Southeast Asia's Health Policy Articles Published in Oxford Journals

The current issue "Health Policy and Planning" series published in Oxford Journals include many articles from Southeast Asia. These are open access articles. Please see the abstracts below and download the full text for your interests.

 

Capacity building for global health diplomacy: Thailand’s experience of trade and health

Suriwan Thaiprayoon and Richard Smith

Health Policy Plan. 2015 30: 1118-1128

Abstract

Maternal and child health (MCH) handbooks are comprehensive home-based booklets designed to integrate MCH records. Although empirical evidence suggests the handbooks are more effective than current card-type records, this has not been scientifically demonstrated. The objectives of this study were to evaluate the impact of the MCH handbook on maternal knowledge and behaviour as measured by antenatal care (ANC) attendance, delivery with skilled birth attendants (SBAs) and delivery at a health facility. The Cambodian version of the MCH handbook was developed and introduced in two health centres, and two other health centres served as controls. Pre-intervention and post-intervention surveys were conducted with 320 women from the intervention areas and 320 women from the control areas who had given birth within 1 year before the survey. We evaluated the impact of the handbook by using difference-in-differences (DID) analysis and calculated adjusted odds ratios for pre–post changes in key indicators by using logistic regression. In addition, we interviewed multiparous women, health staff and health volunteers to assess the acceptance and cultural appropriateness of the handbook. Content analysis was performed with the English-translated transcriptions. The DID analyses revealed that all key indicators increased in the intervention group against counterfactual assumptions. The intervention also increased maternal knowledge of all topics addressed except for the risk of severe bleeding after delivery; this may be attributable to the influence of cultural belief. Logistic regression showed that the intervention increased ANC attendance, delivery with SBAs and delivery at a health facility, even after adjusting for maternal age, education and economic conditions. The qualitative data indicated that the handbook was well received and culturally appropriate. Thus, the MCH handbook is a reasonable and superior alternative to current card-type maternal records. 

[Abstract] [Full Text] [PDF]

 

Assessing the impact of budget controls on the prescribing behaviours of physicians treating dialysis-dependent patients

Ray-E Chang, Ya-Hsing Tsai, and Robert C Myrtle

Health Policy Plan. 2015 30: 1142-1151

Abstract

Objectives This study examined whether outpatient haemodialysis providers changed their treatment practices with the establishment of an outpatient dialysis global budget (ODGB) through analysing the outpatient visits and medication received by those patients.

Methods A sample of 4668 observations (patient year) of 1350 haemodialysis with hypertension (HH) patients and 4668 observations of 1436 non-HH (NHH) patients were drawn from the National Health Insurance Research Database over the years from 1999 to 2005. The impact of ODGB on hypertension-related outpatient utilization of HH was estimated using the difference in difference (DID) method and examined in three stages: (1) the fee for service stage, the pre-ODGB (2000), (2) the phase-in stage (2001–2002) and (3) the post-ODGB stage (2003–2005).

Results ODGB implementation did not affect the number of dialysis visits for HH patients. However, it did lead to a reduction in fees for antihypertension drugs used by haemodialysis facilities. There was an increase of 4.06 visits per patient per year (P < 0.001) in the number of non-dialysis outpatient with antihypertensive drugs visits for HH patients compared with the control group. The total fees for antihypertensive drugs for HH patients increased by New Taiwan Dollars (NT$)13 008 (P < 0.001) per patient per year relative to the control group after the implementation of ODGB.

Conclusions As ODGB was implemented, HH patients received fewer antihypertensive drugs during their dialysis visit. In addition, there was an increase in the number of non-dialysis outpatient visits by HH patients as well as increased payment in the drugs associated with their non-dialysis outpatient visits compared with the control group. 

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Economic burden of chronic conditions among households in Myanmar: the case of angina and asthma

Soe Htet, Khurshid Alam, and Ajay Mahal

Health Policy Plan. 2015 30: 1173-1183

Abstract

Background Non-communicable diseases (NCDs) are becoming a major source of the national disease burden in Myanmar with potentially serious economic implications.

