µàÕ §à“„™â®à“¬¥â“π ÿ¢ ¿“æ®“°°“√∫√'‚¿§‡§√◊ËÕß

(1)

º≈°√–∑∫µàÕ§à“„™â®à“¬¥â“π ÿ¢¿“æ®“°°“√∫√‘‚¿§‡§√◊ËÕß

¥◊Ë¡·Õ≈°ÕŒÕ≈å¢Õßª√–™“°√‰∑¬

ª√–æ—°µ√å ‡π√¡‘µæ‘∑—°…å°ÿ≈

*^†

™π‘¥“ ‡≈‘»æ‘∑—°…åæß»å

*

®Õ¡¢«—≠ ‚¬∏“ ¡ÿ∑√

*

Õÿ…“ ©“¬‡°≈Á¥·°â«

*^†

¡π∑√—µ¡å ∂“«√‡®√‘≠∑√—æ¬å

*^†

¬» µ’√–«—≤π“ππ∑å

*

*‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ °√–∑√«ß “∏“√≥ ÿ¢

†^†¿“§«‘™“‡¿ —™°√√¡ §≥–‡¿ —™»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈

594

∫∑§—¥¬àÕ °“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å°àÕ„Àâ‡°‘¥º≈‡ ’¬µàÕ√à“ß°“¬, ®‘µ„®·≈–§«“¡‡ªìπÕ¬Ÿà∑“ß —ß§¡‚¥¬√«¡, ∑—Èß¬—ß¡’§«“¡

—¡æ—π∏å°—∫°“√‡°‘¥‚√§¡“°°«à“ ˆ ‚√§ ´÷Ëß°àÕ„Àâ‡°‘¥º≈°√–∑∫µàÕ§à“„™â®à“¬¥â“π ÿ¢¿“æÕ¬à“ß¡“°. Õ¬à“ß‰√°Áµ“¡„π ªí®®ÿ∫—π¬—ß‰¡àæ∫°“√»÷°…“∑’Ëª√–‡¡‘π§à“„™â®à“¬¥â“π ÿ¢¿“æ®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å„πª√–™“°√‰∑¬Õ¬à“ß

§√Õ∫§≈ÿ¡·≈–‡ªìπ√–∫∫.

°“√»÷°…“π’È¡’«—µ∂ÿª√– ß§å‡æ◊ËÕ§”π«≥§à“„™â®à“¬∑“ß¥â“π ÿ¢¿“æ‡π◊ËÕß®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å ‚¥¬¡ÿ¡¡Õß

√–∫∫ “∏“√≥ ÿ¢ „π æ.». ÚıÙ˘. ‡√‘Ë¡µâπ®“°°“√§”π«≥ —¥ à«π¢Õß°“√‡°‘¥‚√§®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å

‚¥¬„™â¢âÕ¡Ÿ≈§«“¡™ÿ°¢Õß°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å„πª√–™“°√‰∑¬ ·≈–§«“¡‡ ’Ë¬ß —¡æ—∑∏å°“√‡°‘¥‚√§∑’Ë¡’ “‡Àµÿ

®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å ·∫àßµ“¡Õ“¬ÿ·≈–‡æ» ∑’Ë‰¥â®“°°“√∑∫∑«π«√√≥°√√¡∑’Ë‡ªìπ°“√«‘‡§√“–Àå‡™‘ß Õ¿‘¡“π·≈â«§Ÿ≥°—∫®”π«πºŸâªÉ«¬∑—ÈßÀ¡¥∑’Ë‡ªìπ‚√§µà“ß Ê „πª√–‡∑»‰∑¬ ®–‰¥â®”π«πºŸâªÉ«¬∑’Ë‡ªìπ‚√§∑’Ë¡’ “‡Àµÿ®“°°“√

∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å. ®“°π—Èπ®÷ß§”π«≥§à“„™â®à“¬∑“ß¥â“π ÿ¢¿“æ‡π◊ËÕß®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å‚¥¬

π”®”π«πºŸâªÉ«¬∑’Ë‡ªìπ‚√§∑’Ë¡’ “‡Àµÿ¡“®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å∑’Ë‰¥â§Ÿ≥°—∫µâπ∑ÿπµàÕÀπà«¬¢Õß°“√√—°…“‚√§

∑’Ë·ºπ°ºŸâªÉ«¬πÕ°·≈–ºŸâªÉ«¬„π.

®“°°“√»÷°…“æ∫«à“§à“„™â®à“¬¥â“π ÿ¢¿“æ „π æ.». ÚıÙ˘ ∑’Ë‡°‘¥¢÷Èπ®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å¡’¡Ÿ≈§à“ Ÿß∂÷ß ı,Ù˘Ò.Ú ≈â“π∫“∑ ‡ªìπ§à“„™â®à“¬∑’Ë‡°‘¥®“°ºŸâªÉ«¬πÕ° Ú,Ù¯¯.Ò ≈â“π∫“∑ ·≈–ºŸâªÉ«¬„π Û,Û.Ò ≈â“π∫“∑. —¥ à«π

§à“„™â®à“¬„πß“π∫√‘°“√ºŸâªÉ«¬„π§‘¥‡ªìπ√âÕ¬≈– ıı ¢Õß§à“„™â®à“¬¥â“π ÿ¢¿“æ∑—ÈßÀ¡¥. º≈°“√»÷°…“§√—Èßπ’È· ¥ß„Àâ‡ÀÁπ

«à“°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å„πª√–‡∑»‰∑¬¡’§«“¡ —¡æ—π∏å°—∫§à“„™â®à“¬¥â“π ÿ¢¿“æ∑—ÈßÀ¡¥∑’Ë‡æ‘Ë¡¢÷ÈπÕ¬à“ß¡’π—¬ ”§—≠.

∑—Èßπ’ÈºŸâ«“ß·ºππ‚¬∫“¬ “¡“√∂π”¢âÕ¡Ÿ≈§à“„™â®à“¬¥â“π ÿ¢¿“æ®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å ‰ª„™â‡æ◊ËÕ°“√ª√–‡¡‘π

·≈–°”Àπ¥π‚¬∫“¬∑’Ë‡À¡“– ¡µàÕ‰ª.

§” ”§—≠: §à“„™â®à“¬¥â“π ÿ¢¿“æ, °“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å, ª√–™“°√‰∑¬

(2)

¿Ÿ¡‘À≈—ß·≈–‡Àµÿº≈

“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å àßº≈°√–∑∫‡™‘ß≈∫µàÕ —ß§¡·≈–‡»√…∞°‘®‡ªìπÕ¬à“ß¡“°‚¥¬‡ªìπ‡Àµÿ ”§—≠¢Õß Õÿ∫—µ‘‡Àµÿ®√“®√, §«“¡√ÿπ·√ß„π§√Õ∫§√—«·≈– —ß§¡ µ≈Õ¥

®πÕ“™≠“°√√¡,´÷Ëßº≈°√–∑∫‡À≈à“π’Èπ”‰ª Ÿà°“√∫“¥‡®Á∫´÷Ëß Õ“®√ÿπ·√ß∂÷ß¢—Èπæ‘°“√À√◊Õ‡ ’¬™’«‘µ·≈–°àÕ„Àâ‡°‘¥°“√ Ÿ≠‡ ’¬

∑√—æ¬å ‘πµà“ß Ê. πÕ°®“°π’È®“°√“¬ß“π¢ÕßÕß§å°“√Õπ“¡—¬‚≈°

æ.». ÚıÙ˜^(Ò) ¬—ß· ¥ß«à“°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å°àÕ

„Àâ‡°‘¥‚√§¡“°°«à“ ˆ ‚√§.

„πÀ≈“¬ªï∑’Ëºà“π‰ª ª√–‡∑»µà“ß Ê ‰¥â¡’°“√ª√–¡“≥§à“

µâπ∑ÿπ∑“ß‡»√…∞°‘®·≈– —ß§¡∑’Ë‡°‘¥¢÷Èπ®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡

·Õ≈°ÕŒÕ≈å^(Ú-ı) ‚¥¬æ∫«à“µâπ∑ÿπ∑“ß‡»√…∞°‘®∑’Ë —ß§¡µâÕß·∫°

√—∫∑’Ë ”§—≠·≈–¡’ —¥ à«π∑’Ë Ÿß‡¡◊ËÕ‡∑’¬∫°—∫µâπ∑ÿπ∑’Ë‡°‘¥¢÷Èπ

∑—ÈßÀ¡¥π—Èπ¡“®“°°“√ Ÿ≠‡ ’¬º≈‘µ¿“æ∑—Èß®“°°“√‡ ’¬™’«‘µ

°àÕπ∂÷ß«—¬Õ—π§«√ ·≈–°“√ Ÿ≠‡ ’¬º≈‘µ¿“æ®“°°“√¢“¥ß“π

·≈–¢“¥ª√– ‘∑∏‘¿“æ¢≥–∑”ß“π. Õ¬à“ß‰√°Áµ“¡·¡â«à“µâπ∑ÿπ

¥â“π ÿ¢¿“æ®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈åµàÕµâπ∑ÿπ∑’Ë

‡°‘¥¢÷Èπ∑—ÈßÀ¡¥®–‡ªìπ —¥ à«π∑’Ë‰¡à¡“°π—°‡¡◊ËÕ‡∑’¬∫°—∫µâπ∑ÿπ

®“°°“√ Ÿ≠‡ ’¬º≈‘µ¿“æ. ·µàµâπ∑ÿπ à«ππ’È°Á¬—ß®—¥‡ªìπµâπ∑ÿπ

∑’Ë¡’§«“¡ ”§—≠‡æ√“–‡ªìπµâπ∑ÿπ∑“ßµ√ß∑’Ë¡’¡Ÿ≈§à“ Ÿß·≈–

‡ªìπµâπ∑ÿπ∑’Ë “¡“√∂À≈’°‡≈’Ë¬ß‰¥â À“°‰¡à¡’°“√∫√‘‚¿§‡§√◊ËÕß

¥◊Ë¡·Õ≈°ÕŒÕ≈å.

