§à“„™â®à“¬¢Õß «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√ °—∫°“√„™â¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘

§à“„™â®à“¬¢Õß «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√

°—∫°“√„™â¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘

®ÿÓ¿√≥å ≈‘¡«—≤π“ππ∑å

*

πæ§ÿ≥ ∏√√¡∏—™Õ“√’

^†

Õ√Õπß§å «≈’¢®√‡≈‘»

^‡

æ—™π’ ∏√√¡«—ππ“

^‡

 ÿæ≈ ≈‘¡«—≤π“ππ∑å

*

 —¡ƒ∑∏‘Ï »√’∏”√ß «— ¥‘Ï

^†

*§≥–‡¿ —™»“ μ√å ¡À“«‘∑¬“≈—¬¢Õπ·°àπ

† ”π—°ß“π«‘®—¬‡æ◊ËÕ°“√æ—≤π“À≈—°ª√–°—π ÿ¢¿“æ‰∑¬

‡§≥–‡¿ —™»“ μ√å ¡À“«‘∑¬“≈—¬¡À“ “√§“¡

ÒÙ˘

∫∑§—¥¬àÕ ‡ªìπ‡«≈“°«à“ Ú ∑»«√√…·≈â«∑’Ë§à“„™â®à“¬¢Õß√–∫∫ «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√´÷Ëß„™â√–∫∫°“√®à“¬‡ß‘π·∫∫ª≈“¬

‡ªî¥‡μ‘∫‚μÕ¬à“ß√«¥‡√Á«·≈–μàÕ‡π◊ËÕß ‚¥¬‡©æ“–Õ¬à“߬‘Ëß„π™à«ßÀ≈—ß∑’˧à“√—°…“欓∫“≈ºŸâªÉ«¬πÕ° Ÿß°«à“ºŸâªÉ«¬„π °“√

«‘‡§√“–Àå¢âÕ¡Ÿ≈°“√„™â¬“¢Õß‚√ß欓∫“≈√—∞¢π“¥„À≠à ®“° Úˆ „π ÛÙ ·Ààß„π√–∫∫®à“¬μ√ߢÕߺŸâªÉ«¬πÕ°„πªï ÚııÚ æ∫ —¥ à«π¢Õ߬“πÕ°∫—≠™’¬“À≈—°·Ààß™“쑇©≈’ˬ√âÕ¬≈– ÙÒ μ“¡®”π«π§√—Èß°“√ —Ëß„™â ·≈–√âÕ¬≈– ˆ˜ μ“¡¡Ÿ≈§à“¬“

‚¥¬‚√ß欓∫“≈¡À“«‘∑¬“≈—¬¡’ —¥ à«π°“√ —Ëß„™â¬“πÕ°∫—≠™’¬“À≈—°œ  Ÿß∑’Ë ÿ¥ (√âÕ¬≈– Ùı ¢Õß„∫ —Ë߬“) „π¢≥–∑’Ë‚√ß æ¬“∫“≈ —ß°—¥°√–∑√«ß “∏“√≥ ÿ¢·≈– —ß°—¥Õ◊Ëπ¡’ —¥ à«πμË”°«à“ (√âÕ¬≈– Ûı ·≈– ÙÚ μ“¡≈”¥—∫) ∑—Èßπ’È  —¥ à«πμ“¡

¡Ÿ≈§à“¢Õ߬“πÕ°∫—≠™’¬“À≈—°œ ¡’§à“„°≈⇧’¬ß°—π (√âÕ¬≈– ˆˆ-ˆ¯) °≈ÿ࡬“∑’Ë¡’§à“„™â®à“¬ Ÿß ˆ Õ—π¥—∫·√°´÷Ë߇ªìπ —¥ à«π ª√–¡“≥√âÕ¬≈– ÙÒ ¢Õß§à“„™â®à“¬¢Õ߬“∑ÿ°√“¬°“√ ‰¥â·°à ¬“§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥ ¬“μâ“π¡–‡√Áß ¬“μâ“π¢âÕÕ—°‡ ∫ ¬“

μâ“π°√–¥Ÿ°æ√ÿ𠬓°≈ÿà¡ ACEI-ARB ·≈–¬“≈¥°“√À≈—Ëß°√¥ μ“¡≈”¥—∫ ‚¥¬¡’ —¥ à«π¢Õ߬“πÕ°∫—≠™’¬“À≈—°œ μ“¡¡Ÿ≈§à“

μ—Èß·μà √âÕ¬≈– ¯ˆ.Ù  ”À√—∫¬“§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥ √âÕ¬≈– ¯˜.¯  ”À√—∫¬“ ACEI-ARB √âÕ¬≈– ˘Û.ˆ  ”À√—∫¬“

