Evidence-based priority setting for the National Health Development Plan of Thailand

Walaiporn Patcharanarumol, Kanitta Bundhamcharoen, Phusit Prakongsai, Waraporn Poungkantha, Viroj Tangcharoensathien

International Health Policy Program (IHPP) - Thailand

Contact Information: Waraporn PoungkanthaInternational Health Policy Program, Ministry of Public Health. Tiwanon Road, Muang, Nonthaburi 11000Tel: +66 (0)2 590 2355-7 Fax:+66 (0)2 590 2385 http://www.ihpp.thaigov.net

IntroductionThe study on burden of disease and health risks among Thais in 1999

and 2004 indicate an increasing trend in burden of disease and illness caused by chronic non-communicable diseases and health risk

behavior, particularly diabetes mellitus (DM), cardio-vascular disease, cerebro-vascular disease (CVD), cancer, and illness caused

by harmful use of alcohol. The number of disability-adjusted life year (DALY) loss from NCD increased from 5.6 million in 1999 to 6.5 million in 2004, while the number of DALY loss attributable to

communicable disease (CD) decreased from 2.6 million in 1999 to 2.1 million in 2004, and the number of DALY loss from accident and

injuries were similar between both years of the studies (Table 1).

Source: The report on burden of disease and illness of Thais in 1999 and 2004

The National Economic and Social Development Board (NESDB) commissioned IHPP to explore and provide guidance on which policy intervention and how to prioritize investment in health sector in the

10th National Development Plan of the country which cover the period from 2007 to 2011.

MethodsThe study applies comprehensive literature reviews, secondary data

analyses, interview of key informants, and brainstorming meeting among key stakeholders to answer four specific objectives: a)

burden of disease (BOD) priorities; b) health interventions currently implemented in Thailand against what recommended by DCP2; c)

costs of top-ten BOD in terms of medical expenditure, and productivity loss due to premature deaths and morbidity; d)

assessment of medium term economic framework in different scenario of health sector investment.

codeBurden of diseases

DALY loss (yr)

Curative expenditurePremature death

Absenteeism

OP IP Total OP IP OP+IP1 A3 HIV/AIDS 19% 28% 4% 17% 35% 6% 8% 6%2 F5 Liver cancer 8% 1% 2% 1% 10% 1% 3% 1%3 H DM 9% 31% 4% 18% 4% 35% 9% 32%4 J1 Depression 7% 1% 0.1% 0.4% 0% 1% 1% 1%5 J4 Alcohol 7% 0.4% 1% 1% 1% 2% 5% 2%6 L2 Cataracts 2% 3% 8% 6% 0% 5% 4% 5%7 M3 IHD 7% 7% 11% 9% 6% 5% 6% 5%8 M4 CVD 13% 4% 10% 7% 9% 4% 9% 5%9 N1 COPD 6% 3% 5% 4% 3% 8% 6% 7%

12 UTraffic

accidents 15% 14% 50% 31% 26% 28% 45% 30%Total from 12 leading BOD

(million Baht)

100% 100% 100% 100% 100% 100% 100% 100%

4,780,000 32,452 29,484 61,936 208,287 9,836 1,437 11,273

ObjectiveTo describe how Thailand use evidence on country’s burden of

disease and cost-effectiveness of health interventions from the 2nd edition Disease Control Priority in Developing Countries (DCP2) to

set priorities in health sector investment in the 10th National Health Development Plan.

2007 2008 2009 2010 2011

Total Health Expenditure (THE in million Baht) 305,472.61 336,467.61 394,854.76 435,041.23 479,945.85

P&P Expenditure 21,505.16 22,504.21 47,006.51 49,004.60 51,002.70

P&P higher than status quo 0.00 0.00 23,503.25 24,502.30 25,501.35

THE, % GDP 3.61% 3.66% 4.00% 4.11% 4.22%

P&P, % GDP 0.25% 0.24% 0.48% 0.46% 0.45%

P&P, Baht per capita 325 336 694 715 738

Type of disease burden1999

(million DALY loss)2004

(million DALY loss)Male Female Total Male Female Total

Communicable disease 1.6 1.0 2.6 1.2 0.9 2.1Non-communicable disease

2.9 2.6 5.6 3.4 3.1 6.5Accident and injuries 1.0 0.3 1.3 1.0 0.3 1.3Total 5.6 3.9 9.5 5.7 4.2 9.9

ISPOR 14th Annual European Congress5-8 November 2011

Hotel Auditorium Madrid, Madrid, Spain

Table 3: Total health expenditure and expenditure for HP & disease prevention*

* This scenario is to double health expenditure for health promotion and disease prevention in status quo scenario from 2009 onward, and expenditure for curative care and administration hold at the level in the status quo projection.

Discussion and ConclusionThailand must invest more on health of the population, in particular on disease prevention and health promotion to address three national health priorities: HIV/AIDS, road traffic injuries and diabetes mellitus through cost effective interventions in and outside the health sector. The most probable scenario for increasing investment in health promotion and disease prevention is to double the amount of investment for health promotion and disease prevention. Also, resources can be mobilized from local administrations and communities, and should be managed by efficient and accountable agency with effective mechanisms.