodi Hospital. The annual subscription for medical student is 700 baht per person per year, but the actual medical costs are higher 53,213 baht, excluding investment, materials and labour cost. The most common illness was upper respiratory tract infection. The average cost per prescription was 163 baht (range 6-1391 baht) and the sixth year students spent more than the fourth and fifth years. Frequency of consultation was more in the fourth than the fifth and sixth year students and total medical students (namely 4.01, 1.66, 1.92, 2.55 times/student/year respectively). The consultation was done in the emergency room (72.0%) more often than in the health clinic (1.9%). CONCLUSION: Medical students should attend special clinics regularly, except in an emergency, to get continual medicare and save medical costs. Determining the maximum medical cost per student per year is a strategy of saving cost. To promote understanding and allay anxiety, medical students should have the benefit of health promotion, prevention and orientation as they are in continual contact with all forms of contagious diseases. If this preventive measure is effective, the incidence of illness should be lower and the cost reduced.