≈¥°“√À≈—Ëß°√¥ ·≈– Ÿß∂÷ß√âÕ¬≈– ˘˜.Ú  ”À√—∫¬“μâ“π¢âÕÕ—°‡ ∫ ·¡â«à“°≈ÿ࡬“‡À≈à“π’È®–¡’¬“„π∫—≠™’¬“À≈—°·Ààß™“μ‘∑’Ë º≈‘쉥â„πª√–‡∑»„Àâ‡≈◊Õ°„™â‰¥âÀ≈“¬√“¬°“√ πÕ°®“°π’È §à“„™â®à“¬√âÕ¬≈– ˘Ú.Û, ¯ˆ., ˆı. ·≈– ÙÙ. ¢Õß°≈ÿ࡬“

≈¥°“√À≈—Ëß°√¥ ¬“§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥ ¬“ ACEI-ARB ·≈–¬“μâ“π¢âÕÕ—°‡ ∫ μ“¡≈”¥—∫ ‡°‘¥®“°¬“∑’Ë¡’ºŸâ®”Àπà“¬√“¬

‡¥’¬« ®“°°√≥’»÷°…“„π‚√ß欓∫“≈¡À“«‘∑¬“≈—¬·ÀàßÀπ÷Ëß´÷Ëß “¡“√∂§«∫§ÿ¡°“√„™â¬“πÕ°∫—≠™’¬“À≈—°œ ‰¥â¥’°«à“‚√ß æ¬“∫“≈Õ’°À≈“¬·Ààß æ∫«à“ ¿“«–ºŸâπ”¢ÕߺŸâ∫√‘À“√·≈–§«“¡‡¢â¡·¢ÁߢÕߧ≥–°√√¡°“√‡¿ —™°√√¡·≈–°“√∫”∫—¥¢Õß

‚√ß欓∫“≈¡’§«“¡ ”§—≠μàÕ°“√§«∫§ÿ¡§à“„™â®à“¬¥â“𬓠´÷Ëß®–™à«¬≈¥¿“«–§ÿ°§“¡®“°°≈¬ÿ∑∏å∑“ß°“√μ≈“¥¢Õß∫√‘…—∑¬“

∑—»π§μ‘∑“ß≈∫¢ÕߺŸâ —Ëß„™â¬“μàÕ¬“„π∫—≠™’¬“À≈—°·Ààß™“μ‘ √«¡∑—Èß°“√‰¡à¡’π‚¬∫“¬∑’Ë™—¥‡®π®“° à«π°≈“ß ¥—ßπ—Èπ§«√ àß

‡ √‘¡„Àâ¡’°“√°”Àπ¥π‚¬∫“¬§«∫§ÿ¡°“√„™â¬“∑’Ë™—¥‡®π ‰¥â·°à °“√„™âπ‚¬∫“¬√“§“Õâ“ßÕ‘ß ”À√—∫°“√‡∫‘°®à“¬ °“√ √â“ß

√–∫∫μ‘¥μ“¡·≈–§«∫§ÿ¡°”°—∫‚¥¬Õ“»—¬°“√ª√–¡«≈¢âÕ¡Ÿ≈°“√„™â¬“¢Õß‚√ß欓∫“≈∑’ˇ©æ“–‡®“–®ßμàÕºŸâ —Ëß„™â√“¬∫ÿ§§≈

πÕ°®“°π’È §«√¡’°“√ √â“ß·√ß®Ÿß„®·°à‚√ß欓∫“≈∑’Ë “¡“√∂§«∫§ÿ¡§à“„™â®à“¬‰¥â ·≈–°“√æ—≤π“»—°¬¿“æ¢Õß∫ÿ§§≈“°√

„π°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈ ·≈–°“√¡’‡«∑’·≈°‡ª≈’ˬπ‡√’¬π√Ÿâ

§” ”§—≠: §à“„™â®à“¬¥â“𬓠¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘ √–∫∫ «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√

¿Ÿ¡‘À≈—ß·≈–‡Àμÿº≈

«— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√‡ªìπ√–∫∫∑’Ë√—∞∫“≈®—¥„Àâ

·°à¢â“√“™°“√ æπ—°ß“π·≈–≈Ÿ°®â“ߢÕß√—∞ ·≈–§√Õ∫§√—«

‡¡◊ËÕ¡’°“√„™â∫√‘°“√ ÿ¢¿“殓° ∂“π欓∫“≈ ∂◊Õ‡ªìπ ‘∑∏‘

ª√–‚¬™πå∑’Ë„Àâ·°à°≈ÿà¡∫ÿ§§≈¥—ß°≈à“«πÕ°‡Àπ◊Õ®“°‡ß‘π‡¥◊Õπ À√◊Õ§à“®â“ß´÷Ëßμ“¡ª√°μ‘¡’Õ—μ√“μÌË“°«à“æπ—°ß“πÀ√◊Õ≈Ÿ°®â“ß„π

