Dr Phusit Prakongsai, M.D., Ph.D. - International Health Policy Program (IHPP), Thailand - Dr

Dr Phusit Prakongsai

M.D., Ph.D.

International Health Policy Program (IHPP), Thailand

Dr

Bangkok | Thailand

Main Specialties: Public Health

Additional Specialties: Ph.D in Public Health and Policy


Top Author

Dr Phusit Prakongsai, M.D., Ph.D. - International Health Policy Program (IHPP), Thailand - Dr

Dr Phusit Prakongsai

M.D., Ph.D.

Introduction

Phusit Prakongsai earned his PhD in Public Health and Policy from London School of Hygiene and Tropical Medicine (LSHTM), United Kingdom in 2008, Medical Doctor Degree from Mahidol University in 1988, and a Certificate in Preventive Medicine from Thai Medical Council in 1993. He has 10 years of field experience in public health and health service management in three district hospitals in the rural area of Thailand from 1988 to 1998. He served as the principal investigator and co-investigator of several research projects related to health system and policy, health insurance, universal health coverage, and health care finance at the International Health Policy Program (IHPP), Bureau of Policy and Strategy, Ministry of Public Health (MOPH) of Thailand from 1999 to present. He received the WHO long-term fellowship for pursuing his PhD study in London in 2002. After his graduation, he was appointed to be the director of International Health Policy Program (IHPP), MOPH of Thailand from October 2010 to December 2014, and served as the Director of Bureau of International Health (BIH), MOPH from October 2014 to June 2017. Since then, he has been appointed as Senior Advisor on Health Promotion, Office of Permanent Secretary, MOPH from June 2017 until present.

Primary Affiliation: International Health Policy Program (IHPP), Thailand - Bangkok , Thailand

Specialties:

Additional Specialties:


View Dr Phusit Prakongsai’s Resume / CV

Education

May 2008
London School of Hygiene and Tropical Medicine, UK
Ph.D. in Public Health and Policy
May 1998
Doctor of Medicine
Mahidol University, Thailand
May 1993
Medical Council of Thailand
Certificate of Proficiency in Preventive Medicine

Publications

22Publications

469Reads

190Profile Views

173PubMed Central Citations

Making Fair Choices on the Path to Universal Health Coverage: Applying Principles to Difficult Cases

Health Systems & Reform, 3(4):1–12, 2017

Health Systems & Reform

Progress toward universal health coverage (UHC) requires making difficult trade-offs. In this journal, Dr. Margaret Chan, the World Health Organization (WHO) Director-General, has endorsed the principles for making such decisions put forward by the WHO Consultative Group on Equity and UHC. These principles include maximizing population health, priority for the worse off, and shielding people from health-related financial risks. But how should one apply these principles in particular cases, and how should one adjudicate between them when their demands conflict? This article by some members of the Consultative Group and a diverse group of health policy professionals addresses these questions. It considers three stylized versions of actual policy dilemmas. Each of these cases pertains to one of the three key dimensions of progress toward UHC: which services to cover first, which populations to prioritize for coverage, and how to move from out-of-pocket expenditures to prepayment with pooling of funds. Our cases are simplified to highlight common trade-offs. Though we make specific recommendations, our primary aim is to demonstrate both the form and substance of the reasoning involved in striking a fair balance between competing interests on the road to UHC.

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September 2017
33 Reads

Analysis of health promotion and prevention financing mechanisms in Thailand.

Health Promot Int 2017 Aug;32(4):702-710

Department of Public Health, Graduate School of Medicine, Juntendo University, Japan.

