1. 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 Poungkantha International Health Policy Program, Ministry of Public Health. Tiwanon Road, Muang, Nonthaburi 11000 Tel: +66 (0)2 590 2355-7 Fax:+66 (0)2 590 2385 http://www.ihpp.thaigov.net Introduction The 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 10 th National Development Plan of the country which cover the period from 2007 to 2011. Methods The 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. code Burden of diseases DALY loss (yr) Curative expenditure Prematur e death Absenteeism OPIPTotalOPIPOP+IP 1A3HIV/AIDS19%28%4%17%35%6%8%6% 2F5Liver cancer8%1%2%1%10%1%3%1% 3HDM9%31%4%18%4%35%9%32% 4J1Depression7%1%0.1%0.4%0%1% 5J4Alcohol7%0.4%1% 2%5%2% 6L2Cataracts2%3%8%6%0%5%4%5% 7M3IHD7% 11%9%6%5%6%5% 8M4CVD13%4%10%7%9%4%9%5% 9N1COPD6%3%5%4%3%8%6%7% 12U Traffic accidents15%14%50%31%26%28%45%30% Total from 12 leading BOD (million Baht) 100% 4,780,00032,45229,48461,936208,2879,8361,43711,273 Objective To describe how Thailand use evidence on country’s burden of disease and cost-effectiveness of health interventions from the 2 nd edition Disease Control Priority in Developing Countries (DCP2) to set priorities in health sector investment in the 10 th National Health Development Plan. 20072008200920102011 Total Health Expenditure (THE in million Baht)305,472.61336,467.61394,854.76435,041.23479,945.85 P&P Expenditure21,505.1622,504.2147,006.5149,004.6051,002.70 P&P higher than status quo0.00 23,503.2524,502.3025,501.35 THE, % GDP3.61%3.66%4.00%4.11%4.22% P&P, % GDP0.25%0.24%0.48%0.46%0.45% P&P, Baht per capita325336694715738 Type of disease burden 1999 (million DALY loss) 2004 (million DALY loss) MaleFemaleTotalMaleFemaleTotal Communicable disease 1.61.02.61.20.92.1 Non-communicable disease 2.92.65.63.43.16.5 Accident and injuries 1.00.31.31.00.31.3 Total 5.63.99.55.74.29.9 ISPOR 14 th Annual European Congress 5-8 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 Conclusion Thailand 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. Results Since 1999 there has been an increasing trend in BOD attributable from alcohol and tobacco consumption, lack of fibre food and physical activities, consumption of high fat & high calorie diet, increasing incidence of diabetes mellitus, hypertension and high blood lipid, traffic injuries, overweight and obesity. Evidence from the share of DALY and productivity loss indicates three national health priorities: HIV/AIDS; road traffic injuries and diabetes mellitus. Most health expenditure of Thailand was spent on curative services, while only 4.5% of that was spent for disease prevention and health promotion (Table 3). Table 2: Share of curative expenditure and premature death of top-ten BOD