„πª√–‡∑»‰∑¬∑’Ëºà“π¡“‰¥â¡’°“√»÷°…“∂÷ß§à“„™â®à“¬¥â“π ÿ¢¿“æ®“°°“√√—°…“æ¬“∫“≈‚√§µà“ß Ê Õ—π¡’ “‡Àµÿ¡“®“°

Abstract Economic Impacts on Health-care Costs among the Thai Population Drinking Alcohol Prapag Neramitpitagkul,*^† Chanida Lertpitakpong,^† Jomkwan Yothasamut,^†

Usa Chaikledkaew,*^† Montarat Thavorncharoensap,*^† Yot Teerawattananon^†

*Department of Pharmacy, Faculty of Pharmacy, Mahidol University, ^†Health Intervention and Technology Assess- ment Program (HITAP), Ministry of Public Health

The drinking of alcohol is closely related to a wide range of physical, mental and social problems.

Most health professionals agree that alcohol affects practically every organ in the human body. Overall, there is a causal relationship between alcohol consumption and more than 60 diseases and injuries. Con- sequently, alcohol drinking has a substantial impact on health-care expenditure. However, health-care costs related to alcohol drinking in the Thai population have not been carefully researched. The objective of this study was to estimate health-care costs due to the diseases caused by drinking alcohol, based on a health system perspective.

First, the alcohol-attributable fractions (AAFs), which are generally defined as the proportion of a disease in a population which is attributable to alcohol drinking, were calculated from the prevalence of alcohol drinking and age- and sex-specific relative risk for each disease. Pooled relative risks derived from meta-analyses were preferable for this calculation. The number of patients in each disease category attributable to alcohol drinking was then calculated as the product of AAFs and the total number of patients with a specific disease, classified by sex and age group.

The health-care costs of alcohol drinking was further estimated by multiplying the number of patients in each disease category attributable to alcohol drinking by the unit cost of treatment. Both out- patient and in-patient visits were taken into account in this study.

Health-care costs attribute to alcohol in this research totalled 5,491.2 million baht (i.e., out-patient department (2,488.1 million baht) and inpatient department (3,003.1 million baht). Costs derived from the in-patient department accounted for 55 percent of the total health-care costs attributable to alcohol. The result of this study indicated that alcohol drinking was significantly associated with a large number of health-care costs in Thailand. Estimation of health-care costs related to alcohol drinking would provide an important insight into future policy appraisal and evaluation.

Key words: economic impact, health-care costs, alcohol drinkers, Thai population

°

(3)

596

°“√¥◊Ë¡·Õ≈°ÕŒÕ≈å^(ˆ) ‚¥¬»÷°…“§à“„™â®à“¬∑’Ë‡°‘¥¢÷Èπ‡©æ“–„π

·ºπ°ºŸâªÉ«¬„π∑’Ë‡ªìπ°“√√—°…“Õ“°“√‡π◊ËÕß®“°·Õ≈°ÕŒÕ≈å

·≈–‚√§∑“ß‡¥‘πÕ“À“√√«¡∑—Èßµ—∫‡∑à“π—Èπ. ¥—ßπ—Èπ§à“√—°…“

æ¬“∫“≈∑’Ë§”π«≥‰¥â®÷ß‰¡à –∑âÕπ§à“„™â®à“¬¥â“π ÿ¢¿“æ∑’Ë·∑â

®√‘ß∑’Ë‡°‘¥®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å„πª√–‡∑»‰∑¬

‰¥â. °“√»÷°…“§√—Èßπ’È®÷ß¡’«—µ∂ÿª√– ß§å‡æ◊ËÕ§”π«≥§à“„™â®à“¬

¥â“π ÿ¢¿“æÕ—π‡π◊ËÕß¡“®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å

„πª√–‡∑»‰∑¬„π æ.». ÚıÙ˘ ‚¥¬„™â¡ÿ¡¡Õß√–∫∫ “∏“√≥ ÿ¢.

√–‡∫’¬∫«‘∏’»÷°…“

°“√»÷°…“·∫àß‡ªìπ Û ¢—ÈπµÕπ¥—ßπ’È

Ò. °“√§”π«≥ —¥ à«π¢ÕßºŸâªÉ«¬„π‚√§µà“ß Ê ∑’Ë¡’ “‡Àµÿ

®“°·Õ≈°ÕŒÕ≈å (Alcohol Attributable Fractions, AAFs)

´÷Ëß “¡“√∂§”π«≥‚¥¬„™â¢âÕ¡Ÿ≈§«“¡™ÿ°¢Õß°“√¥◊Ë¡‡§√◊ËÕß¥◊Ë¡

·Õ≈°ÕŒÕ≈å„πª√–™“°√‰∑¬ (P_i)^(ÒÙ) ·≈–§«“¡‡ ’Ë¬ß —¡æ—∑∏å (RR_i) °“√‡°‘¥‚√§µà“ß Ê ®”·π°µ“¡Õ“¬ÿ·≈–‡æ»´÷Ëß‰¥â®“°¢âÕ¡Ÿ≈

°“√∑∫∑«π«√√≥°√√¡Õ¬à“ß‡ªìπ√–∫∫·≈–°“√«‘‡§√“–Àå‡™‘ßÕ¿‘

¡“π^(˘) ¥â«¬ Ÿµ√µàÕ‰ªπ’È

P_i (RR_i-1) AAF_i =

Σi=oPi (RR_i_-1) + 1

Õ¬à“ß‰√°Áµ“¡ —¥ à«πºŸâªÉ«¬„π°“√∫“¥‡®Á∫∑’Ë¡’ “‡Àµÿ®“°

°“√¥◊Ë¡·Õ≈°ÕŒÕ≈å¡“®“°°“√‡ΩÑ“√–«—ß°“√∫“¥‡®Á∫√ÿπ·√ß

√–¥—∫™“µ‘ æ.». ÚıÙ˘^(Òı) ´÷Ëßº≈§Ÿ≥¢Õß AAFs °—∫®”π«π ºŸâªÉ«¬∑—ÈßÀ¡¥„π‚√§π—Èπ Ê ´÷Ëß‰¥â¢âÕ¡Ÿ≈®“°§≥–∑”ß“π¿“√–

‚√§·≈–°“√∫“¥‡®Á∫®“°æƒµ‘°√√¡ ÿ¢¿“æ·≈–ªí®®—¬‡ ’Ë¬ß æ.».

ÚıÙ˘ ´÷Ëß‡∑à“°—∫®”π«πºŸâªÉ«¬¥â«¬‚√§¥—ß°≈à“«∑’Ë¡’ “‡Àµÿ¡“

®“°°“√¥◊Ë¡·Õ≈°ÕŒÕ≈å (Number_Pt_i).

Ú. °“√ª√–‡¡‘π§à“„™â®à“¬¥â“π ÿ¢¿“æ.

