นโยบายหลักประกันสุขภาพในการดูแลผู้ป่วยปฐมภูมิ

chuchai.s@nhso.go.th chuchai.sn@gmail.com www.facebook.com/Morchuchai1

1.2.3. 4

1. (Indicators and Measurements)2. (National Health Authority)3. (Health Service Provider4. 5 (Healthcare

5. (National Health Information)6. (Health Foreign Policy Office)7. (Health Information6 System and Network)

9.10.11.7

1.2. (National Health Information)3. 8

4.5.6.9

7.8.9. 10

10. 3011. Reprocess)12. 11

1.2. Every Woman Every Child (EWEC)3.4.5. 12

6.7.8.13

: (Globalization)(Legal enforcement) (Health System

- 12- 15 69-346บ ท า /วัน 16 เส้ วา ย ก น-346บ ท นค ม า จ า /วัน 14 12 10 8 6 4 2 0 2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 255017

100%90%80%70%60%50%40%30%20%10% 0% 25292531253325352537253925412542254325442545254725492550 18

100%90%80%70%60%50%40%30%20%10% 0% 2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550

325 6000000 - 500000020 - 400000015 300000010 20000005 10000000 0 20 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550

360 %ครัวเรือ นกลางที่ นชั้ มีรถจักรย นต์ อ วเรือ งห านย ต่ ครั นทั้ มด 14000000 ครัวเรือ ที่ น-จน มีรถจักรย นต์ านย ครัวเรือน-กลางที่มีรถจักรย นต์ านย 1200000050 ครัวเรือน-รวยที่ มีรถจักรย นต์ านย ครัวเรือ งห ที่ น-ทั้ มด มีรถจักรย นต์ านย 1000000040 800000030 600000020 400000010 20000000 0 21 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550

Generation 2010 2020 2030Baby Boomer - -Gen X - -Gen Y -Gen M - 6,462 22,204

The Implications of Social Media

What’s Social About Health Behavior? Asymptomatic Screenings Lifestyle Modifications Cessation of Addictive Behaviors Medical Regimen Compliance Precaution Adoption

m-Change and Obesity The appropriate model for obesity and weight management is tailored information according to design principles suggested by Social Cognitive Theory and the Social Marketing Model. The health behaviors to target are self-monitoring of diet and physical activity. The devices are Web-enabled “smart” cellular telephones and wireless PDAs. JT Tufano & BT Karras. Mobile eHealth Interventions for Obesity: A Timely Opportunity to Leverage Convergence Trends. Journal of Internet Medical Research 2005;7(5):e58).

Burden attributable to risk factors, 1999-2004 U s fes x na e 9 % .4 20 04 1 .8 3 % A hl lco o 8 % .1 19 99 5 % .8 T ba o cco 5 % .7 5 % .1 B o pre s re lo d s u 5 % .5 5 % .0 N t w a gh lm t o e rin e e 4 % .5 4 % .2 O s be ity 3 % .7 3 % .9 C o s ro h le te l 2 % .2 2 % .3 F it &v gie ru e s 1 % .7 1 % .4 P y ica in ctiv h s l a ity 1 % .3 1 % .2 Illicit drugs 0 % .9 3 % .6 A po tio ir llu n 0 % .9 1 % .4 Wte &s n tio a r a ita n 0 % .5 0 % .7 Mln tritio - in s n rd a u n t ta da 0 % .3 0 % .7 N t w a gs a lt o e rin e tbe 0 % .3 0 % .4Mln tritio - T a s n rd a u n h i ta da 0 % .2 0 % .3 0 % .0 2 % .0 4 % .0 6 % .0 8 % .0 1 .0 0 % 1 .0 2 % 1 .0 4 % 1 .0 6 % %o to l b r e f ta ud n

2550 35 10 2.4 50 5.4  Sugar  Oily fast food  Salted snacks

HIV infections in Thailand 10,000,000 9,000,000 8,000,000 7,000,000Current HIV Infections 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 1,000,000 0 1985 1990 1995 2000 2005 2010 2015 2020 Year Source: Tim Brown High-Risk Behaviors Changed Behaviors (Actual, Beginning 1990)

Atherosclerosis: A Worldwide Challenge for the 21st CenturyMortality rate: 1999-2004 mortality rate by age group1.00000 <1 1- 4 5- 9 -1 4 -1 9 -2 4 -2 9 -3 4 -3 9 -4 4 -4 9 -5 4 -5 9 -6 4 -6 9 -7 4 -7 9 -8 4 -8 9 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 850.10000 male1999 female19990.01000 male2004 female20040.001000.00010 year “Cardiovascular disease accounts for 14.8 million deaths per year worldwide”. W.H.O. report 1998

