Umfassender Versicherungsschutz im thailändischen Gesundheitssystem: eine Nutzenanalyse

Mit Hilfe der thailändischen Sozial- und Wirtschaftsdaten aus dem Jahre 2002 untersucht der Aufsatz die Nutzenverteilung im thailändischen Gesundheitssektor. Analysiert werden die Verteilungen medizinischer Nutzen von diversen Gruppen innerhalb des thailändischen Gesundheitssystems. Die Studie kommt zu dem Ergebnis, dass der Nutzen auf jeder Ebene des Gesundheitswesens im Vergleich zur Zahlungsfähigkeit der Patienten gleich ausgeprägt ist. Bezieht man jedoch die Qualität der Einrichtungen ein, erkennt man einen ungleichen Zugang von Menschen mit unterschiedlichem sozio-ökonomischen Status. Die reiche Bevölkerung wird in Provinzkrankenhäusern, die eine bessere und spezialisiertere Behandlung ermöglichen, begünstigt. Einrichtungen mit begrenzter Behandlungsmöglichkeit wie Gesundheitszentren und Gemeinschaftskrankenhäuser behandeln hingegen eher die ärmeren Bevölkerungsschichten. Der Artikel diskutiert den ungleichen Zugang zum Gesundheitswesen, die Fehlallokation von Gesundheitsressourcen im Land, die Anwendung von Nebenzahlungen unter dem 30-Baht-Gesundheitssystem und die Überlappungen in den Zuweisungen im Allgemeinen Gesundheitssystem Thailands

Mental Health Status and its Determinants Among Older People in Rural Area in the District of Banyumas Central java

Elderly people experience several health problems due to their vulnerability to many diseases, which may affect their mental health. This study aims to assess mental health status among older people and its determinants in rural areas.  It is a cross-sectional study design and involves 412 respondents from 9 villages in the district of Banyumas, Central Java, Indonesia. The data was analyzed by using a logistic regression model. The findings showed that older people with a large number of family members were four times more likely to have a mental health problem than those with a small number. Older people with a history of chronic disease had a threefold greater risk of experiencing mental health problems than older people without chronic disease. Three times as many elderly people with middle economic status reported having mental health issues. Older people with lower education have fewer mental health problems compared to older people who graduated from higher education levels. Health check-up was discovered to influence mental health problems, with older people who did checkups even if irregularly having fewer mental health problems than older people who never did. The study concludes that family size, chronic disease history, economic condition, education, and health check-up are determinants of mental health problems in rural Indonesia

Assessing Coastal Vulnerability to Climate Change: A Case Study of Nakhon Si Thammarat and Krabi

Climate change is increasingly impacting both environments and human communities. Coastal regions in Thailand are experiencing more severe impacts, which vary based on the unique physical and socio-economic characteristics of each area. To assess the vulnerability of coastal regions in Thailand, this study focused on two provinces, Nakhon Si Thammarat (NST) and Krabi, each representing distinct coastal environments. NST, situated on the Gulf of Thailand’s east coast, has an agriculture-based economy, while Krabi, on the Andaman Sea’s west coast, relies heavily on tourism. The study utilized a multi-criteria decision analysis approach (MCDA) and GIS to analyze the Coastal Vulnerability Index at the sub-district level. The results revealed that, although NST was more vulnerable than Krabi to socio-economic factors such as the poverty rate and the number of fishery households, Krabi was much more vulnerable in the physical environment, including wave height, tidal level, coastal erosion, and slope. However, overall, Krabi exhibited high to the highest levels of coastal vulnerability, while NST displayed moderate to high levels. These findings provide valuable insights for policymakers and government agencies, aiding in the development of strategies to mitigate vulnerability and enhance the quality of life for local residents in both province

Coastal Erosion and Flood Coping Mechanisms in Southern Thailand: A Qualitative Study

Communities in coastal regions are affected by the impacts of extreme climatic events causing flooding and erosion. Reducing the impacts of flood and erosion in these areas by adopting coping strategies that fortify the resilience of individuals and their localities is desirable. This study used summative content analysis to explore the coping mechanisms of coastal communities before, during, and after various dangers relating to flooding and erosion. The findings from the study show that effective surveillance systems, disaster preparedness, risk mapping, early warning systems, availability of databases and functional command systems, as well as reliable funding are essential to efficiently cope with hazards of coastal flooding and erosion. As flooding and erosion have been predicted to be more severe due to climate change in the coming years, the adoption of effective natural and artificial mechanisms with modern technologies could help coastal regions to be more resilient in coping with the dangers associated with flooding and erosion. Pragmatic policies and programs to this end by actors are critical to averting crises induced by flooding and erosion in coastal areas

Impacts and Constraints of Universal Coverage in Thailand's Public Health: A Survey Study in the Northeast Region

