Health Effects of the Asthma Care Program under the Universal Coverage Scheme in Children and Young Adults in Thailand.

This study aimed to evaluate the effect of the asthma care program available under the Universal Coverage Scheme (UCS) in Thailand on hospital admissions per 100,000 population, its regional and seasonal variation, readmission within 28 days, and the asthma-specific fatality rate of patients aged 0-29 years in 2009-2016 compared with those in 2007-2008. A retrospective study was conducted using data sources from the UCS register and in-patient databases from the National Health Security Office (NHSO), Thailand. Hospital admissions per 100,000 population was the highest among those aged 0-4 years, but the trends decreased from 470.8 to 288.1 per 100,000 population in 2010-2014. The hospital admission rates were high in Southern Thailand and common in rainy seasons. The readmission rates within 28 days slightly decreased in all age groups in 2016 compared to those in 2007. The case fatality rate of patients aged 20-29 years decreased from 0.40% in 2007 to 0.34% in 2016. The readmission rate within 28 days and case fatality rate were the highest in patients aged 20-29 years. In conclusion, the asthma hospital admission, readmission, and case fatality rates declined over time along with the investment in the asthma care program under the UCS in Thailand. The highest hospital admission rates in patients aged 0-4 years and the readmission and case fatality rates in patients aged 20-29 years should be given more attention. Recordings of individual service utilization data in asthma patients, including quality of care provided, should be monitored to improve the asthma care system.

Access to reperfusion therapy and mortality outcomes in patients with ST-segment elevation myocardial infarction under universal health coverage in Thailand.

BACKGROUND: Evidence on access to reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI) and associated mortality in developing countries is scarce. This study determined time trends in the nationally aggregated reperfusion and mortality, examined distribution of percutaneous coronary intervention (PCI) utilization across provinces, and assessed the reperfusion-mortality association in Thailand that achieved universal health coverage in 2002. METHODS: Data on hospitalization with STEMI in 2011-2017 of 69,031 Universal Coverage Scheme (UCS) beneficiaries were used for estimating changes in the national aggregates of % reperfusion and mortality by a time-series analysis. Geographic distribution of PCI-capable hospitals and PCI recipients was illustrated per provinces. The reperfusion-mortality association was determined using the propensity-score matching of individual patients and panel data analysis at the hospital level. The exposure is a presence of PCI or thrombolysis. Outcomes are all-cause mortality within 30 and 180 days after an index hospitalization. RESULTS: In 2011-2017, the PCI recipients increased annually 5.7 percentage (%) points and thrombolysis-only recipients decreased 2.2% points. The 30-day and 180-day mortalities respectively decreased annually 0.20 and 0.27% points among the PCI recipients, and they increased 0.79 and 0.59% points among the patients receiving no reperfusion over the same period. Outside Bangkok, the provinces with more than half of the patients receiving PCI increased from 4 provinces of PCI-capable hospitals in 2011 to 37 provinces, which included the neighboring provinces of the PCI-capable hospitals in 2017. Patients undergoing reperfusion had lower 30-day and 180-day mortalities respectively by 19.6 and 21.1% points for PCI, and by 14.1 and 15.1% points for thrombolysis only as compared with no reperfusion. The use of PCI was associated with decreases in 30-day and 180-day mortalities similarly by 5.4-5.5% points as compared with thrombolysis only. A hospital with 1% higher in the recipients of PCI had lower mortalities within 30 and 180 days by approximately 0.21 and 0.20%, respectively. CONCLUSIONS: Patients with STEMI in Thailand experienced increasing PCI access and the use of PCI was associated with lower mortality compared with thrombolysis only. This is an evidence of progress toward a universal coverage of high-cost and effective health care.

Trend of Cesarean Section Rates and Correlations with Adverse Maternal and Neonatal Outcomes: A Secondary Analysis of Thai Universal Coverage Scheme Data.

Objectives The main purpose of this article is to estimate the trend and projection of cesarean section rates (CSRs) and explore correlations between CSRs with adverse maternal and perinatal outcomes, namely maternal mortality ratios (MMRs), rates of postpartum hemorrhage (PPH), neonatal mortality rates (NMRs), and birth asphyxia per 1,000 live births across all regions of Thailand. Study design A secondary analysis of the hospital-based database of pregnant women and newborns under the Thai Universal Coverage Scheme between January 2009 and December 2017 was conducted. Results Overall annual CSR significantly increased from 23.2% in 2009 to 32.5% in 2017. With the same rate of increase, the CSR of 59.1% was projected by the year 2030 that could be reduced to 30.0% if an annual rate of CS reduction of 1% was assumed using Joinpoint regression. The increasing CSRs were significantly correlated with higher MMRs ( r = 0.20, p = 0.03) and birth asphyxia ( r = 0.39, p < 0.001). The correlation trends were similar when the analyses were stratified by year in the majority of years. Overall correlations between CSRs and rates of PPH or NMRs were not statistically significant. Conclusion CSRs in Thailand continuously increased and were correlated with adverse maternal and perinatal outcomes. More effort at the national level to reduce unnecessary CS is urgently required.

Budget impact analysis of the new reimbursement policy for day surgery in Thailand.

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.

Improving the measurement of maternal mortality in Thailand using multiple data sources.

BACKGROUND: Thailand uses cause of death records in civil registration to summarize maternal mortality statistics. A report by the Department of Health using the Reproductive Age Mortality Studies (RAMOS) reported that the maternal mortality ratio (MMR) in 1997 was approximately three to four times higher than MMR based on the civil registration cause of death records. Here, we used multiple data sources to systematically measure maternal mortality in Thailand and showed a disparity between age groups and regions. METHODS: We calculated the number of maternal deaths using a two-stage method. In the first stage, we counted the number of deceased mothers who successfully gave live births. In the second stage, we counted the number of women who died during the pregnancy, delivery, or the postpartum period without a live birth. RESULTS: The number of maternal deaths dropped from 268 in 2007 to 226 in 2014. Nearly 50 % of the deaths occurred in Stage 1. The maternal mortality ratio in 2007 was 33.6 per 100,000 live births; the rate fell to 31.8 in 2014. The age ranges of women observed were 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, and 45-49, and the MMR averages were 21.5, 23.8, 27.0, 42.1, 67.7, 115.4, and 423.4 per 100,000 live births, respectively. The Southern region consistently exhibited the highest MMR compared to other regions for every year analyzed, except 2012. Women in Bangkok had a lower risk of dying during pregnancy, delivery, and the postpartum period than women from other regions. CONCLUSIONS: We demonstrated that using multiple administrative data sources in the two-stage method was an efficient method that provided systematic measurement and timely reporting on the maternal mortality ratio. An additional benefit of the method was that information provided from the combined data sources, (e.g., the number of maternal deaths by age group and region) was relevant to the safe motherhood policy.