Ú.Ò °“√ª√–‡¡‘π§à“„™â®à“¬®“°°“√¡“√—∫∫√‘°“√∑’Ë

·ºπ°ºŸâªÉ«¬πÕ° (Total Cost _OPD) ´÷Ëß §”π«≥‰¥â®“°

Ÿµ√µàÕ‰ªπ’È

Total Cost_OPD = (Number_Pt_i* Frequency_i * Average Cost_i)

‚¥¬ Number_Pt_i = ®”π«πºŸâªÉ«¬¥â«¬‚√§ i ∑’Ë¡’ “‡Àµÿ

¡“®“°·Õ≈°ÕŒÕ≈å

Frequency_i = ®”π«π§√—Èß‡©≈’Ë¬∑’ËºŸâªÉ«¬‚√§ i ¡“

√—∫∫√‘°“√∑’Ë·ºπ°ºŸâªÉ«¬πÕ°µàÕªï

Average Cost_i = §à“„™â®à“¬‡©≈’Ë¬µàÕ§√—Èß¢Õß°“√

¡“√—∫∫√‘°“√∑’Ë·ºπ°ºŸâªÉ«¬πÕ°¢ÕßºŸâªÉ«¬‚√§ i

∑—Èßπ’È ®”π«π§√—Èß‡©≈’Ë¬ ·≈–§à“„™â®à“¬‡©≈’Ë¬µàÕ§√—Èß∑’Ë¡“√—∫

∫√‘°“√ §”π«≥®“°∞“π¢âÕ¡Ÿ≈ºŸâªÉ«¬πÕ°®“°»Ÿπ¬å«‘®—¬·≈–

µ‘¥µ“¡§«“¡‡ªìπ∏√√¡∑“ß ÿ¢¿“æ §≥–·æ∑¬»“ µ√å

¡À“«‘∑¬“≈—¬π‡√»«√ ´÷Ëß‡ªìπ∞“π¢âÕ¡Ÿ≈∑’Ë‰¥â®“°‚√ßæ¬“∫“≈»Ÿπ¬å,

‚√ßæ¬“∫“≈∑—Ë«‰ª ·≈–‚√ßæ¬“∫“≈™ÿ¡™π ®“° Ò¯ ®—ßÀ«—¥

®”π«π ¯Ò ‚√ßæ¬“∫“≈„π æ.». ÚıÙˆ ·≈–ª√—∫§à“µ“¡

Õ—µ√“‡ß‘π‡øÑÕ „Àâ‡ªìπ æ.». ÚıÙ˘.

Ú.Ú °“√ª√–‡¡‘π§à“„™â®à“¬®“°°“√¡“√—∫∫√‘°“√„π

·ºπ°ºŸâªÉ«¬„π ´÷Ëß§”π«≥‰¥â®“° Ÿµ√µàÕ‰ªπ’È

Total Cost_IPD = (Number_Pt_i* Adjusted RW_i * Cost Per RW)

‚¥¬ Adjusted RW_i = §à“πÈ”Àπ—° —¡æ—∑∏å∑’Ëª√—∫µ“¡

«—ππÕπ (Adjusted Relative Weight) „πºŸâªÉ«¬‚√§ i Cost Per RW= §à“„™â®à“¬‡©≈’Ë¬µàÕÀπ÷ËßÀπà«¬πÈ”

Àπ—° —¡æ—∑∏å‡©≈’Ë¬∑’Ëª√—∫µ“¡«—ππÕπ

∑—Èßπ’È Cost Per RW ‰¥â®“°¢âÕ¡Ÿ≈¢Õß ”π—°ß“πÀ≈—°

ª√–°—π ÿ¢¿“æ·Ààß™“µ‘ „Àâ®à“¬µ“¡°≈ÿà¡«‘π‘®©—¬‚√§√à«¡ (Diag- nosis Related Group, DRG) µ“¡Õ—µ√“ Ò Adjusted Rela- tive Weight ‚¥¬®à“¬„πÕ—µ√“ Ò,Û ∫“∑ µàÕ Ò Adjusted RW^(Òˆ) „π¢≥–∑’Ë Adjusted RW_i ‰¥â®“°∞“π¢âÕ¡Ÿ≈ºŸâªÉ«¬„π

®“° ”π—°ß“π°≈“ß “√ π‡∑»∫√‘°“√ ÿ¢¿“æ ( ° .). ∑—Èßπ’È

∑”°“√·¬°§”π«≥§à“„™â®à“¬¥â“π ÿ¢¿“æ¢ÕßºŸâªÉ«¬„πµ“¡

‘∑∏‘ª√–°—π ÿ¢¿“æ¢ÕßºŸâªÉ«¬ ‚¥¬∞“π¢âÕ¡Ÿ≈¥—ß°≈à“«§√Õ∫

§≈ÿ¡¢âÕ¡Ÿ≈ºŸâªÉ«¬„π√–∫∫ «— ¥‘°“√√—°…“æ¬“∫“≈¢Õß¢â“√“™°“√

(Civil Servant Medical Benefit Scheme, CSMBS) ·≈–

‘∑∏‘ª√–°—π ÿ¢¿“æ∂â«πÀπâ“ (UC) ·µà‰¡à‰¥â§√Õ∫§≈ÿ¡ ‘∑∏‘

ª√–°—π ÿ¢¿“æÕ◊Ëπ Ê ‡™àπ ‘∑∏‘ª√–°—π —ß§¡ À√◊ÕºŸâªÉ«¬∑’Ë√—∫

κ

(4)

∫√‘°“√∑’Ë‚√ßæ¬“∫“≈‡Õ°™π ·≈– ∂“π∫√‘°“√Õ◊Ëπ Ê ∑’ËÕ¬ŸàπÕ°

‡Àπ◊Õ®“°¢âÕ¡Ÿ≈®“° ”π—°ß“π°≈“ß “√ π‡∑»∫√‘°“√ ÿ¢¿“æ.

¥—ßπ—Èπ®÷ß∑”°“√ª√—∫¢âÕ¡Ÿ≈®“°∞“π¢âÕ¡Ÿ≈¥—ß°≈à“«‚¥¬Õ¬Ÿà∫π ¡¡ÿµ‘∞“π∑’Ë«à“®”π«πºŸâªÉ«¬∑’ËÕ¬ŸàπÕ°‡Àπ◊Õ®“°¢âÕ¡Ÿ≈®“°

”π—°ß“π°≈“ß “√ π‡∑»∫√‘°“√ ÿ¢¿“æ¡’Õ¬Ÿà√âÕ¬≈– Û ¢Õß

®”π«πºŸâªÉ«¬∑—ÈßÀ¡¥µ“¡∑’ËºŸâ‡™’Ë¬«™“≠‡ πÕ·π–.

º≈°“√»÷°…“

º≈°“√§”π«≥À“ —¥ à«πºŸâªÉ«¬„π‚√§µà“ß Ê ∑’Ë¡’ “‡Àµÿ

®“°·Õ≈°ÕŒÕ≈å¢Õßª√–™“°√‰∑¬ · ¥ß„πµ“√“ß∑’Ë Ò.

®“°°“√§”π«≥æ∫«à“ §à“ —¥ à«π¢Õß°“√‡°‘¥‚√§∑’Ë¡’

“‡Àµÿ®“°·Õ≈°ÕŒÕ≈å ¡’∑—Èß§à“∫«°·≈–≈∫. §à“∑’Ë‡ªìπ∫«°

· ¥ß∂÷ß°“√‡ªìπªí®®—¬‡ ’Ë¬ß¢Õß·Õ≈°ÕŒÕ≈å, „π¢≥–∑’Ë§à“≈∫

· ¥ß∂÷ßº≈¢Õß·Õ≈°ÕŒÕ≈å„π°“√ªÑÕß°—π‚√§´÷Ëßæ∫‰¥â„π‚√§

‡∫“À«“π, ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õßµ’∫, ‚√§π‘Ë«∂ÿßπÈ”¥’, ¿“«–

À—«„®¢“¥‡≈◊Õ¥ ·≈–À—«„®≈â¡‡À≈«. ∑—Èßπ’È„π°“√§”π«≥§à“„™â

®à“¬∑“ß¥â“π ÿ¢¿“æ„π§√—Èßπ’È®–∑”°“√§”π«≥‡©æ“–„π‚√§∑’Ë¡’

§à“ —¥ à«π¢Õß°“√‡°‘¥‚√§∑’Ë¡’ “‡Àµÿ®“°·Õ≈°ÕŒÕ≈å ∑’Ë¡’§à“

‡ªìπ∫«°‡∑à“π—Èπ.