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http://dx.doi.org/10.1093/heapro/daw010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914417PMC
August 2017
28 Reads

Three case studies in making fair choices on the path to universal health coverage

Health and Human Rights, December 2016

Health and Human Rights

The goal of achieving Universal Health Coverage (UHC) can generally be realized only in stages. Moreover, resource, capacity and political constraints mean governments often face difficult trade-offs on the path to UHC. In a 2014 report, Making fair choices on the path to UHC, the WHO Consultative Group on Equity and Universal Health Coverage articulated principles for making such trade-offs in an equitable manner. We present three case studies which illustrate how these principles can guide practical decision-making. These case studies show how progressive realization of the right to health can be effectively guided by priority-setting principles, including generating the greatest total health gain, priority for the worse off, and financial risk protection. They also demonstrate the value of a fair and accountable process of priority setting.

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December 2016
26 Reads

Impact of the health insurance scheme for stateless people on inpatient utilization in Kraburi Hospital, Thailand.

Risk Manag Healthc Policy 2016 30;9:261-269. Epub 2016 Nov 30.

London School of Hygiene and Tropical Medicine, London, UK.

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http://dx.doi.org/10.2147/RMHP.S117173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5140032PMC
November 2016
41 Reads

Analysis of health promotion and prevention financing mechanisms in Thailand

Health Promotion International, 2016, 1–9

Health Promotion International

In the transition to the post-2015 agenda, many countries are striving towards universal health coverage (UHC). Achieving this, governments need to shift from curative care to promotion and prevention services. This research analyses Thailand’s financing system for health promotion and prevention, and assesses policy options for health financing reforms. The study employed a mixed-methods approach and integrates multiple sources of evidence, including scientific and grey literature, expenditure data, andsemi-structured interviews with key stakeholders in Thailand. The analysis was underpinned by the use of a well-known health financing framework. In Thailand, three agencies plus local governments share major funding roles for health promotion and prevention services: the Ministry of Public Health (MOPH), the National Health Security Office, the Thai Health Promotion Foundation and Tambon Health Insurance Funds. The total expenditure on prevention and public health in 2010 was 10.8% of the total health expenditure, greater than many middle-income countries that average 7.0– 9.2%. MOPH was the largest contributor at 32.9%, the Universal Coverage scheme was the second at 23.1%, followed by the local governments and ThaiHealth at 22.8 and 7.3%, respectively. Thailand’s health financingsystem for promotion andprevention is strategic andinnovativedueto the three complementary mechanisms in operation. There are several methodological limitations to determine the adequate level of spending. The health financing reforms in Thailand could usefully inform policymakers on ways to increase spending on promotion and prevention. Further comparative policy research is needed to generate evidence to support efforts towards UHC.

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March 2016
25 Reads

Challenges in the provision of healthcare services for migrants: A systematic review through providers' lens

BMC Health Services Research (2015) 15:390

BMC Health Services Research

Background: In recent years, cross-border migration has gained significant attention in high-level policy dialogues in numerous countries. While there exists some literature describing the health status of migrants, and exploring migrants’ perceptions of service utilisation in receiving countries, there is still little evidence that examines the issue of health services for migrants through the lens of providers. This study therefore aims to systematically review the latest literature, which investigated perceptions and attitudes of healthcare providers in managing care for migrants, as well as examining the challenges and barriers faced in their practices. Methods: A systematic review was performed by gathering evidence from three main online databases: Medline, Embase and Scopus, plus a purposive search from the World Health Organization’s website and grey literature sources. The articles, published in English since 2000, were reviewed according to the following topics: (1) how healthcare providers interacted with individual migrant patients, (2) how workplace factors shaped services for migrants, and (3) how the external environment, specifically laws and professional norms influenced their practices. Key message of the articles were analysed by thematic analysis. Results: Thirty seven articles were recruited for the final review. Key findings of the selected articles were synthesized and presented in the data extraction form. Quality of retrieved articles varied substantially. Almost all the selected articles had congruent findings regarding language andcultural challenges, and a lack of knowledge of a host country's health system amongst migrant patients. Most respondents expressed concerns over in-house constraints resulting from heavy workloads and the inadequacy of human resources. Professional norms strongly influenced the behaviours and attitudes of healthcare providers despite conflicting with laws that limited right to health services access for illegal migrants. Discussion: The perceptions, attitudes and practices of practitioners in the provision of healthcare services for migrants were mainly influenced by: (1) diverse cultural beliefs and language differences, (2) limited institutional capacity, in terms of time and/or resource constraints, (3) the contradiction between professional ethics and laws that limited migrants’ right to health care. Nevertheless, healthcare providers addressed such problems by partially ignoring the immigrants’ precarious legal status, and using numerous tactics, including seeking help from civil society groups, to support their clinical practice. Conclusion: It was evident that healthcare providers faced several challenges in managing care for migrants, which included not only language and cultural barriers, but also resource constraints within their workplaces, and disharmony between the law and their professional norms. Further studies, which explore health care management for migrants in countries with different health insurance models, are recommended.

