Universal Health Coverage (UHC) is a well-embraced policy goal in the 21th century, which aims to ensure financial risk protection while assuring access to quality care.  However, up to this date, out-of-pocket (OOP) payment remains the principal means of financing health care throughout much of Asia, which leaves people financially unprotected in the face of illness.  High OOP payment at point of service is likely to either make people become medically impoverished after paying for health care, or force people to forgo treatment needed, which is detrimental to one’s health.   This presentation is based on empirical results derived from EQUITAP  (Equity in Asia-Pacific Health Systems) Project II on catastrophic payment that aims to estimate the magnitude and distribution of OOP payments for health care in 23 countries and territories in the Asia-Pacific Region in 2007.  We also draw comparisons to the results in 2000 as changes arise due to various reforms implemented since 2000.

Jui-fen Rachel Lu, is the Fulbright Visiting Scholar at the Center for East Asian Studies, Stanford University, and Professor in the Graduate Institute of Business and Management and Department of Health Care Management, College of Management, at Chang Gung University in Taiwan, where she teaches comparative health systems, health economics, and health care financing and has served as department chair (2000-2004), Associate Dean (2009-2010) and Dean of the College of Management (2010-2013).  She earned her B.S. from National Taiwan University, and her M.S. and Sc.D. from Harvard University, and she was also a Takemi Fellow at Harvard (2004-2005) and is an Honorary Professor at Hong Kong University (2007-2017). She cofounded the Taiwan Society of Health Economics (TaiSHE) in 2008 and is currently the President of TaiSHE (2014-2017).  Professor Lu also serves as a board director for the International Health Economics Association (iHEA) (2016) and a member of the Arrow Award Committee for iHEA (2014-2016).

Her research interests are in assessing the impact of the NHI program on health care markets and household consumption patterns, and comparative health systems in the Asia-Pacific region with a focus on equity performance.  She is a long-time and active member of the Equitap (Equity in Asia-Pacific Health Systems) research network.  Professor Lu has also been appointed to serve on several advisory boards to the Taiwan Ministry of Health and Welfare and National Health Insurance Administration, Ministry of Science and Technology.

She received the Minister Wang Jin Naw Memorial Award for Best Paper in Health Care Management in 2002 and was the recipient of the IBM Faculty Award in 2009.

Background: Substance abuse has been an important social and public health problem in Thailand for decades. The National Household Survey on Substance and Alcohol Use in Thailand, which has been conducted 5 times, shows that substance abuse has steadily increased. Extrapolated country-wide in recent data, the estimated number of people who had ever used at least one addictive substance at some time in their life was 3,531,436 or 7.30% of the total population aged 12-65 years. Krathom, Methamphetamine, Ice, and cannabis were the most prevalent substances of abuse.

Methods: Historical documentation, policy reports, and group discussion with key professionals who work in the substance abuse community were used in this study. The objectives of this study were to complete a document review, determine the effectiveness of previous  Thai illegal substance measures, and consider options for the future.

Findings: Although the Thai government has dedicated human resources and an enormous budget to controlling drug use, substance abuse has become a more severe problem when compared with previous years. There are many organizations trying to create and develop programs, measures, and policies for dealing with substance abuse. These policies usually have had loopholes which resulted in corruption of officers, undercutting the public health value, creating dilemmas for impoverished families experiencing drug abuse, ignoring human rights, and creating a negative attitude among society toward drug users. Barriers to establishing successful drug abuse policies in Thailand include limited access to data and data management, a lack of efficiency and cost-benefit measures and policies, and limited use of evidence-based research.

Conclusion: To address illegal substance abuse in the future, the stakeholders should work to reduce the incidence of new sellers and the prevalence of new users. This would result in diminishing the health impact and criminal aspect of illegal substance use, increase social awareness, and motivate communities to participate in managing this issue. To reach these goals, the policy should concurrently aim at curtailing the supply of illicit drugs and reducing their demand. The strategies relevant to drug policy consist of primary prevention, services for chronic drug users, supply control and regulations, prescription regimes, and the use of criminal sanctions, especially consideration of decriminalization of krathom use.

Darika Saingam is a researcher from Thailand. Her research works have focused on patterns and consequences of alcohol, tobacco, and illegal substance use. Currently she joins the Walter H. Shorenstein Asia-Pacific Research Center as the Developing Asia Health Policy Postdoctoral Fellow for the 2015-16 year. She completed her doctorate in epidemiology at the Prince of Songkla University in 2012, and has worked as a researcher at the University’s epidemiology unit since, as well as a researcher at the Thailand Substance Abuse Academic Network since 2014.

The lecture aims to introduce the prevalence of Non-communicable Diseases (NCDs) in Zhejiang Province in China, and also share experience of Control and Prevention of NCDs. The lecture is composed by five parts. Firstly, NCDs surveillance system in Zhejiang will be introduced, including its establishment history and system coverage. Then, epidemiological characteristics of major NCDs (such as diabetes, cancer, stroke, and acute coronary heart disease events) will be presented, as well as NCDs related behavioral risk factors and hospital-based injury surveillance. Next, current work of NCDs prevention and control in Zhejiang Province will be described, including work network, human resources, community management and pilot programs for NCDs. Fourthly, economic cost of diabetes will be illustrated. Finally, countermeasures for NCDs Prevention and Control will be discussed.

Min Yu is deputy director of Zhejiang Provincial Center for Disease Control and Prevention. He was awarded as New-Century 151 Talents of Zhejiang Province, China. He is a committee member of Epidemiology Branch of Chinese Preventive Medicine Association. He is the leader of key discipline of Non-Communicable Diseases epidemiology (NCDs), and led the establishing of NCDs and behavioral risk factor surveillance system in Zhejiang province.  

Yu got Medical degree in Zhejiang University and Master degree of Public Health in Peking Medical University. Now his research focuses on epidemiology of NCDs, strategy for NCDs control and prevention, and disease burden.