Methods Using data on 5484 households from the World Health Survey (WHS), this study assessed the household-level economic burden of two chronic conditions, angina and asthma, in Myanmar. Propensity score matching (PSM) and coarsened exact matching (CEM) methods were used to compare household out-of-pocket (OOP) spending, catastrophic and impoverishment effects, reliance on borrowing or asset sales to finance OOP healthcare payments and employment among households reporting a member with angina (asthma) to matched households, with and without adjusting for comorbidities. Sensitivity analyses were carried out to assess the impacts of alternative assumptions on common support and potential violations of the assumption of independence of households being angina (asthma) affected and household economic outcomes, conditional on the variables used for matching (conditional independence).

Results Households with angina (asthma) reported greater OOP spending (angina: range I$1.94–I$4.31; asthma: range I$1.53–I$2.01) (I$1 = 125.09 Myanmar Kyats; I$=International Dollar) almost half of which was spending on medicines; higher rates of catastrophic spending based on a 20% threshold ratio of OOP to total household spending (angina: range 6–7%; asthma: range 3–5%); greater reliance on borrowing and sale of assets to finance healthcare (angina: range 12–14%; asthma: range 40–49%); increased medical impoverishment and lower employment rates than matched controls. There were no statistically differences in OOP expenses for inpatient care between angina-affected (asthma-affected) households and matched controls. Our results were generally robust to multiple methods of matching. However, conclusions for medical impoverishment impacts were not robust to potential violations of the conditional independence assumption.

Conclusions Myanmar is expanding public spending on health and has recently launched an innovative programme for supporting hospital-based care for poor households. Our findings suggest the need for interventions to address OOP expenses associated with outpatient care (including drugs) for chronic conditions in Myanmar’s population. 

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Effect of a maternal and child health handbook on maternal knowledge and behaviour: a community-based controlled trial in rural Cambodia

Satoko Yanagisawa, Ayako Soyano, Hisato Igarashi, Midori Ura, and Yasuhide Nakamura

Health Policy Plan. 2015 30: 1184-1192

Abstract

Maternal and child health (MCH) handbooks are comprehensive home-based booklets designed to integrate MCH records. Although empirical evidence suggests the handbooks are more effective than current card-type records, this has not been scientifically demonstrated. The objectives of this study were to evaluate the impact of the MCH handbook on maternal knowledge and behaviour as measured by antenatal care (ANC) attendance, delivery with skilled birth attendants (SBAs) and delivery at a health facility. The Cambodian version of the MCH handbook was developed and introduced in two health centres, and two other health centres served as controls. Pre-intervention and post-intervention surveys were conducted with 320 women from the intervention areas and 320 women from the control areas who had given birth within 1 year before the survey. We evaluated the impact of the handbook by using difference-in-differences (DID) analysis and calculated adjusted odds ratios for pre–post changes in key indicators by using logistic regression. In addition, we interviewed multiparous women, health staff and health volunteers to assess the acceptance and cultural appropriateness of the handbook. Content analysis was performed with the English-translated transcriptions. The DID analyses revealed that all key indicators increased in the intervention group against counterfactual assumptions. The intervention also increased maternal knowledge of all topics addressed except for the risk of severe bleeding after delivery; this may be attributable to the influence of cultural belief. Logistic regression showed that the intervention increased ANC attendance, delivery with SBAs and delivery at a health facility, even after adjusting for maternal age, education and economic conditions. The qualitative data indicated that the handbook was well received and culturally appropriate. Thus, the MCH handbook is a reasonable and superior alternative to current card-type maternal records. 

[Abstract] [Full Text] [PDF]

 

Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing

Viroj Tangcharoensathien, Supon Limwattananon, Walaiporn Patcharanarumol, Jadej Thammatacharee, Pongpisut Jongudomsuk, and Supakit Sirilak

Health Policy Plan. 2015 30: 1152-1161

Abstract: 

Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser–provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite annual budget.

[Abstract] [Full Text] [PDF]

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