µ“√“ß∑’Ë Ú ·≈– Û · ¥ß§à“„™â®à“¬®“°°“√¥◊Ë¡‡§√◊ËÕß¥◊Ë¡

·Õ≈°ÕŒÕ≈å¢ÕßºŸâªÉ«¬πÕ°·≈–ºŸâªÉ«¬„πµ“¡≈”¥—∫. ∑—Èßπ’Èæ∫

«à“§à“„™â®à“¬¥â“π ÿ¢¿“æ¢ÕßºŸâªÉ«¬πÕ°·≈–ºŸâªÉ«¬„π∑’Ë‡°‘¥¢÷Èπ

®“°‚√§À√◊Õ¿“«–∑’Ë¡’ “‡Àµÿ®“°°“√¥◊Ë¡‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å

¡’§à“‡∑à“°—∫ Ú,Ù¯¯.Ò ·≈– Û,Û.Ò ≈â“π∫“∑ µ“¡≈”¥—∫,

‚¥¬‚√§∑’Ë¡’§à“„™â®à“¬¥â“π ÿ¢¿“æ Ÿß ÿ¥„π·ºπ°ºŸâªÉ«¬πÕ° Û Õ—π¥—∫·√° ‰¥â·°à‚√§‡Õ™‰Õ«’√âÕ¬≈– Ûˆ, °“√„™â·Õ≈°ÕŒÕ≈å

„π∑“ß∑’Ëº‘¥√âÕ¬≈– ÚÛ, ‚√§≈¡™—°√âÕ¬≈– Ò¯. à«π‚√§∑’Ë¡’

§à“„™â®à“¬¥â“π ÿ¢¿“æ Ÿß ÿ¥„π·ºπ°ºŸâªÉ«¬„π Û Õ—π¥—∫·√°

‰¥â·°à°“√∫“¥‡®Á∫®“°Õÿ∫—µ‘‡Àµÿ®“°°“√®√“®√∑“ß∫°√âÕ¬≈– ÙÒ,

‚√§¡–‡√Áßµ—∫ √âÕ¬≈– ¯, ‚√§µ—∫·¢Áß·≈–¿“«–µ‘¥ ÿ√“√âÕ¬≈– ˜ µ“¡≈”¥—∫, √«¡§à“„™â®à“¬®“°°“√¥◊Ë¡·Õ≈°ÕŒÕ≈å∑—ÈßÀ¡¥¡’¡Ÿ≈§à“

ı,Ù˘Ò.Ú ≈â“π∫“∑ ·≈–®”π«πºŸâªÉ«¬∑—ÈßÀ¡¥∑’ËµâÕß¡“‡¢â“√—∫

∫√‘°“√‚¥¬¡’·Õ≈°ÕŒÕ≈å‡ªìπ “‡Àµÿ Û,Ú˘,ÙÚ˜ §π. ®“°

µ“√“ß∑’Ë Ù · ¥ß„Àâ‡ÀÁπ«à“§à“„™â®à“¬¥â“π ÿ¢¿“æ¢ÕßºŸâ™“¬¡’§à“

µ“√“ß∑’Ë Ò §à“ —¥ à«πºŸâªÉ«¬„π‚√§µà“ßÊ ∑’Ë¡’ “‡Àµÿ®“°·Õ≈°ÕŒÕ≈å

¢Õßª√–™“°√‰∑¬ (√âÕ¬≈–)

‚√§ ™“¬ À≠‘ß

‡Õ¥ å Û˘ Ò˜

°“√„™â·Õ≈°ÕŒÕ≈å„π∑“ß∑’Ëº‘¥ Ò Ò

≈¡™—° ˆˆ ÚÒ

µ‘¥ ÿ√“ Ò Ò

§«“¡¥—π‚≈À‘µ Ÿß ÚÒ ÒÚ

µ—∫·¢Áß ¯Ú Ú˜

‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ° ÒÙ -˜

¿“«–À—«„®‡µâπº‘¥®—ßÀ«– ∫√‘‡«≥ Û˘ Òˆ ÿª√â“‡«π∑√‘§ÿ≈“√å

‡π◊ÈÕßÕ°™π‘¥Õ◊ËπÊ ÒÙ Ù

–‡°Á¥‡ß‘π Û¯ Ò˜

∑“√°πÈ”Àπ—°µ—«πâÕ¬ Ù -Ú

¡–‡√Áß√‘¡Ωïª“°·≈–§ÕÀÕ¬ ıÚ Ò˜

¡–‡√Áß‡µâ“π¡„π µ√’ - ı

¡–‡√Áß°√–‡æ“–Õ“À“√ ˆ˘ Ò

Õÿ∫—µ‘‡Àµÿ®√“®√∑“ß∫° Ûˆ Ûˆ

¡–‡√ÁßÀ≈Õ¥Õ“À“√ ˆ ÚÙ

∂Ÿ°∑”√â“¬ ı˜ ı˜

µ—∫ÕàÕπÕ—°‡ ∫‡√◊ÈÕ√—ß Ò Ò

°√–‡æ“–Õ“À“√Õ—°‡ ∫ Ò Ò

¡–‡√Áß°≈àÕß‡ ’¬ß ˆ¯ Úˆ

Õÿ∫—µ‘‡Àµÿ®“°°“√∑”ß“π ˜ ˜

‚√§´÷¡‡»√â“™π‘¥¢—È«‡¥’¬« ˆ 

µ—∫ÕàÕπÕ—°‡ ∫‡√◊ÈÕ√—ß·≈–‡©’¬∫æ≈—π Ûˆ Ò

¡–‡√Áßµ—∫ Ù˘ Òˆ

æ‘…‡Õ∏“πÕ≈ Ò Ò

À≈Õ¥‡≈◊Õ¥„πÀ≈Õ¥Õ“À“√‚ªÉßæÕß ˜˜ ÚÛ

Õ—µ«‘π‘∫“µ°√√¡ ÚÛ ÚÛ

‚√§®‘µ Ò Ò

°≈â“¡‡π◊ÈÕÀ—«„®º‘¥ª√°µ‘ Ò Ò

°“√‡ª≈’Ë¬π·ª≈ß¢Õß√–∫∫ª√– “∑ Ò Ò

æ‘…‡Õ∏“πÕ≈™π‘¥Õ◊Ëπ Ò Ò

¿“«°“√≥å‡®√‘≠‡µ‘∫‚µ¢Õß‡¥Á°„π§√√¿å Ò Ò

º‘¥ª√°µ‘

√–¥—∫·Õ≈°ÕŒÕ≈å„π‡≈◊Õ¥ Ÿß Ò Ò

ª≈“¬ª√– “∑Õ—°‡ ∫ Ò Ò

·Õ≈°ÕŒÕ≈å‡ªìπæ‘… Ò Ò

æ‘…‡¡∏“πÕ≈ Ò Ò

®¡πÈ” ÒÚ ÒÚ

(5)

598

µ“√“ß∑’Ë Ú §à“„™â®à“¬¥â“π ÿ¢¿“æ∑’Ë‡°‘¥®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å„π·ºπ°ºŸâªÉ«¬πÕ°

®”π«πºŸâªÉ«¬ §à“√—°…“æ¬“∫“≈ §à“„™â®à“¬ §à“„™â®à“¬∑—ÈßÀ¡¥

‚√§ (√“¬) (∫“∑µàÕ§√—Èß) (≈â“π∫“∑) (≈â“π∫“∑)

™“¬ À≠‘ß ™“¬ À≠‘ß

‡Õ¥ å ÒÚÚ,ÚÚ ÛÒ,¯˘ ˘Û˜.¯ ˜ÒÙ.Û Ò¯ı.˘ ˘.Û

°“√„™â·Õ≈°ÕŒÕ≈å„π∑“ß∑’Ëº‘¥ Ò,ÙÚÚ,˘ÒÚ ÒÛ¯,ÚÛ˘ Òˆˆ.ÙÙ ıÚ.Û ı.ı ı˜.¯

≈¡™—° ÒÒÚ,ıÒı ˆı,˜˜¯ ı¯Û.ˆ¯ Ú˜˜.ı ÒˆÚ.Ú ÙÛ˘.˜

¿“«–µ‘¥ ÿ√“ ¯˘Û,ÙÙÛ ˆı,Û˜ı ˆ¯.Ù Ò˘Ù. ÒÙ.Ú Ú¯.Ú

§«“¡¥—π‚≈À‘µ Ÿß Ú˜,˘˘Ò Ú˜,Ú˜ ˜ˆ¯.Ûˆ ÒÛ.Ò ˘˘.ı ÚÚ.ˆ

µ—∫·¢Áß Ò˜,˘¯Ò Ú,ˆ˜ ı˘Ù.˘ ıÛ.˜ ˜.¯ ˆÒ.ı

À≈Õ¥‡≈◊Õ¥„π ¡Õß·µ°* Ù,ı˘Ù -Ò,˜Ú¯ Ò,Ò.Ù ÒÙ.˘ -ı.ˆ ÒÙ.˘

¿“«–À—«„®‡µâπº‘¥®—ßÀ«– ÿª√â“‡«π∑√‘§ÿ≈“√å ¯,˜˜Û ı,˜Û ÚÚˆ.¯ˆ ˜. Ù. ÒÒ.

‡π◊ÈÕßÕ°™π‘¥Õ◊Ëπ Ê Û,ÚÒÛ Ú,˜Ú¯ ˜˜.¯˜ ı.Ò Ù.Û ˘.Ù

–‡°Á¥‡ß‘π Ù,˜˜ Ò,ıˆÒ ÛÚÙ.˘ ˆ.Û Ú.Ò ¯.Û

∑“√°πÈ”Àπ—°µ—«πâÕ¬* ˜,ı˘Ò -ı,Úı¯ ÙÚı.ÚÚ ˜.ˆ -ı.Ú ˜.ˆ

¡–‡√Áß√‘¡Ωïª“°·≈–§ÕÀÕ¬ Ú,˘ı¯ ¯˜¯ ˆ˜Û.˜Ù ı.˜ Ò.˜ ˜.Ù

¡–‡√Áß‡µâ“π¡„π µ√’  Ò,ÙÚÒ ˘˘¯.ˆÙ . ˜.Ò ˜.Ò

¡–‡√Áß°√–‡æ“–Õ“À“√ Ò,ÙÚ˜ ÒÙı Ò,Òı˘.Û¯ ı.ˆ .ˆ ˆ.Ú

Õÿ∫—µ‘‡Àµÿ®“°®√“®√∑“ß∫° Ò˜,¯˘ˆ Ù,ÒÙ ÚÙ¯.ıÚ ¯.˘ Ú.Ò ÒÒ.

