There rural hospitals in Chai Nart and Nakhon

There is an ancient
Chinese proverb that runs in my family: “?????????????”,
which means “preserve your dignity as nobody; promote social welfare as
somebody”. Learning from saying and doing, I was often taken by my family from
when I was young to rural areas for actual examples. Though there are some
inequalities in education, economics and basic infrastructures between rural
and urban areas, I am impressed with how local schools and hospitals can make
such a huge contribution to the local society. This has engraved in my mind and
I have set forth to be part of ‘somebody’ with the responsibility of social
welfare promotion.

As I worked as a
medical volunteer in rural hospitals in Chai Nart and Nakhon Ratchasima, the
importance of local hospital had come back to my mind. I have talked with many
patients that their lives including their loved ones’ had been saved by the
hospital. Thus, I have learned that these hospitals are vital parts of the
healthcare system in Thailand. Unfortunately, I have also learned that many
hospitals were facing financial problems as well. During my time in Sappaya
Hospital in Chai Nart, I learned that its financial status is in critical (Risk
score=7)1. At first, I could not understand and did not pay much
attention to this matter. Nonetheless, this issue seemed to concern a large
number of hospital staffs and finally developed my curiosity. After further
digging on this matter, I was devastated to find out that this financial
problem was not only in Sappaya. There were countless numbers of hospitals
facing this situation nationally. And should the financial problems not be
solved, the hospitals will not be able to continue treating the patients. Many
patients will have to travel a far-reaching distance in order to get a simple
treatment. Money and time will be wasted as a result. Moreover, some patients might
not be able to get treatment as they cannot afford the cost of travel. Now I
could not care less anymore.

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Apart from financial
problems, there is one particular health issue that strucks me during working
in rural hospitals; that of ‘strokes’. It is an important global health issue
that needs urgent attention clinically and economically. In Thailand, stroke is
the first largest killer and most of the survivors are left with permanent
disability. I saw numerous stoke victims who required ultimate care from their
families and health facilities. Therefore, as well as being a substantial cause
of morbidity and mortality, stroke is also an enormous economic burden to both
our healthcare system and caregivers of stroke victims. These two particular
issues are utmost significance and inspired me to study more. Since then, I am
determined to find solutions to the problems I had witnessed firsthand.

Management of acute
ischemic stroke patients is determined by two important factors namely early
hospital arrival time and effective treatment. According to my experience with
stroke patients as a medical volunteer, I found that most of the patients did
not know what was happening to them or how urgent it was for them to go to
hospitals. And as the patients were ignorant of these issues, the EMS providers
could not deliver the timely action that strokes require for treatment. A lack
of awareness from the beginning is the root cause of problems that eventually
results in disabilities of survivors, and this later inspired me to undertake
the stroke awareness project.

In the aspect of
effective treatment, after consulting with my mentor; Assoc. Prof. Yongchai
Nilanont, I was introduced to the new advent therapy called ‘Thrombectomy’.
Aside from thrombolysis which is worldwide acclaimed as an effective treatment
for acute ischemic stroke, thrombectomy is another highly effective therapy
which has been recently accepted as standard treatment in patients with acute
ischemic stroke. Nevertheless, there are limited facilities to provide this
treatment along with costs of treatment cannot be fully reimbursed in the
national healthcare system of Thailand. Consequently, rarely patients who
require this treatment receive it.

Considering financial
problems and economic burden of stroke, I am aware that implementation of
thrombectomy cannot be achieved without thorough discretions. After putting
many efforts to find the solution, I found out that there is an emerging field
known as health economic evaluations. They are used as assistance in health
care resource allocation decisions. There are many forms of health economic
evaluations including cost-effectiveness analysis and I dare say that this is
the solution I am looking for. I believe that to promote thrombectomy to be
implemented in national healthcare system cannot solely rely on clinical
efficiency but cost-effectiveness is also of paramount. Cost-effectiveness
analysis is used to help healthcare policymakers and clinicians decide on the
greatest utility of the resources available. It will ensure that patients will
benefit from receiving the most effective treatment whereas hospitals also
benefit from effective health care resource allocations.

According to budget
constraints and limited resources in our country, I strongly hold that
cost-effectiveness analysis is an alternative solution to our financial
problems and economic burden of stroke. Thereby, I propose this project to
estimate whether thrombectomy is cost-effective or not in the context of
Thailand. And hopefully, this project could be a model to encourage an application
of health economic evaluations in assessment of other treatment interventions
apart from stroke and other aspects of health policy including prevention
programs, diagnostics, and rehabilitation. I heartily believe that through
implementation of health economic evaluation, we can together reach the ultimate
goal ‘financial sustainability’ of Thailand’s national healthcare system. I
realise that this project may seem somewhat grandiose but every step takes us
forward, and the time to start is now.