¿ “ § ‡ Õ ° ™ π √ – ∫ ∫   «—   ¥‘ ° “ √ √— ° … “ æ ¬ “ ∫ “ ≈ ¢â “ √ “ ™ ° “ √

§√Õ∫§≈ÿ¡ª√–™“°√ª√–¡“≥ ˆ.ı ≈â“π§π ‚¥¬‡ªìπºŸâ¡’ ‘∑∏‘

¿“¬„μâæ√–√“™°ƒ…Æ’°“‡ß‘π «— ¥‘°“√§à“√—°…“欓∫“≈ æ.».

ÚıÚÛ (·≈–©∫—∫·°â‰¢‡æ‘Ë¡‡μ‘¡) ª√–¡“≥ ı.Ù ≈â“π§π ´÷Ëß ª√–°Õ∫¥â«¬ ¢â“√“™°“√ æπ—°ß“π·≈–≈Ÿ°®â“ߢÕß√—∞ Ò.¯

≈â“π§π ·≈–∫ÿ§§≈„π§√Õ∫§√—« Û.ˆ ≈â“π§π

°“√™¥‡™¬§à“„™â®à“¬¥â“π°“√√—°…“欓∫“≈¥—ß°≈à“«

Õ“»—¬ß∫ª√–¡“≥·ºàπ¥‘π´÷Ëß·μà‡¥‘¡®—¥ √√„Àâ·μà≈– à«π√“™°“√

·μàμàÕ¡“ °√¡∫—≠™’°≈“ß °√–∑√«ß°“√§≈—߇ªìπºŸâ¥Ÿ·≈√—∫º‘¥

™Õ∫°“√„™â®à“¬‡ß‘π·≈– ‘∑∏‘ª√–‚¬™πå¢Õß√–∫∫œ ‚¥¬

§√Õ∫§≈ÿ¡∫√‘°“√√—°…“欓∫“≈·∫∫ºŸâªÉ«¬πÕ°·≈–ºŸâªÉ«¬„π

¢Õß ∂“π欓∫“≈ ´÷Ëß√«¡∂÷ßÀâÕß摇»…„π‚√ß欓∫“≈¢Õß√—∞

·≈–‚√ß欓∫“≈‡Õ°™π„π°√≥’Õÿ∫—쑇Àμÿ©ÿ°‡©‘π √–∫∫π’È„™â°“√

®à“¬‡ß‘π§à“√—°…“欓∫“≈„Àâ·°à ∂“π欓∫“≈μ“¡√“¬∫√‘°“√

·∫∫¬âÕπÀ≈—ßμ“¡∑’Ë∂Ÿ°‡√’¬°‡°Á∫ (Retrospective fee for ser- vice, FFS) ´÷Ëß∂◊Õ«à“‡ªìπ·∫∫ª≈“¬‡ªî¥^(Ò) „πÕ¥’μ∫√‘°“√·∫∫

Abstract Expenditure of Civil Servant Medical Benefit Scheme and the use of non-essential medicines Chulaporn Limwattananon*, Noppakun Thammatacharee^†, Onanong Waleekhachonloet^‡,

Patchanee Thamwanna^‡, Supon Limwattananon*, Samrit Srithamrongsawat^†

*Faculty of Pharmaceutical Sciences, Khon Kaen University, ^†Health Insurance System Research Office, ^‡Faculty of Pharmacy, Mahasarakham University