¡–‡√ÁßÀ≈Õ¥Õ“À“√ ¯ÛÚ Ò˜ı Ò,Úˆ˜.ˆ¯ Ú.˘ .ˆ Û.ı

∂Ÿ°∑”√â“¬ Ù,˘˘ Ò,ˆÛ ÛÚ.ÛÙ Û. Ò. Ù.

µ—∫ÕàÕπÕ—°‡ ∫‡√◊ÈÕ√—ß Û˘Ù Òıı Ò,¯Û. Ò.ı .ˆ Ú.Ò

°√–‡æ“–Õ“À“√Õ—°‡ ∫ Ú,¯Ò¯ Ù¯¯ Ûˆ.ÚÙ Ò.ˆ .Û Ò.¯

¡–‡√Áß°≈àÕß‡ ’¬ß Ù¯ı Ûˆ ˜ıÛ.ıÙ Ò.Ò .Ò Ò.Ú

°“√∫“¥‡®Á∫∑’Ë‡°‘¥®“°°“√∑”ß“π Ú,˜Úı ¯Ùı ÛÚ¯.ÛÚ Ò.ı .ı Ú.

‚√§´÷¡‡»√â“™π‘¥ ¢—È«‡¥’¬« ÛÛÛ ÙÙ ˆÛ¯.Û .˘ .Ò Ò.

µ—∫ÕàÕπÕ—°‡ ∫‡√◊ÈÕ√—ß·≈–‡©’¬∫æ≈—π ıÒ˘ ıÛ ˘˜.ÙÙ Ò. .Ò Ò.Ò

¡–‡√Áßµ—∫ ˆ,Ò¯˜ ¯¯˜ ıÚ.ÙÙ .˘ .Ò Ò.

æ‘…‡Õ∏“πÕ≈ Ù,ıÙˆ ˜Ù˜ Òˆ.Ú .¯ .Ò .˘

À≈Õ¥‡≈◊Õ¥„πÀ≈Õ¥Õ“À“√‚ªÉßæÕß ˘ˆ ÒÒˆ Ú˘˘.¯Ú .˜ .Ò .˜

¶à“µ—«µ“¬ ˘˜Û Ò,Ú˘Ò Ú˜¯.Òˆ .Ù .ı Ò.

‚√§®‘µ ˜Ù˜ ÒÚ¯ Û¯Ò.˘ .Ù .Ò .ı

°≈â“¡‡π◊ÈÕÀ—«„®º‘¥ª√°µ‘ ıÒ Ò Ò,˜¯ı.ÚÙ .Û .Ò .Ù

°“√‡ª≈’Ë¬π·ª≈ß¢Õß√–∫∫ª√– “∑ ÒıÚ Ò¯ ˜Û˘.ÒÛ .Ú . .Û

æ‘…‡Õ∏“πÕ≈™π‘¥Õ◊Ëπ Ò˘ˆ Úı Ùı.¯Ù .Ò .Ò .Û

¿“«–°“√‡®√‘≠‡µ‘∫‚µ¢Õß‡¥Á°„π§√√¿åº‘¥ª√°µ‘ ÚÚ ÚÙı Ù¯.ÒÚ . .Ò .Ú

√–¥—∫·Õ≈°ÕŒÕ≈å„π‡≈◊Õ¥ Ÿß ÒÛÚ Ú˘ ıÚı.˘˘ .Ò . .Ò

ª≈“¬ª√– “∑Õ—°‡ ∫ ÛÙ ÛÙ ı˘.ı¯ . . .Ò

æ‘…·Õ≈°ÕŒÕ≈å ÒÒ Ú¯ Û˜˘.ˆÚ .Ò . .Ò

æ‘…‡¡∏“πÕ≈ Ò ÛÒ Ú˜Ò.ÛÚ . . .

®¡πÈ” Ò Ò Û¯.˘Ù . . .

π‘Ë«„π∂ÿßπÈ”¥’* -Ò,ÙÚÒ -¯˜Ù ¯ˆ.˜ -Ú.˘ -Ò.¯ -Ù.ˆ

‡∫“À«“π* -ˆı,¯ -ÛÛ,Ùı˘ ˜ˆ¯.Ûˆ -ÚÛ˘.˜ -ÒÚÒ.˘ -ÛˆÒ.ı

¿“«–À—«„®¢“¥‡≈◊Õ¥* -ı,¯¯¯ -Ú,˜˜˜ Û˘Ú.Òˆ -Ò.Û -Ù.˘ -Òı.Ú

À≈Õ¥‡≈◊Õ¥„π ¡Õßµ’∫* -ˆ¯ -Ò,ÛÛ¯ Ú˜Û.ˆ -.ˆ -˘.ˆ -Ò.Ú

À—«„®≈â¡‡À≈«^#   ˆÚ˜. . . .

√«¡ Ú,ˆ˜ı,ıÒÛ ÛıÛ,˘ÒÙ Ò,˘ÙÒ.ı ıÙˆ.˜ Ú,Ù¯¯.Ò

*AAF < , ^#¢âÕ¡Ÿ≈‰¡à‡æ’¬ßæÕ„π°“√§”π«≥

(6)

