Patcharanarumol Walaiporn, Panichkriangkrai Warisa, Wangmo Sangay, Thammatacharee Jadej, Uechi Masaaki, Wanwong Yaowaluk
International Health Policy Programme (IHPP), Ministry of Public Health, Nonthaburi Province, Thailand.
National Health Security Office, Bangkok, Thailand.
WHO South East Asia J Public Health. 2016 Apr;5(1):27-33. doi: 10.4103/2224-3151.206549.
Universal health coverage (UHC) is a key policy issue in countries of the World Health Organization (WHO) South-East Asia Region. However, despite projections of significant increases in burden, there is little protection against the financial risks associated with noncommunicable diseases (NCDs), including diabetes. Thailand achieved UHC of all 67 million of the population in 2002, under three public health insurance schemes. The country therefore provides a case-study on diabetes prevention and care in the context of UHC. Although the budget for the Thai Universal Coverage (UC) scheme, which covers nearly 80% of the population, increased significantly during 2003-2013, the proportion allocated to clinical prevention and health promotion declined from 15% to 11%. The financial case for investment in diabetes prevention is made, particularly with respect to a focus on primary care and the use of community volunteers. The UC scheme can expand to nearly 100% population coverage, with a comprehensive benefit package and financial risk protection. Although the rates of complications and fatalities in patients with diabetes have improved over the last few years, achievement of well-controlled fasting blood glucose for all patients is still the main challenge for further improvement. It is recommended that, in order to improve coverage of diabetes care and prevention, it is essential for countries in the WHO South-East Asia Region to include major NCD services, in particular primary prevention, in their UHC strategies. Since a resilient health system is key to UHC delivery, strengthening of the health workforce and infrastructure should be part of any action plan to prevent and control diabetes.
全民健康覆盖（UHC）是世界卫生组织（WHO）东南亚区域各国的一个关键政策问题。然而，尽管预计负担将大幅增加，但对于包括糖尿病在内的非传染性疾病（NCDs）相关的财务风险，几乎没有保护措施。泰国在2002年通过三项公共医疗保险计划实现了6700万全体人口的全民健康覆盖。因此，该国提供了一个在全民健康覆盖背景下开展糖尿病预防和护理的案例研究。尽管覆盖了近80%人口的泰国全民覆盖（UC）计划的预算在2003 - 2013年期间显著增加，但分配给临床预防和健康促进的比例却从15%降至11%。文中阐述了投资糖尿病预防的财务理由，特别是在关注初级保健和社区志愿者的使用方面。全民覆盖计划可以扩大到近100%的人口覆盖范围，提供全面的福利套餐和财务风险保护。尽管糖尿病患者的并发症和死亡率在过去几年有所改善，但让所有患者实现空腹血糖良好控制仍是进一步改善的主要挑战。建议为了提高糖尿病护理和预防的覆盖率，世界卫生组织东南亚区域各国必须在其全民健康覆盖战略中纳入主要的非传染性疾病服务，特别是一级预防。由于有韧性的卫生系统是实现全民健康覆盖的关键，加强卫生人力和基础设施应成为预防和控制糖尿病的任何行动计划的一部分。