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September 2015
26 Reads

Prevalence of pressure ulcers in Thai wheelchair users with chronic spinal cord injuries

Spinal Cord (2015), May; 1-5

Spinal Cord

Study design: A cross-sectional study. Objectives: To study prevalence of pressure ulcers (PrUs), quality of life (QoL) and effect of wheelchair cushions used by Thai wheelchair users with chronic spinal cord injury (SCI). Setting: Maharaj Hospital, Chiang Mai, Thailand. Methods: Thai chronic SCI wheelchair users, aged over 18 years and non-ambulatory with ASIA impairment scale A, B or C were recruited. They completed the PrUs questionnaire and rated the EuroQoL-5D and their health status with a visual analog scale (VAS). Demographic data of each participant were extracted from medical records. The EQ-5D health states were transformed to utility scores by using the Thai algorithm and the prevalence of PrUs was reported. The EQ-5D, the utility scores and the health status VAS were compared between those with and without current PrUs and between those participants using foam and air-filled cushions. Results: Of 129 participants, 26.4% had current PrUs at the time of the study, 27.9% had healed PrUs and 45.7% never had PrUs. The median VAS score for health status was 70 (Q1=50, Q3=80). Based on the EQ-5D, only one dimension (anxiety/depression) was significantly different between those with and those without current PrUs (P=0.015). Those using an air-filled cushions had a mean utility score four times higher than of those using a foam cushion (0.131 vs 0.032, P=0.089) but not statistically significant. Conclusions: PrUs are still prevalent among Thai wheelchair users with chronic SCI. Anxiety/depression is associated with current ulcers.

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May 2015
72 Reads

Universal coverage with supply-side reform: The impact on medical expenditure risk and utilization in Thailand

Journal of Public Economics 2015;121: 79-94

Journal of Public Economics

We estimate the impact on out-of-pocket (OOP) medical expenditure of a major reform in Thailand that greatly extended health insurance coverage to achieve universality while implementing supply-side measures intended to deliver cost-effective care from an increased, but modest, public health budget. Difference-in-differences comparison of groups to whom coverage was extended or deepened with those whose coverage did not change indicates that the reform reduced OOP expenditure by 28% on average and by 42% at the 95th percentile of the conditional distribution. Simulations suggest that exposure to medical expenditure risk was reduced by three-fifths, on average, generating a social welfare gain equivalent to 80–200% of the approximate deadweight loss from financing the reform. Estimated effects on health care access suggest that the policy managed to reduce households' medical expenses while also raising their utilization of both inpatient and ambulatory care.

