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ABSTRACT
Problem Statement: The universal coverage policy (UCP) and 30 Baht Scheme was launched in Thailand in February, 2001.
Since then, the National Drug Policy in Thailand has limited the number of drugs available in community hospitals and has
permitted use of traditional medicines for treatment. Some patients were prescribed traditional medicines to lower the cost of
treatment as a substitute for modern medicine.
Objectives: To assess trends in haemorrhoids prescriptions, comparing the use of traditional and modern medicines in a
community hospital before and after the UCP, and to compare the cost of haemorrhoids treatment before and after policy
implementation. The traditional drug prescribed was Petch Sang Kart. The modern alternative was Proctosedyl.
Design: Retrospective time series study.
Methods: All haemorrhoids prescriptions from October 2000 to January 2003 were collected. The trends of prescriptions and
cost of traditional and modern medicines for treatment of haemorrhoids were compared before and after the UCP was
implemented.
Outcome Measures: The percentage of patients who were given traditional medicines and/or modern medicine for
haemorrhoids per month; the average number of tablets of traditional or modern medicine used per person per month; the
cost of treatment per prescription per person per month; and the ratio between the number of traditional and modern
medicines prescribed per person per month.
Results: A total of 256 prescriptions covering the study period were analyzed. All patients received traditional medicines,
while about half of them received both traditional and modern medicine. The average cost of prescriptions per person per
month decreased (24.0 versus 7.1 baht, p = 0.001). Likewise, the number of traditional medicine prescribed per visit per
month decreased (traditional = 8.0 versus 3.3 tablets, p =0.004). However, the number of modern medicine prescribed per
visit per month and the ratio between traditional and modern medicine remained stable (3.4 versus 2.0 tablets, p = 0.124,
ratio=.40 versus .86 , p= .052).
Conclusions: The Universal Coverage Policy of Thailand resulted in a reduction in provision of traditional medicine, the
ratio of medications, and the cost of prescriptions. The effectiveness of treatment between the two periods are being analyzed.
BACKGROUND (1)
The Universal Coverage Policy (UCP) and
30 Baht Scheme was launched in Thailand
in 2001. Under the Scheme, people pay 30
Baht for each visit or admission. Since
then, the National Drug Policy has limited
the number of drugs available in
community hospitals and has permitted use
of traditional medicine for treatment. Some
patients were prescribed traditional
medicine to lower the cost of treatment as
substitute for modern medicine.
BACKGROUND (2)
Many traditional medicines in Thailand are in
use without clinical trial against modern
drugs. This is the first of a number of studies
to be undertaken to make comparison
traditional and modern drug. The traditional
drug prescribed was Petch Sang Kart (Cissus
Quadrangularis Linn). The modern
alternative was Proctosedyl.
OBJECTIVES
-To assess trends in haemorrhoids prescriptions, comparing the
use of traditional and modern medicines in a community hospital
before and after the UCP
-To compare the cost of haemorrhoids treatment before and after
policy implementation
METHOD (1)
Study Design: Retrospective time series study
Study Area: A community hospital in Chiang Mai
The haemorrhoids prescriptions from October 2000 to
January 2003 were collected. The level and trends of
prescriptions and cost of traditional and modern medicines
for treatment of haemorrhoids were compared before and
after the implementation of 30 Baht Scheme
Measurement
1.
The percentage of patients who were given traditional
medicines and/or modern medicine for haemorrhoids per
month
2.
The average number of tablets of traditional or modern
medicine used per person per month
3. The cost of treatment per prescription per person per
month
4.
The ratio between the number of traditional and modern
medicines prescribed per person per month.
RESULTS (1)
Overall of 256 prescriptions were analyze, two-third of
prescriptions were female. The mean age of patients was
45.74 years with S.D. =15.12 and range 10-81 years.
All patients were prescribed Petch Sang Kart with half of
them received both Petch Sang Kart and Proctosedyl.
RESULT (2)
(Baht/Tablet)
50
45
40
35
30
25
PSK
Proc
Cost
20
15
10
5
0
Ratio
1
2
3 4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20
Month
Figure1: PSK: The average tablet of PSK per visit per month
Proc: The average tablet of Proctosedyl per visit per month
Cost: The cost of treatment per visit per month
Ratio: The ratio of tablet PSK/Proc per visit per month
Remark: PSK= Petch Sang Kart (Cissus Quadrangularis)
RESULTS (3)
-The average cost of prescriptions per person per month
decreased (24.0 versus 7.1 Baht, p = 0.001).
-The number of traditional medicine prescribed per visit per
month decreased (traditional = 8.0 versus 3.3 tablets, p =0.004).
-The number of modern medicine prescribed per visit per
month and the ratio between traditional and modern medicine
remained stable (3.4 versus 2.0 tablets, p = 0.124, ratio=.40
versus .86 , p= .052).
CONCLUSIONS
The retrospective study of heamorrhoids treatment
in a community hospital found that the Universal
Coverage Policy of Thailand resulted in a reduction
in provision of traditional medicine, the ratio of
medications, and the cost of prescriptions.