µ“√“ß∑’ËÛ§à“„™â®à“¬¥â“π ÿ¢¿“æ∑’Ë‡°‘¥®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å„π·ºπ°ºŸâªÉ«¬„π ®”π«πºŸâªÉ«¬§à“„™â®à“¬µàÕ§√—Èß§à“„™â®à“¬∑“ß¥â“π ÿ¢¿“æ§à“„™â®à“¬∑“ß¥â“π ÿ¢¿“æ ‚√§(√“¬)∑’Ë¡“√—∫∫√‘°“√„π‡æ»™“¬„π‡æ»À≠‘ß§à“„™â®à“¬√«¡ (≈â“π∫“∑)(≈â“π∫“∑)(≈â“π∫“∑) ™“¬À≠‘ßCSMBSUCCSMBSUCCSMBSUC Õÿ∫—µ‘‡Àµÿ®“°®√“®√∑“ß∫°ı,ÛÛÚÒ˜,ı˘˘Ò˜,˘ˆ¯.¯˘Ù.ÙÛÒˆ.ÚÒ,ÚÚ.ˆ ¡–‡√Áßµ—∫ÒÚ,ÚÚˆÒ,˜ıÛÒ¯,ÙÒ¯.ÙˆÒˆ,Úˆ˜.¯ÚıÒ.ÚÒıÛ.˜˜.ÛÚÚ.ÚÛÙ.Û µ—∫·¢ÁßÒˆ,Úı˜Ú,Ûı¯ÒÛ,ÚÒÒ.¯ÒÒÒ,¯Òˆ.ÒˆÛÒ.ÒÒˆÙ.ÛÙ.ıÚÛ.¯ÚÚÛ.˜ ¿“«–µ‘¥ ÿ√“ÚÛ,ÙˆÛÒ,˜ÒˆÒÚ,ıÛ˜.Òˆ¯,˜˘.ÛÚÙ¯.ÚÒı¯.ıÛ.ıÒÒ.ˆÚÚÒ.¯ ‡Õ¥ åÒÙ,ıııÛ,˜¯¯Ò,˘ˆ¯.Ù˜Ò,ÚÚÛ.˜¯ˆ.ıÒÙÚ.˜Ò.˜Û˜.ÒÒ¯¯.Ò §«“¡¥—π‚≈À‘µ Ÿßˆ,¯ˆ˘ˆ,ˆÛÚ˘,˘ı˘.˜˘,ÛÛÙ.¯˘ÒÙ.Ûı.˜ÒÛ.¯Ù¯.˘ÒÚ˜.¯ ¿“«–À—«„®‡µâπº‘¥®—ßÀ«– ÿª√â“ ‡«π∑√‘§ÿ≈“√åˆ,ˆÛ,Ù˜ÛÒ˜,˜Ú.ÚıÒÚ,ˆÙı.ÛÒÒ˜.ÛˆÛ.ÚÒ.Ûˆ.ıÒÚˆ.˘ ≈¡™—°¯,ÒÒÙ,˜ÛˆÒ,ÚˆÛ.˘ı˜,Ú˘¯.ı¯˜.ÛıÛ.˘Ù.ÛÛÒ.ı˘˜.Ò ¡–‡√Áß√‘¡Ωïª“°·≈–§ÕÀÕ¬Ù,ÛÚÚÒ,Ú¯ÚÒ˜,Ò¯Ú.ÙˆÒ˜,ÒÙÚ.Ú˘ÒÙ.˘ı˘.ÚÙ.ÙÒ˜.ˆ˘ˆ.Ò À≈Õ¥‡≈◊Õ¥„πÀ≈Õ¥Õ“À“√‚ªÉßæÕßÛ,ˆ¯ÙÙÙıÒ˘,ÒˆÚ.ÒÚÒ˘,Ù˘.ˆ˘Ò.˘ˆ.˜Ò.Û˜.Û¯.Û ¡–‡√Áß°√–‡æ“–Õ“À“√Ú,ÛÒÙÛıÛÚı,ÚÙ˜.ÛˆÚÙ,Û.˜˘ÒÛ.ˆÙÛ.ÒÚ.Òˆ.ˆˆı.Ù ¡–‡√ÁßÀ≈Õ¥Õ“À“√Ú,ÛÚÛÚÙÚı,ıˆ˜.ˆ˘ÚÚ,˜˜˘.Ù¯Ò.ˆÙÛ.Ò.ıˆ.ÒˆÒ.Ò °√–‡æ“–Õ“À“√Õ—°‡ ∫˜,ÒÛ˘Ò,ÚÛıı,˜˜ı.ÚÒı,ˆˆ¯.˘Û.˘Ûˆ.ˆ.˜ˆ.ÛÙ˜.ˆ ¡–‡√Áß°≈àÕß‡ ’¬ßÚ,¯ı˜ÚÒ,Úı.˘ˆÒ¯,¯¯˜.ÒÒ˜.˘ÛÒ.Û.ˆÚ.ÛÙÚ.Ú µ—∫ÕàÕπÕ—°‡ ∫‡√◊ÈÕ√—ß·≈–‡©’¬∫æ≈—πÚ,ÛÒÒıÒÒı,ÛÛÒ.ııÒı,ı.ÛˆÙ.ÚÚ¯.¯.ÙÛ.Ûˆ.Ù À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°*Ú,Ò˘ÚÚıÒ˘,Ú¯Û.ˆˆÒˆ,Ò¯.ıˆÒ.ÙÛ˜.Ò-Û.˘-ÒÙ.Ù˜.ı µ—∫ÕàÕπÕ—°‡ ∫‡√◊ÈÕ√—ßÒ,Ú˜ıÒı,ıˆ¯.ÙıÒÙ,Ò˜ı.¯˘Ú.ˆÒı.˜Ò.ˆ.ÚÚı.Ù ¡–‡√Áß‡µâ“π¡„π µ√’Ò,ı¯˜Òı,ÚÙÚ.˘˜Òı,Úı.Ò¯--ˆ.ÙÒ˜.¯ÚÙ.Ú ¶à“µ—«µ“¬˜¯Ò,ı˜˜˜,Ù¯Û.˘¯ˆ,ÒÚ¯.ı.ÙÙ.ı.˜˘.ÒÒÙ.ˆ °“√„™â·Õ≈°ÕŒÕ≈å„π∑“ß∑’Ëº‘¥˜Û¯,˘˜˘.ıÙ˜,ˆÛı.Û˘.ıÛ.Ò..ÛÛ.˘ ∑“√°πÈ”Àπ—°µ—«πâÕ¬*Ùı˜ÙÙÒ˜,¯˘.˜ÒÚ,ÒÙ.ıˆ.Û¯.ˆ-.Ú-ˆ.¯.˘ –‡°Á¥‡ß‘πÒ˜ÚıˆÒÙ,˜Òı.ˆÒÒ,˘Ù..ıÒ.Ù.Ú.ıÚ.ı ‚√§®‘µÚˆıÙıˆ,ÙÒ.˘¯ˆ,ıˆÒ.Ò.ÒÒ.ˆ..ÛÚ.

(7)

600

°“√‡®√‘≠‡µ‘∫‚µ¢Õß‡¥Á°„π§√√¿åº‘¥ª√°µ‘ÚÒÚÚ¯¯,Ûˆ.ˆı,˜ÛÒ.˘ı..Ò.ÒÒ.ÚÒ.ı æ‘…·Õ≈°ÕŒÕ≈åÒÚ¯ı˜,ıˆ.Úˆ,Û˘Ú.Ò¯.Ò.˜..ÛÒ.Ú æ‘…‡¡∏“πÕ≈ÚÙ˜Ûı,ı¯Ò.ı˜˘,ÒıÛ.ˆÒ..Ú..ˆ.˘ °≈â“¡‡π◊ÈÕÀ—«„®º‘¥ª√°µ‘ÙÛ˘ÒÛ,ÙÛı.ÛÚÒÛ,ˆÛ˘.Úˆ.Ò.ı..Ò.˜ ª≈“¬ª√– “∑Õ—°‡ ∫ÒÒÒ,Ò¯ˆ.˜Ú,˘Ò.Ò¯..Ú..Ú.Ù ‡∫“À«“πÒ,Ú˘¯.˘˜˘,¯˜Ò.ıÚ-ˆ.Ú-Ú˘.Ú-Û.Ú-ÒÙ.¯. À≈Õ¥‡≈◊Õ¥„π ¡Õßµ’∫*Ò˘,Ú¯Û.ˆˆÒˆ,Ú¯.¯-.˘-Ú.ˆ-ÒÛ.¯-Û˘.Ú. π‘Ë«„π∂ÿßπÈ”¥’Ò˘,ÚÛÛ.Ò˘Ò¯,ıÚÛ.ıÚ-˘.Ò-Û.Ù-ı.ˆ-Ò¯.˜. ¿“«–À—«„®¢“¥‡≈◊Õ¥*Ú˘,Ù¯.ıˆÒ¯,˜Û¯.˜˘-ı˘.¯-ÒÒÙ.˜-Ú.Û-Û˘.. À—«„®≈â¡‡À≈«Òı,Ú˜Ù.˘ÒÛ,ˆÒ.Òı..... ∂Ÿ°∑”√â“¬**..... °“√‡ª≈’Ë¬π·ª≈ß¢Õß√–∫∫ª√– “∑**..... ®¡πÈ”**..... æ‘…‡Õ∏“πÕ≈**..... √–¥—∫·Õ≈°ÕŒÕ≈å„π‡≈◊Õ¥ Ÿß**..... æ‘…‡Õ∏“πÕ≈™π‘¥Õ◊Ëπ**..... ‡π◊ÈÕßÕ°™π‘¥Õ◊Ëπ**..... ‚√§´÷¡‡»√â“™π‘¥¢—È«‡¥’¬«**..... °“√∫“¥‡®Á∫®“°°“√∑”ß“π**..... √«¡Òˆ¯,ıÙ˘ı,ÚıÛ,Û.Ò * §à“ Alcohol - Attributable Fractions (AAF) ¡’§à“‡ªìπ≈∫ ** ‰¡àæ∫¢âÕ¡Ÿ≈§à“„™â®à“¬®“°∞“π¢âÕ¡Ÿ≈ + ‰¡à “¡“√∂À“§à“ AAF ‰¥â

µ“√“ß∑’ËÛ(µàÕ) ®”π«πºŸâªÉ«¬§à“„™â®à“¬µàÕ§√—Èß§à“„™â®à“¬∑“ß¥â“π ÿ¢¿“æ§à“„™â®à“¬∑“ß¥â“π ÿ¢¿“æ ‚√§(√“¬)∑’Ë¡“√—∫∫√‘°“√„π‡æ»™“¬„π‡æ»À≠‘ß§à“„™â®à“¬√«¡ (≈â“π∫“∑)(≈â“π∫“∑)(≈â“π∫“∑) ™“¬À≠‘ßCSMBSUCCSMBSUCCSMBSUC

(8)

Ÿß°«à“ºŸâÀ≠‘ß Ù ‡∑à“, —¥ à«π§à“„™â®à“¬¥â“π ÿ¢¿“æ∑’Ë‡°‘¥¢÷Èπ

®“°°“√¥◊Ë¡‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å„πºŸâªÉ«¬„π·≈–ºŸâªÉ«¬πÕ°

§‘¥‡ªìπ√âÕ¬≈– ıı ·≈– Ùı ¢Õß§à“„™â®à“¬∑—ÈßÀ¡¥ µ“¡≈”¥—∫.

