Suchergebnisse

OBJECTIVE: To assist with strategic planning for the eradication of malaria in Henan Province, China, which reached the consolidation phase of malaria control in 1992, when only 318 malaria cases were reported. METHODS: We conducted a prospective two-year study of the costs for Henan's malaria control programme. We used a cost model that could also be applied to other malaria programmes in mainland China, and analysed the cost of the three components of Henan's malaria programme: suspected malaria case management, vector surveillance, and population blood surveys. Primary cost data were collected from the government, and data on suspected malaria patients were collected in two malaria counties (population 2 093 100). We enlisted the help of 260 village doctors in six townships or former communes (population 247 762), and studied all 12 325 reported cases of suspected malaria in their catchment areas in 1994 and 1995. FINDINGS: The average annual government investment in malaria control was estimated to be US$ 111 516 (case-management 59%; active blood surveys 25%; vector surveillance 12%; and contingencies and special projects 4%). The average cost (direct and indirect) for patients seeking treatment for suspected malaria was US$ 3.48, equivalent to 10 days' income for rural residents. Each suspected malaria case cost the government an average of US$ 0.78. CONCLUSION: Further cuts in government funding will increase future costs when epidemic malaria returns; investment in malaria control should therefore continue at least at current levels of US$ 0.03 per person at risk.

China's health reforms of the 1980s led to privatization of rural health care with adverse impact on farmers. A decade later a new rural co-operative medical scheme (RCMS), was piloted throughout many provinces to promote better equity. Although many schemes later collapsed owing to inadequate funding, some continue to the present. This article compares such a scheme with the out-of-pocket system in Henan province. We study the township hospitals, focusing on cost of services, utilization rates and impact of RCMS on hospitals' financial sustainability. Our results derive from monthly hospital records and a survey of four hospitals in two adjacent counties, one county with low-premium RCMS and the other with the out-of-pocket system.All hospitals charged for preventive activities (such as antenatal care, immunization), an unfortunate consequence of limited government support. It was not clear that on average, the total cost of individual patient visits in RCMS hospitals was lower than non-RCMS hospitals. Farmers were generally unaware of their insurance entitlements, except the catastrophic illnesses for which there was a real benefit from refund of US$100 or more. Although the effect of the RCMS on hospital charges was unclear it was notable that the utilization rates in RCMS areas were twice those in non-RCMS.We conclude that RCMS hospitals were better funded because of re-imbursements from the insurance scheme and therefore were more viable as sources of good health care. Thus, health care could become more equitable under RCMS than the out-ofpocket system. China is now beginning to test a revised form of RCMS with pooling at the county level, increased premiums (10 yuan per person) and increased government funding. However, it must be followed closely to determine the effect on rural services and health care costs for farmers.

Resumen.La economía de Tailandia ha cambiado rápidamente de la agricultura a la industria manufacturera y el sector de los servicios, pero el ordenamiento del mercado laboral y la representación de los trabajadores son mucho menos consistentes que en los países desarrollados, donde hubo una transición más lenta y gradual hace ya décadas. Los autores estudian el robustecimiento de las políticas y la legislación tailandesas en el ámbito de la seguridad y la salud en el trabajo, que obedece a las normas internacionales y a la nueva Constitución democrática. Por último, identifican los principales retos pendientes, entre ellos el cumplimiento de la ley y una medición mejor de los efectos del trabajo en la salud física y mental.

Résumé.La Thaïlande a connu une transition économique rapide, de l'agriculture aux secteurs manufacturier et tertiaire, puis vers l'emploi plus formel. Toutefois, la réglementation du marché du travail et la représentation des salariés sont moins affirmées que dans les pays développés, où cette transition s'est effectuée graduellement et plus lentement, il y a plusieurs décennies. Les auteurs examinent le renforcement des politiques et de la législation thaïlandaise sur la sécurité et la santé au travail en réponse aux normes internationales du travail, à l'adoption d'une nouvelle constitution démocratique, à la crainte d'embargos commerciaux étrangers et aux accidents mortels du travail. Ils concluent en identifiant les principaux défis auxquels sont confrontés les décideurs politiques, y compris l'application de la législation et les méthodes pour mesurer les nouveaux risques professionnels sur la santé mentale et physique des travailleurs.

Thailand has experienced a rapid economic transition from agriculture to industry and services, and from informal to formal employment. It has much less state regulation and worker representation relative to developed nations, who underwent these transitions more slowly and sequentially, decades earlier. We examine the strengthening of Thai government policy and legislation affecting worker's health, responding to international norms, a new democratic constitution, fear of foreign importer embargos and several fatal workplace disasters. We identify key challenges remaining for Thai policy makers, including legislation enforcement and the measurement of impacts on worker's mental and physical health.

Abstract.Thailand has experienced a rapid economic transition from agriculture to manufacturing and services, and to more formal employment. Its labour market regulation and worker representation, however, are much weaker than they are in developed countries, which underwent these transitions more slowly and sequentially, decades earlier. The authors examine the strengthening of Thailand's policy and legislation on occupational safety and health in response to international standards, a new democratic Constitution, fear of foreign trade embargoes, and fatal workplace disasters. In concluding, they identify key challenges remaining for policy‐makers, including enforcement of legislation and measurement of new mental and physical health effects.

We examine the influence of urbanization on household structure, social networks, and health in Thailand. We compare lifetime urban or rural dwellers and those who were rural as children and urban as adults. Data derived from a large national cohort of 71,516 Sukhothai Thammathirat Open University adult students participating in an on‐going longitudinal study of the health‐risk transition in Thailand. The rural‐urban group, one‐third of cohort households, was significantly different from other groups (e.g., smaller households). The rural‐rural and the urban‐urban groups often were the two extremes. Urbanization, after adjusting for covariates, was a risk factor for poor overall health and depression. Urbanization is a mediator of the health‐risk transition underway in Thailand. Health programs and policies directed at transitional health outcomes should focus on the health risks of the urbanizing population, in particular smoking, drinking, low social trust, and poor psychological health.