DALYs ranks in 1999 and 2004Males Year 2004 Year 1999 R ank Disease DALYs(000) % % DALYs(000) Disease 1 HIV/AIDS 645 11.3 17.2 960 HIV/AIDS 2 Traffic accidents 584 10.2 9.2 511 Traffic accidents 3 S troke 332 5.8 4.8 268 S troke 4 Alcohol dependence/harmful use 332 5.8 4.4 248 Liver cancer 5 Liver and bile duct cancer 280 4.9 3.0 168 Diabetes 6 C OP D 187 3.3 2.9 164 Ischaemic heart disease 7 Ischaemic heart disease 184 3.2 2.8 157 C OP D (emphysema) 8 Diabetes 175 3.1 2.8 156 Homicide and violence 9 C irrhosis 144 2.5 2.7 148 S uicides 10 Depression 137 2.4 2.5 138 Drug dependence/harmful useFemales Y ear 2004 Y ear 1999 R ank Disease DALY s(000) % % DALY s(000) Disease 1 S troke 313 7.4 9.4 373 HIV/AIDS 2 HIV/AIDS 291 6.9 7.1 281 S troke 3 Diabetes 271 6.4 6.8 267 Diabetes 4 Depression 191 4.5 3.7 145 Depression 5 Ischaemic heart disease 142 3.4 3.0 118 Liver cancer 6 Traffic accidents 125 3.0 3.0 118 Osteoarthritis 7 Liver and bile duct cancer 124 3.0 2.9 115 Traffic accidents 8 Osteoarthritis 118 2.8 2.9 113 Anaemia 9 C OP D 115 2.7 2.8 110 Ischaemic heart disease 10 C ataracts 111 2.6 2.4 96 C ataracts

social morbidity

Chronic Conditions -   

Full Integration: Population Based and ChronicCare Case Based Model HEALTH IMPROVEMENT DISEASE MANAGEMENT Lifestyle interventions Disease Low risk At risk Early Signs Symptoms Disease Management Preventive Services Case Management Screening Primary and Secondary Acute Disease Prevention treatment Management HEALTH MANAGEMENT POPULATION-BASED CASE-BASED

 2554-2563 2553-2555

Effective coverage of diabetes 100% 80% 60% 40% 20% 0% treat controlled 2004 2009 2004 2009 2004 2009 2004 2009 2004 2009 2004 2009 2004 2009 2004 2009 treat uncontrolled 45-59 60-69 70-79 80+ 45-59 60-69 70-79 80+ know but not treat male female not awareEffective coverage of diabetic servicesSource: NHES (2004, 2009)

: (PPIS) OBMI PHT OWAIST STROKE HT PDM DM 36

2552-2555 9 DM & DM with HT (NHES 51-52)3,000,000 2 498 491 2 527 629 2 351 763 2 459 78 88.2,500,000 1 50 77. 682,000,000 71. 38 จำนวน ผป.เบำหวำน ทีเข้ำถึ ง ่ 5 เปรียบเทียบกับอัตรำควำมชุก1,500,000 จำนวนผป.เบำหวำนทีเข้ำถึ งบริกำร ่1,000,000 500,000 - ปี 2552 ปี 2553 ปี 2554 ปี 2555 DM UC 6.9 % : 12, 18 files

- (%) (%) (%) Fasting Plasma Glucose - mg/dL HbA1c HbA1c < 7%− FPG 70-130 mg/dL HbA1c < 7%− FPG <70/>130 mg/dL HbA1c < 7% 21 Lipid profile LDL < 100 mg/dL ≤ mmHg Albumin Protein Microalbuminuria ACE inhibitor ARB

- (%) (%) (%) 2 3 4 5 − −16 Diabetic Retinopathy *

DM/HT 2553-2555 NHSO- NCD Board SystemManager Team- DM/ HT- DM/HT Case Manager- DM HT Chronic care model-- /- DM HT- DM/HT /- DM/HT- DM HT- DM/HT

Chronic Care ModelEpping-Jordan, J E et al. Qual Saf Health Care 2004;13:299-305

Community-based health care 7. 1. Health Sufficiency 2. Promotion Economy Considerate 6. Better Society StrongDiseases Community Communitycontrol health 3. 5. 4. Treatment Care for Care for of common Elderly Chronic Diseases diseases

Excellent Center Tertiary Medical Care Tertiary Referral Center Care ( Care) SecondaryCare Special Medical CaReferral System Secondary Care Primary Medical Care ( Care) General Practice Primary Care Family Practice, NP ( Care) Primary Health Care Self-Care Managem Holistic Integrated Continuous Care Care Care

NGOClinical & functional outcomes

21 : AEC World Health Report: 2008

2554 Primary Care On top payment1.2.3.4. PCA

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/ - :90008000 7718 742470006000 55085000 393540003000 26892000 8881000 0 2549-50 2551 2552 2553 2554 2555 7,718 .25%) 56 65 %)

1.2.3.4. 10

นโยบายหลักประกันสุขภาพในการดูแลผู้ป่วยปฐมภูมิ

by Chuchai Sornchumni on Jan 20, 2013

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