Thailand’s policy on universal health coverage (UHC) has made good progress since its inception in 2002. Every Thai citizen is now entitled to essential preventive, curative and palliative health services at all life stages. Like its counterparts elsewhere, however, the policy faces challenges. A predominantly tax-financed system in a nation with a high proportion of people living in poverty will always strive to contain rising costs. Disparities exist among the different health insurance schemes that provide coverage for Thai citizens. National health expenditure is heavily borne by the government, primarily to reduce financial barriers to access for the poor. The population is ageing and the disease profiles of the population are changing alongside the modernization of Thai people’s lifestyles. Thailand is now aiming to enhance and sustain its UHC policy. We examine the merits of different policy options and aim to identify the most promising and feasible way to enhance and sustain UHC. We argue that developing the existing primary care system in Thailand has the greatest potential to provide more self-sustaining, efficient, equitable and effective UHC. Primary care needs to move from its traditional role of providing basic disease-based care, to being the first point of contact in an integrated, coordinated, community-oriented and person-focused care system, for which the national health budget should be prioritized.
Vitamin D deficiency has been linked to hypertension. Although vitamin D deficiency is common in tropical regions, no data on its association with hypertension were available. We randomly selected 137 cases and controls whose plasma in 1985 was available for the assessment of vitamin D status and calculated the odds ratio of having hypertension in 1997. In all, 36% of the participants were vitamin D deficient. The odds ratio of having hypertension was marginally significant for vitamin D deficiency (0.59, P ¼ 0.05) and statistically significant for body mass index (BMI)-defined overweight (1.8, P ¼ 0.02). The inverse relationship between vitamin D deficiency and hypertension became statistically significant after further adjustment for BMI, high-density lipoprotein cholesterol and triglyceride (0.55, P ¼ 0.03). Stepwise regression identified BMI-defined overweight and vitamin D deficiency as the variables of significance in relation to hypertension. Our data suggest that vitamin D deficiency, although not a rarity in Thailand, was not associated with an increased risk of developing hypertension in Thai people.
Objective: Low serum insulin-like growth factor-1 (IGF-1) is an independent risk factor for cardiovascular disease and diabetes. These noncommunicable diseases are extremely common in urban black South Africans, but their IGF-1 concentration is unknown. We aimed to compare serum IGF-1 concentrations of African and Caucasian people; to investigate their agerelated IGF-1 decline and to determine whether IGF-1 could account, at least in part, for the high prevalence of noncommunicable diseases in black Africans.Design and Methods: This cross-sectional study involved 211 African and 316 Caucasian men and women (aged 20-70 yrs). Fasting glucose, insulin, lipids, albumin, creatinine, liver enzymes, cotinine, high-sensitivity C-reactive protein (hsCRP), reactive oxygen species (ROS), IGF-1, blood pressure (BP) and pulse wave velocity (PWV) were determined.
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