この論文は国立情報学研究所の学術雑誌公開支援事業により電子化されました。This paper assesses impacts and constraints of the implementation of universal coverage (UC) in Thailand's public health system so far in selected provinces of the northeast region. Based on incidence and findings discovered in the survey, we can draw out a depiction to explain linkages and systematic consequences of the situations from the Primary Care Units (PCUs) to secondary and tertiary level hospitals. The depiction simply describes the current situation and the impact of UC on the whole system of care provisions with specific constraints at each facility level, and illustrates the systematically negative cyclic consequences of those constraints. Due to the "primary constraints" at all facility levels - mainly because of a shortage of health workers and inadequate budget financing - the Sarng-Nam-Sorm (health promotion and disease prevention ahead of curative health care) and Klai-Baan-Klai-Jai (Health facility near dwelling) strategies of the UC policy face failures at the PCU level, which, as a result, do not reduce, but rather increase number of the patients at the hospital level. Unbearable workloads and poor equipment with a lack of specific needed professionals at most secondary level hospitals at the district level has tended to push them to more often refer inpatient cases to tertiary level hospitals in the provincial cities because it is better and safer for patients. This is often viewed by the tertiary level hospital as over-referral, and puts a tremendous burden on them in terms of physical workloads and financial cost. In this study, we explained that these impacts from facilities in lower levels to those at higher levels are "linking consequences", which will eventually negatively result backward on the lower level facilities in terms of "secondary constraints". In the long run, if no attempt is made to ease the constraints and improve the situation - mainly regarding the inadequacy of the health workforce and funding- this vicious cycle of negative consequences could collapse the whole public health care system and UC

タイ シャカイ ホショウ ニ オケル カイホケン セイド ノ ジッシ : ケンコウ ホケン セイド ノ ジッセキ ト ソノ エイキョウ

京都大学0048新制・課程博士博士(地域研究)甲第13194号地博第44号新制||地||14(附属図書館)UT51-2007-H467京都大学大学院アジア・アフリカ地域研究研究科東南アジア地域研究専攻(主査)教授 水野 廣祐, 教授 松林 公蔵, 教授 玉田 芳史学位規則第4条第1項該当Doctor of Area StudiesKyoto UniversityDA

Assessment of People's Views of Thailand's Universal Coverage (UC): A Field Survey in Thangkwang Subdistrict, Khonkaen

この論文は国立情報学研究所の学術雑誌公開支援事業により電子化されました。This paper assesses a variety of views held by the Thai people residing in an area considered "rural" in the Khonkaen province of northeastern Thailand concerning the adoption in 2001 of Universal Coverage (UC) through the 30 Baht Scheme. According to findings from a questionnaire process that included casual interviews, a number of respondents expressed favorable opinions of the concepts underlying the implementation as well as its performance so far. This was especially the case with respect to lower medical expenses, qualitative improvements in health care provision, and attitudes toward the 30 Baht Scheme. Some of those covered by other health schemes, mainly the elderly who obtain their health benefits through the Civil Servant Medical Benefit Scheme (CSMBS), even mentioned a preference to be switched to the 30 Baht Scheme if it were allowed. The fixed co-payment of 30 baht per episode is seen as affordable and fairly reasonable to people across socioeconomic statuses, and therefore need not be revised. For most factors related to satisfaction with the utilisation of medical care, average scores indicate satisfaction. The "co-payment" scored the most satisfactory and "transportation costs" scored the least satisfactory.Now that they are entitled to the right to access better medical care through UC, a larger proportion of people reported that they prefer to visit public health facilities when care is needed rather than private facilities more often compared to the pre-UC period. The rate of care utilisation is also tentatively higher. In this study, an analysis of medical care expenses shows an inequitable burden of the expenses on people across three strata of income groups, which are classified by annual household income per head

Correlates of HIV Testing Experience among Migrant Workers from Myanmar Residing in Thailand: A Secondary Data Analysis.

BACKGROUND:Thailand continues to attract an increasing number of migrant workers (MW) from neighboring countries including mainly Myanmar, Cambodia, and Laos; however, little is known about the extent to which MWs from these countries have access to HIV prevention, treatment, and care services. We used data from the baseline survey of the Prevention of HIV/AIDS among MWs in Thailand (PHAMIT-2) project to document the prevalence of, and factors associated with, HIV testing among MWs from Myanmar, the largest group of MWs in Thailand. METHODS AND FINDINGS:The baseline survey of PHAMIT-2 was conducted in 2010 among MWs from Myanmar, Cambodia, and Laos in 10 purposely-selected provinces of Thailand. Of the 1,034 participants who qualified for the analysis to identify correlates of HIV testing, only 5.3% reported ever having been tested for HIV. Factors associated with HIV testing included having a secondary or higher education level (AOR, 2.58; CI, 1.36-4.90; P = 0.004), being female (AOR, 1.96; CI, 1.05-3.66; P = 0.033), knowing someone who died of AIDS (AOR, 1.81; CI, 1.00-3.27; P = 0.048), working in the fishery sector (AOR, 2.51; CI, 1.28-4.92; P = 0.007), and not having a work permit (AOR, 3.71; CI, 1.36-10.13; P = 0.010). CONCLUSION:Our study, in addition to revealing significantly low HIV testing among MWs from Myanmar, identifies important barriers to HIV testing which could be addressed through interventions that promote migrants' culturally-sensitive and friendly service, for example by facilitating flow of information about places for HIV testing, availability of language assistance, and ensuring confidentiality of HIV testing

Multivariate analysis of factors associated with ever have been tested for HIV.

<p>Multivariate analysis of factors associated with ever have been tested for HIV.</p