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  • Author: Sophal Ear
  • Publication Date: 02-2012
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: Emerging infectious diseases (EIDs) pose international security threats because of their potential to inflict harm upon humans, crops, livestock, health infrastructure, and economies. The following questions stimulated the research described in this paper: What infrastructure is necessary to enable EID surveillance in developing countries? What cultural, political, and economic challenges stand in the way of setting up such infrastructure? And are there general principles that might guide engagement with developing countries and support EID surveillance infrastructure? Using the U.S. Naval Area Medical Research Unit No. 2 as common denominator, this paper compares barriers to EID surveillance in Cambodia and Indonesia and presents key factors—uncovered through extensive interviews—that constrain disease surveillance systems. In Cambodia, the key factors that emerged were low salaries, poor staff and human resources management, the effect of patronage networks, a culture of donor dependence, contrasting priorities between the government and international donors, and a lack of compensation for animal culling. The Cambodian military has also played a part. The government ceased a merit-based salary supplement scheme for civil servants after the military is alleged to have demanded similar pay incentives that donors had no interest in funding. In Indonesia the key issues emerging as barriers to effective surveillance include poor host-donor relationships, including differing host-donor priorities and a misunderstanding of NAMRU-2 by Indonesian authorities; low salaries; a decline in the qualifications of personnel in the Ministry of Health; poor compensation for animal culling; and difficulties incentivizing local-level reporting in an era of decentralization. As the interviews with in-country practitioners revealed, low levels of development in general are the main impediments to building EID surveillance infrastructure and are perhaps beyond the scope of health and scientific agencies at this point. Nevertheless, promoting greater understanding of these issues is a critical first step in mitigating negative outcomes.
  • Topic: Agriculture, Economics, Health, Human Welfare, Infrastructure
  • Political Geography: Indonesia, Cambodia, Southeast Asia
  • Author: Panrasri Khonputsa, JL Veerman, M Bertram, S Yamwong, P Vathesatogkit, SS Lim, T Vos
  • Publication Date: 04-2011
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: We derived equations for predicting cardiovascular disease (CVD) risks for Thai men and women, separately, over a specific time period using associations between risk factors and CVD events from the Framingham cohort study. The equations were recalibrated against the cumulative risks estimated for Thailand. Equations were developed separately for predicting risks of ischemic heart disease (IHD) and stroke. Recalibration of the Framingham equations reduced the CVD risks predicted for Thai men by 97% and for Thai women by 10%. The correction was largest at younger ages. In older women, recalibration increased the predicted risk. When compared with an existing equation for Thai men our recalibrated Framingham equation produced similar predictions for CVD risks over 8 years. However, the recalibrated Framingham equations are more flexible because they can be used for predicting risks over any time span and for women and men.
  • Topic: Demographics, Health
  • Political Geography: Thailand, Southeast Asia
  • Author: Sanita Hirunrassamee, Sauwakon Ratanawijitrasin
  • Publication Date: 03-2009
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: Hospitals in Thailand operate in a multiple insurance payment environment. This paper examines 1) access to medicines and other medical technologies, 2) treatment outcomes, and 3) efficiency in resource use, among beneficiaries of the three government health insurance schemes in Thailand. Using 2003-2005 inpatient data for patients with three tracer diseases from three government hospitals, we find that utilization of more expensive items differs between patients whose insurers pay on a closed- or open-ended basis. Where new vs. conventional drugs are both available, patients whose insurer pays on a fee-for-service basis tend to have greater access to new drugs, compared to patients whose insurer pays on a capitated or case basis. Similar patterns were found where there are options between originator vs. generic drugs, drugs in different dosage forms, and more vs. less advanced diagnostic technologies. Effects of insurance payment are more pronounced where price gaps among the medical technologies are significant. Efficiency results are mixed, depending on nature of the disease conditions and type of resources required for treatment.
  • Topic: Demographics, Health
  • Political Geography: Thailand, Southeast Asia
  • Publication Date: 12-2009
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: The principal-agent problem in health care asserts that providers, being imperfect agents for patients, will act to maximize their profits at the expense of the patients' interests. This problem applies especially where professional regulations are lacking and incentives exist to directly link providers' actions to their profits, such as a fee-for-service payment system. The current analysis tests for the existence of the principal-agent problem in the private health market in Vietnam by examining the prescribing patterns of the private providers. We show that (1) private providers were able to induce demand by prescribing more drugs than public providers for a similar illness and patient profile; (2) private providers were significantly more likely to prescribe injection drugs to gain trust among the patients; and (3) patients' education as a source of information and empowerment has enabled them to mitigate the demand inducement by the providers. Our hypotheses were supported with evidence from Vietnam National Health Survey 2001 and 2002, the first and, so far, only comprehensive health survey in the country.
  • Topic: Health, Human Welfare
  • Political Geography: Asia, Australia/Pacific, Southeast Asia