«‘®“√≥å

°“√§”π«≥§à“„™â®à“¬∑“ß¥â“π ÿ¢¿“æ„π°“√√—°…“‚√§∑’Ë¡’

“‡Àµÿ®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å„π§√—Èßπ’È §”π«≥

·≈– ˘ ¿“«–, ´÷Ëßæ∫«à“¡’¡Ÿ≈§à“ Ÿß∂÷ß ı,Ù˘Ò.Ú ≈â“π∫“∑

·≈–À“°π”‚√§Õ◊Ëπ Ê ‡™àπ ‚√§°√–‡æ“–Õ“À“√, °“√·∑âß∫ÿµ√,

‚√§¡–‡√Áßµà“ß Ê ¡“§”π«≥¥â«¬®–∑”„Àâ§à“„™â®à“¬∑’Ë§”π«≥‰¥â

¡’§à“ Ÿß¢÷Èπ.

®”°—¥„π·ßà¢Õß¢âÕ¡Ÿ≈æ◊Èπ∞“π∑’Ë„™â„π°“√§”π«≥ ‚¥¬§à“„™â®à“¬

µàÕ§√—Èß„π°“√‡¢â“¡“√—∫∫√‘°“√„π·ºπ°ºŸâªÉ«¬πÕ°§”π«≥¡“

®“°∞“π¢âÕ¡Ÿ≈ºŸâªÉ«¬πÕ°®“°»Ÿπ¬å«‘®—¬·≈–µ‘¥µ“¡§«“¡‡ªìπ

∏√√¡∑“ß ÿ¢¿“æ §≥–·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬π‡√»«√

´÷Ëß§à“„™â®à“¬¥—ß°≈à“«Õ“®‰¡à‡ªìπµ—«·∑π§à“„™â®à“¬¢Õß∑—Èßª√–‡∑».

Õ¬à“ß‰√°Áµ“¡∞“π¢âÕ¡Ÿ≈¥—ß°≈à“«‡ªìπ∞“π¢âÕ¡Ÿ≈¢π“¥„À≠à∑’Ë ÿ¥

‡∑à“∑’Ë¡’Õ¬Ÿà ´÷Ëß∑”°“√‡°Á∫√«∫√«¡¢âÕ¡Ÿ≈®“°‚√ßæ¬“∫“≈∑—ÈßÀ¡¥

¯Ò ‚√ßæ¬“∫“≈´÷Ëß°√–®“¬µ—«Õ¬Ÿà„π Ò¯ ®—ßÀ«—¥. ¥—ßπ—Èπ

¢âÕ¡Ÿ≈∑’Ë‰¥â®÷ß¡’§«“¡πà“‡™◊ËÕ∂◊Õ„π√–¥—∫Àπ÷Ëß. ”À√—∫§à“„™â®à“¬

µàÕ°“√¡“√—∫∫√‘°“√„π·ºπ°ºŸâªÉ«¬„ππ—Èπ‰¥â¡“®“°∞“π¢âÕ¡Ÿ≈

ºŸâªÉ«¬„π®“° ”π—°ß“π°≈“ß “√ π‡∑»∫√‘°“√ ÿ¢¿“æ ´÷Ëß®–

·¬°§”π«≥µ“¡ ‘∑∏‘ª√–°—π ÿ¢¿“æ¢ÕßºŸâªÉ«¬ ‰¥â·°à «— ¥‘°“√√—°…“æ¬“∫“≈¢Õß¢â“√“™°“√ (Civil Servant Medi-

cal Benefit Scheme, CSMBS) ·≈– ‘∑∏‘ª√–°—π ÿ¢¿“æ

∂â«πÀπâ“ (Universal Coverage, UC) ‡∑à“π—Èπ, ·µà‰¡à‰¥â

§√Õ∫§≈ÿ¡ ‘∑∏‘ª√–°—π ÿ¢¿“æÕ◊ËπÊ ¥—ßπ—Èπ®÷ßµâÕß∑”°“√ª√—∫

§à“‚¥¬„™â ¡¡µ‘∞“π«à“®”π«πºŸâªÉ«¬„π Ú ‘∑∏‘¥—ß°≈à“«§‘¥‡ªìπ

√âÕ¬≈– ˜ ¢ÕßºŸâªÉ«¬∑—ÈßÀ¡¥, ´÷Ëß§«“¡∂Ÿ°µâÕß¢Õß ¡¡µ‘∞“ππ’È ¡§«√‰¥â√—∫°“√µ√«® Õ∫„Àâ™—¥‡®π¡“°¬‘Ëß¢÷Èπ. πÕ°®“°π’È

§à“§«“¡‡ ’Ë¬ß —¡æ—∑∏å∑’Ëπ”¡“§”π«≥§à“ —¥ à«π¢Õß°“√‡°‘¥

‚√§∑’Ë‡°‘¥¢÷Èπ®“°·Õ≈°ÕŒÕ≈åπ—Èπ‡ªìπ¢âÕ¡Ÿ≈∑’Ë‰¥â®“°°“√»÷°…“

„πµà“ßª√–‡∑»´÷Ëß‰¡à‰¥â‡ªìπ¢âÕ¡Ÿ≈¢Õßª√–‡∑»‰∑¬‚¥¬µ√ß Õ¬à“ß‰√°Áµ“¡°Á‡ªìπ¢âÕ¡Ÿ≈∑’Ë‰¥â¡“®“°°“√∑∫∑«π«√√≥°√√¡

‡™‘ßÕ¿‘¡“π´÷Ëß‡ªìπ°“√»÷°…“∑’Ë¡’§«“¡πà“‡™◊ËÕ∂◊Õ Ÿß ÿ¥ ·≈–À“°

®√‘ß¡“°¢÷Èπ. ∑—Èßπ’È°“√·°â‰¢¢âÕ®”°—¥¥—ß°≈à“« “¡“√∂∑”‰¥â‚¥¬

°“√«‘‡§√“–Àå§«“¡‰«¢Õßµ—«·ª√∑’Ëπ”¡“„™â§”π«≥§à“„™â®à“¬ ‡™àπ

§à“„™â®à“¬µàÕ§√—Èß¢Õß°“√¡“‡¢â“√—∫∫√‘°“√„π·ºπ°ºŸâªÉ«¬πÕ°

·≈–ºŸâªÉ«¬„π. ®“°°“√«‘‡§√“–Àå§«“¡‰«„π§√—Èßπ’Èæ∫«à“§à“„™â

®à“¬∑“ß¥â“π ÿ¢¿“æ∑’Ë‡°‘¥®“°°“√¥◊Ë¡‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å Õ“®¡’§à“Õ¬Ÿà√–À«à“ß ı,ÙıÒ.Ò- ı,ıÛÒ.Ú ≈â“π∫“∑.

‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫º≈°“√»÷°…“„π§√—Èßπ’È°—∫º≈°“√»÷°…“

¢Õß‚§√ß°“√«‘®—¬æ—≤π“√Ÿª·∫∫‡æ◊ËÕ°“√ªÑÕß°—π°“√¥◊Ë¡ ÿ√“

·≈–‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å„π æ.». ÚıÙ¯^(ˆ) æ∫«à“§à“„™â®à“¬

¥â“π√—°…“æ¬“∫“≈¡’§à“ª√–¡“≥ ÛÙ˘ ≈â“π - Ò,˘˜ ≈â“π

∫“∑. Õ¬à“ß‰√°Áµ“¡§«“¡·µ°µà“ß¢Õßº≈°“√»÷°…“∑’Ë‡°‘¥¢÷Èππ’È “¡“√∂Õ∏‘∫“¬‰¥â®“°§«“¡§√Õ∫§≈ÿ¡™π‘¥µâπ∑ÿπ∑’Ëπ”¡“

ª√–‡¡‘π, ·À≈àß¢âÕ¡Ÿ≈∑’Ë„™â ·≈–√–‡∫’¬∫«‘∏’«‘®—¬„π°“√ª√–‡¡‘π µ“√“ß∑’Ë Ù √ÿª®”π«πºŸâªÉ«¬·≈–§à“„™â®à“¬∑’Ë‡°‘¥¢÷Èπ‚¥¬¡’ “‡Àµÿ®“°·Õ≈°ÕŒÕ≈å„πª√–‡∑»‰∑¬

√“¬ §à“„™â®à“¬ (≈â“π∫“∑) §à“„™â®à“¬∑—ÈßÀ¡¥

ª√–‡¿∑∫√‘°“√

™“¬ À≠‘ß ™“¬ À≠‘ß (≈â“π∫“∑)

ºŸâªÉ«¬πÕ° (§π) Ú,ˆ˜ı,ıÒÛ ÛıÛ,˘ÒÙ Ò,˘ÙÒ.ı ıÙˆ.ˆ Ú,Ù¯¯.Ò

ºŸâªÉ«¬„π (§√—Èß) Òˆ¯,ıÙ˘ ı,Úı Ú,ÛÚÙ.˘ ˆ˜¯.Ú Û,Û.Ò

√«¡ Ù,Úˆˆ.Ù Ò,ÚÚÙ.¯ ı,Ù˘Ò.Ú

(9)