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December 2014
28 Reads

Health insurance for people with citizenship problems in Thailand: a case study of policy implementation within a complex health system

BMC Health Services Research 2014,14(Suppl 2):P121

BMC Health Services Research

Background: Health care provision for non-citizens (illegal migrants, stateless people, etc) is a common problem across the world. Since 2002, Thailand has achieved universal health coverage through the introduction of the UHC scheme covering almost all residents. However, people with citizenship problems, so-called ‘stateless people’, were left uninsured. Consequently, the ‘Health Insurance for People with Citizenship Problems’ (HIS-PCP) policy was adopted in 2010. This study sought to examine operational constraints facing the implementation of the policy, through the views of ground-level providers. Materials and methods: A qualitative, case-study approach was devised. Individual in-depth interviews and group interviews with 33 key informants were conducted in Tak and Ranong Provinces. Findings: The policy faced several operational problems from all health-system angles. Inadequate communication and unclear service guidelines contributed to the ineffectiveness in budget spent and services provision. The problems were linked with the regulation concerning patient referral, which contradicted the legal requirements imposed on, and the highly mobile behaviour of, the stateless people. Some providers adapted their practices to meet on-the-job difficulties, including establishing a mutual agreement between neighbouring hospitals to allow stateless patients to bypass the primary care gatekeeper, but this then created a sense of unfair treatment amongst UCS beneficiaries. These challenges were intertwined with official procrastination over nationality verification procedures and poor collaboration between Ministries. Conclusions: The HIS-PCP encountered various constraints along its implementation. Inadequate communication and discordance between policy objectives and perceptions of healthcare staff were key explanations. Impractical legal instruments and distinctive behaviours/characteristics of stateless people made the problems more complex. Policy recommendations were suggested. In the short term, technical and human-resources capacities of the scheme’s governing body should be strengthened. Communications between the authorities within the Ministry of Public Health (MOPH) and collaboration with the Ministry of Interior, should be improved. Guidelines concerning budgeting and scope of service provision should be fine-tuned. In the long run, the nationality verification of stateless people should be expedited. The MOPH should develop clear and practical guidelines to assist health personnel to cope with citizenship problems of patients, which are beyond routine clinical services.

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July 2014
26 Reads

ASEAN health in the post-2015 development agenda

BMC Public Health 2014, 14(Suppl 1):I2

BMC Public Health

The health sector has led the development success of the MDG era and created an unprecedented opportunity to achieve more health and social development after 2015. The health-related MDGs have raised the profile of global health to the highest political level, mobilized civil society, increased development assistance for health, and contributed to considerable improvements in health outcomes in low- and middle-income countries. Achievements of health-related MDGs among ASEAN countries are remarkable, and it is crucial to keep the momentum for accelerating progress toward the MDG and sustainable development. Member states of WHO-SEAR proposed that “human well-being and happiness” must be the overarching goal for the post-2015 development agenda. It is recognized that equity and human rights are at the center of development, and well-being is the core contributor for individual and social happiness. The four pillars of well-being and happiness are identified as 1) sustainable and equitable socio-economic development, 2) good and responsible governance, 3) environmental sustainability, and 4) community and cultural participation. A key component of “well-being and happiness” is universal health coverage which implies equitable access to essential health services with financial and social protection. In addition, to achieve the unfinished MDG agenda and tackling the growing problems of NCDs, a life-course approach comprising continuum of care with balance of the preventive, promotive, curative and palliative aspects of health care has been recommended. Health systems based on the primary health care need to be strengthened to improve efficiency in service delivery, mobilize adequate resources and equitable financing through good governance. Indicators and targets for each dimension of human well-being must be identified and focused on equity analysis through disaggregated data covering income, age, gender, rural/urban and vulnerable groups. Ownership, intersectoral collaboration, wider involvement of stakeholders, and more partnerships must be leveraged to achieve the post-2015 development agenda.

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January 2014
34 Reads

Promoting universal financial protection: how the Thai universal coverage scheme was designed to ensure equity.

Health Res Policy Syst 2013 Aug 6;11:25. Epub 2013 Aug 6.

International Health Policy Program, Ministry of Public Health, Tivanon Road, Nonthaburi Province 11000, Thailand.

