1. Abstract No. 452

2. Prescription Patterns for Treatment of Hemorrhoids before and after Implementation of the Universal Coverage Policy: A Study in a Community Hospital, Chiang Mai Province, Thailand
Orapin Chaipayom
Institute of Health Research,
Chulalongkorn University
April 2, 2004

3. The Universal Coverage Policy of Thailand
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The Universal Coverage Policy of Thailand
- An increasing of health expenditure
- Health expenditure per capita increased
- About 30 % of the total Thai population remain uninsured
What should these people do when they are confronted with high cost care for their illness?

4. Public risk protection schemes
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Public risk protection schemes
Civil servants medical benefit scheme
Law income card scheme
Voluntary health card scheme
Social security scheme

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30 Baht health policy
The government launched the 30 Baht health policy in 2001
Under the Scheme, people pay 30 Baht for each visit or admission
The National Drug Policy has limited the number of drugs in the hospitals and permitted use of traditional medicine for treatment

6. BACKGROUND Many traditional medicines in Thailand
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BACKGROUND
Many traditional medicines in Thailand
The traditional drug prescribed was Petch Sang Kart (Cissus Quadrangularis Linn).
The modern alternative was Proctosedyl.

7. OBJECTIVES To assess trends in haemorrhoids prescriptions,
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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

8. METHOD Study Design: Retrospective time series study
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METHOD
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

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Measurement
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
The ratio between the number of traditional and modern medicines prescribed per person per month.

10. RESULTS (1) The 256 prescriptions were analyze
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RESULTS (1)
The 256 prescriptions were analyze
Two-third of prescriptions were female. 
The mean age of patients was years with S.D. =15.12
Range years.
All patients were prescribed Petch Sang Kart with half of them received both Petch Sang Kart and Proctosedyl.

11. RESULT (2) Figure1: PSK: The average tablet of PSK per visit per month
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RESULT (2)
(Baht/Tablet)
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)

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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).

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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.

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