602

‚¥¬‚§√ß°“√«‘®—¬æ—≤π“√Ÿª·∫∫‡æ◊ËÕ°“√ªÑÕß°—π°“√¥◊Ë¡ ÿ√“

æ¬“∫“≈®“°‚√§·≈–Õÿ∫—µ‘‡Àµÿ. „π°“√»÷°…“§√—Èß∑’Ëºà“π‰ª µâπ∑ÿπ¥â“π§à“√—°…“æ¬“∫“≈‰¥â®“°°“√«‘‡§√“–Àå∞“π¢âÕ¡Ÿ≈ºŸâ ªÉ«¬„π¢Õß ”π—°ß“π°≈“ß “√ π‡∑»∫√‘°“√ ÿ¢¿“æ ‚¥¬§‘¥

√«¡§à“„™â®à“¬∑—Èß„π·ºπ°ºŸâªÉ«¬„π·≈–ºŸâªÉ«¬πÕ° ‚¥¬ºŸâªÉ«¬

„π§”π«≥®“°°“√πÕπ‚√ßæ¬“∫“≈¢Õß‚√§∑’Ë‡°’Ë¬«¢âÕß®”π«π ÛÛ ‚√§·≈– ˘ ¿“«– ·≈–æ∫«à“¡’°“√¡“‡¢â“√—∫°“√√—°…“∑’Ë

·ºπ°ºŸâªÉ«¬„π∑’Ë¡’ “‡Àµÿ®“°°“√¥◊Ë¡·Õ≈°ÕŒÕ≈å ´÷Ëß¡’®”π«π

∑—Èß ‘Èπ Ò¯ı,Ù˘Ú §√—Èß.

º≈°“√»÷°…“· ¥ß«à“§à“„™â®à“¬∑“ß¥â“π ÿ¢¿“æ∑’Ë¡’ “‡Àµÿ

®“°°“√¥◊Ë¡‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å„πª√–‡∑»‰∑¬ ¡’ —¥ à«π∑’Ë Ÿß‡¡◊ËÕ‡∑’¬∫°—∫§à“„™â®à“¬∑—ÈßÀ¡¥¥â“π ÿ¢¿“æÕ¬à“ß¡’π—¬ ”§—≠.

∑—Èßπ’ÈºŸâ«“ß·ºππ‚¬∫“¬ “¡“√∂π”¢âÕ¡Ÿ≈§à“„™â®à“¬¥â“π ÿ¢¿“æ

®“°°“√∫√‘‚¿§‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å®“°°“√»÷°…“„π§√—Èßπ’È

‰ª„™â‡æ◊ËÕ°“√ª√–‡¡‘π·≈–°”Àπ¥π‚¬∫“¬∑’Ë‡À¡“– ¡ ·≈–π”

‰ª„™â„π°“√ª√–™“ —¡æ—π∏å„Àâª√–™“™πºŸâ∑’Ë¥◊Ë¡·Õ≈°ÕŒÕ≈å µ√–Àπ—°∂÷ßº≈°√–∑∫µàÕ ÿ¢¿“æ·≈–§«“¡ Ÿ≠‡ ’¬∑“ß

‡»√…∞°‘®∑’Ë‡°‘¥¢÷Èπ®“°°“√¥◊Ë¡·Õ≈°ÕŒÕ≈å ‡æ◊ËÕ«“ß·ºπ·≈–

À“¡“µ√°“√ªÑÕß°—πÕ¬à“ß‡ªìπ√Ÿª∏√√¡µàÕ‰ª„πÕπ“§µ.

°‘µµ‘°√√¡ª√–°“»

»Ÿπ¬å«‘®—¬ªí≠À“ ÿ√“, √«¡∑—Èß ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢, ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“µ‘, ”π—°ß“π°≈“ß “√

π‡∑»∫√‘°“√ ÿ¢¿“æ, ”π—°π‚¬∫“¬·≈–¬ÿ∑∏»“ µ√å, ”π—°ß“πæ—≤π“π‚¬∫“¬ ÿ¢¿“æ√–À«à“ßª√–‡∑» ·≈–Àπà«¬

ß“πµà“ß Ê ‰¥â·°à »Ÿπ¬å«‘®—¬·≈–µ‘¥µ“¡§«“¡‡ªìπ∏√√¡∑“ß ÿ¢¿“æ, §≥–·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬π‡√»«√, ‚§√ß°“√

»÷°…“¿“«–‚√§·≈–°“√∫“¥‡®Á∫®“°æƒµ‘°√√¡ ÿ¢¿“æ·≈–

ªí®®—¬‡ ’Ë¬ß, ”π—°ß“πæ—≤π“π‚¬∫“¬ ÿ¢¿“æ√–À«à“ßª√–‡∑»,

»Ÿπ¬å‡∑§‚π‚≈¬’ “√ π‡∑»°≈“ß, √«¡∂÷ß§≥–∑’Ëª√÷°…“·≈–ºŸâ

‡™’Ë¬«™“≠∑ÿ°§π ‰¥â„Àâ¢âÕ¡Ÿ≈Õ—π‡ªìπª√–‚¬™πåµàÕ°“√»÷°…“«‘®—¬.

‡Õ° “√Õâ“ßÕ‘ß

Ò. WHO. Global status report; 2004.

Ú. Collins DJ, Lapsley HM. Counting the cost: estimates of the social costs of drug abuse in Australia in 1998-1999: Commonwealth Department of Health and Ageing; 2002.

Û. Fenoglio P, Parel V, Kopp P. The social cost of alcohol, tobacco and illicit drug in France, 1997. Eur Addict Res 2003;9:18-28.

Ù. Single E, Robson L, Xie X, Rehm J. The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992. Addiction.

1998;93:991-1006.

ı. Varney SJ, Guest JF. The annual societal cost of alcohol misuse in Scotland. Pharmacoeconomics 2002;20:891-907.

ˆ. π‘æπ∏å æ—«æß»°√, ¡™“¬ ÿ¢ ‘√‘‡ √’°ÿ≈. ‚§√ß°“√«‘®—¬æ—≤π“√Ÿª

·∫∫‡æ◊ËÕªÑÕß°—π°“√¥◊Ë¡ ÿ√“·≈–‡§√◊ËÕß¥◊Ë¡·Õ≈°ÕŒÕ≈å: ∂“∫—π«‘®—¬

‡æ◊ËÕ°“√æ—≤π“ª√–‡∑»‰∑¬, ‡¡…“¬π ÚıÙ¯.

˜. Guttjahr E, Gmel G, Rehm J. Relation between average alcohol consumption and disease : an overview. European Addiction Re- search 2001;7:117-27.

¯. Fisher JC BH, Kapiga SH. The association between HIV infection and alcohol use: a systematic review and meta-analysis of African studies. Sex Transm Dis 2007;34:856-63.

˘. English D, Holman CDJ, Milne E, Winter M, Hulse G, Codde J.

The quantification of drug caused morbidity and mortality in Aus- tralia. Canberra: Commonwealth Department of Human Services and Health; 1995.

Ò. Ridolfo B, Stevenson C. The quantification of drug-caused mortality and morbidity in Australia. Canberra (AS) : Australian Institute of Health and Welfare; 2001.

ÒÒ. Rehm J, Patra J, Popava S. Alcohol - attributable mortality and potential years of life lost in Canada 2001 : implications for prevention and policy. Addiction 2006;101:373-84.

ÒÚ. Corrao G, Rubbiati L, Bagnardi V, Zambon A, Poikolainen K.

Alcohol and coronary heart disease: a meta-analysis. Addiction 2000;95:1505-23.

ÒÛ. Reynold K, Lewis B, John David LN, Gregory LK, Sathya B, He J. Alcohol consumption and risk of stroke: a meta-analysis. JAMA 2003;28:579-88.

ÒÙ. ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢. °“√ ”√«® ¿“«– ÿ¢¿“æÕπ“¡—¬¢Õß ª√–™“™π‰∑¬‚¥¬°“√µ√«®√à“ß°“¬§√—Èß∑’Ë Û æ.». ÚıÙˆ-ÚıÙ˜.

”π—°π‚¬∫“¬·≈–¬ÿ∑∏»“ µ√å °√–∑√«ß “∏“√≥ ÿ¢. ππ∑∫ÿ√’:

”π—°ß“πæ—≤π“√–∫∫¢âÕ¡Ÿ≈¢à“« “√ ÿ¢¿“æ; ÚıÙ˘.

Òı. °√–∑√«ß “∏“√≥ ÿ¢. Annual Epidemiological Survillance Report.

ππ∑∫ÿ√’: ‚√ßæ‘¡æå∑À“√ºà“π»÷°„πæ√–∫√¡√“™Ÿª∂—¡¿å; ÚıÙ˘.

Òˆ. §Ÿà¡◊ÕÀ≈—°ª√–°—π ÿ¢¿“æ∂â«πÀπâ“ ªïß∫ª√–¡“≥ Úıı. ππ∑∫ÿ√’:

”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“µ‘; Úıı.