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http://health-policy-systems.biomedcentral.com/articles/10.1
Publisher Site
http://dx.doi.org/10.1186/1478-4505-11-25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735425PMC
August 2013
60 Reads
18 Citations

Universal Coverage on a Budget:Impacts on Health Care Utilization and Out-of-pocket Expenditures in Thailand

http://www.bmg.eur.nl/fileadmin/ASSETS/bmg/english/HEFPA/Publications/Working_Papers/HEFPA_WP14.pdf

HEFPA Working Paper - WP14

We estimate the impact on health care utilization and out-of-pocket (OOP) expenditures of a major reform in Thailand that extended health insurance to one-quarter of the population to achieve universal coverage while keeping health spending below 4% of GDP. Identification is through comparison of changes in outcomes of groups to whom coverage was extended with those of public sector employees and their dependents whose coverage was not affected. The reform is estimated to have reduced the probability that a sick person goes without formal treatment by 3.2 percentage points (11%). It increased the probability of receiving public ambulatory care by 2.7 ppt (5%) and of admission to a public hospital by 1 ppt (18%). OOP expenditures were reduced by one-third on average, as was the probability of spending more than 10% of the household budget on health care, while spending at the very top of the OOP distribution was reduced by one-half representing substantial reductions in exposure to medical expenditure risk. Supply-side measures implemented with the coverage extension are likely to have helped realize these effects from an increased, but still very tight, budget.

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May 2013
55 Reads

Why has the Universal Coverage Scheme in Thailand achieved a pro-poor public subsidy for health care?

BMC Public Health 2012 22;12 Suppl 1:S6. Epub 2012 Jun 22.

International Health Policy Program, Ministry of Public Health, Thailand.

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http://dx.doi.org/10.1186/1471-2458-12-S1-S6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3382631PMC
December 2012
60 Reads
15 Citations
2.264 Impact Factor

Using health technology assessment for informing coverage decisions in Thailand.

J Comp Eff Res 2012 Mar;1(2):137-46

Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.

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http://dx.doi.org/10.2217/cer.12.10DOI Listing
March 2012
50 Reads
12 Citations

The equity impact of the universal coverage policy: lessons from Thailand.

Adv Health Econ Health Serv Res 2009 ;21:57-81

International Health Policy Program, Ministry of Public Health, Thailand.

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October 2010
58 Reads
15 Citations

Equity in maternal and child health in Thailand.

Bull World Health Organ 2010 Jun 8;88(6):420-7. Epub 2009 Dec 8.

Khon Kaen University, Thanon Mitraparp, Amphoe Muang, Khon Kaen, 40002, Thailand.

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http://dx.doi.org/10.2471/BLT.09.068791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878146PMC
June 2010
50 Reads
19 Citations
5.090 Impact Factor

Can earmarking mobilize and sustain resources to the health sector?

Bull World Health Organ 2008 Nov;86(11):898-901

International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649546PMC
http://dx.doi.org/10.2471/blt.07.049593DOI Listing
November 2008
12 Reads
2 Citations
5.090 Impact Factor

Regional public health education: current situation and challenges.

Bull World Health Organ 2007 Dec;85(12):903-4

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636299PMC
http://dx.doi.org/10.2471/blt.07.048587DOI Listing
December 2007
16 Reads
3 Citations
5.090 Impact Factor

Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand.

Bull World Health Organ 2007 Aug;85(8):600-6

Department of Social and Administrative Pharmacy, Khon Kaen University, Khon Kaen, Thailand.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636377PMC
http://dx.doi.org/10.2471/blt.06.033720DOI Listing
August 2007
21 Reads
58 Citations
5.090 Impact Factor

Dual job holding by public sector health professionals in highly resource-constrained settings: problem or solution?

Bull World Health Organ 2005 Oct 10;83(10):771-6. Epub 2005 Nov 10.

Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel Street, Londoin WC1E 7HT, England.

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http://dx.doi.org//S0042-96862005001000014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626421PMC
October 2005
17 Reads
21 Citations
5.090 Impact Factor