Over two decades, the expenditure for Civil Servant Medical Benefit Scheme (CSMBS) which em- ployed the open-ended provider payment methods has a continual double-digit annual growth. In recent years, the outpatient expenditure outpaced the inpatient one. An analysis of prescriptions and expendi- tures of the outpatient drugs of 26 out of 34 large public hospitals under the direct billing system in 2009 revealed that on average 41% of total prescriptions and 67% of expenditure belonged to those not covered by the current National Lists of Essential Medicines. The highest proportion of the non-essential (NE) drug prescriptions occurred in university hospitals (45%), whereas the NE proportion in the Ministry of Public Health hospitals and other ministries was relatively lower (35% and 42%, respectively). However, the NE share of drug expenditure was similar across the three hospital types (66-68%). The top six thera- peutic classes of drugs, sharing 41% of total drug expenditure, were antilipids, anticancers, antiosteoarthritis (nonsteroidal anti-inflammatory drugs -NSAID, COX-2 inhibitors and symptomatic slow-acting drugs for osteoarthritis -SYSADOA), antiosteoporosis, angiotensin converting enzyme inhibitors (ACEI) and antigiotensin-2 receptor blockers (ARB), and antisecretory/antiulcers (histamine-2 receptor antagonists - H2RA and proton pump inhibitors -PPI). The NE drugs accounted for 86.4% of the expenditure for antilipids, 87.8% for ACEI-ARB, 93.6% for antiulcers and 97.2% for antiosteoarthritis. With respect to market status, the single-source products accounted for 92.3, 86.0, 65.0, and 44.0% of the expenditure for antiulcers, antilipids, ACEI-ARB, and antiosteoarthritis, respectively. A case study of university hospital with rela- tively low use of NE drugs revealed that leadership of the hospital administrator and the Pharmacy and Therapeutic committee is a key to success of cost containment that can counteract threats from market strategies of drug industry and misunderstanding of prescribers toward the use of the NE drugs. It was recommended the central administration of CSMBS should give priority to cost-containment policies in- cluding reference pricing systems for drug reimbursement, monitoring and evaluation using prescriber- specific drug utilization data. In addition, appropriate financial incentive for well-performed hospitals, capacity building for hospital personnel in data analysis and platforms for knowledge sharing should be introduced.

Key words: Civil Servant Medical Benefit Scheme, drug expenditure, National Lists of Essential Medicines

 

ÒıÒ

ºŸâªÉ«¬πÕ°ºŸâ¡’ ‘∑∏‘μâÕß Ì“√Õß®à“¬‡ß‘π„Àâ·°à ∂“π欓∫“≈

°àÕπ·≈⫇∫‘°§◊π®“°Àπ૬ߓπμâπ —ß°—¥„π¿“¬À≈—ß ·μàÀ≈—ß

®“°ªï ÚıÙ˘ ºŸâ¡’ ‘∑∏‘ “¡“√∂‡≈◊Õ°¢÷Èπ∑–‡∫’¬π‡æ◊ËÕ„Àâ‚√ß æ¬“∫“≈‡√’¬°‡°Á∫‚¥¬μ√ß®“°°√¡∫—≠™’°≈“ß (ç√–∫∫®à“¬μ√ßé)  ”À√—∫∫√‘°“√·∫∫ºŸâªÉ«¬„π ‚√ß欓∫“≈‡ªìπºŸâ‡∫‘°®“°°√¡

∫—≠™’°≈“ßμ“¡°≈ÿà¡«‘π‘®©—¬‚√§√à«¡ (diagnosis-related group, DRG) ´÷Ë߇ªìπ√–∫∫∑’ˇ√‘Ë¡„™â„π™à«ß‡«≈“„°≈⇧’¬ß°—∫

√–∫∫®à“¬μ√ߢÕߺŸâªÉ«¬πÕ° ‡ªìπ∑’Ëπà“ —߇°μ«à“ ·¡â®–¡’°“√

μ—Èßß∫ª√–¡“≥≈à«ßÀπâ“ ”À√—∫„™â®à“¬„π√–∫∫ «— ¥‘°“√√—°…“

欓∫“≈¢â“√“™°“√·μà„π√–À«à“ߪïÀ“°ß∫ª√–¡“≥∑’Ëμ—È߉«â‰¡à

‡æ’¬ßæÕ°Á “¡“√∂‡∫‘°®à“¬®“°ß∫°≈“߉¥â^(Ú)

æ∫«à“ §à“„™â®à“¬¢Õß√–∫∫ «— ¥‘°“√√—°…“欓∫“≈

¢â“√“™°“√ Ÿß°«à“√–∫∫À≈—°ª√–°—π ÿ¢¿“æ∂â«πÀπ⓪√–¡“≥ Ù

‡∑à“ ∑—Èß∑’Ë∑—Èß Õß√–∫∫Õ“»—¬ß∫ª√–¡“≥·ºàπ¥‘π‡™àπ‡¥’¬«°—π

§à“„™â®à“¬∑’Ë Ÿß¡“°¢Õß «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√

 —ππ‘…∞“π«à“  à«πÀπ÷Ëßπà“®–‡°‘¥®“°°“√¡’ºŸâ„™â∫√‘°“√∑’Ë

‡°…’¬≥Õ“¬ÿ·≈â«„π —¥ à«π∑’Ë¡“°°«à“ (√âÕ¬≈– ÚÒ ·≈–√âÕ¬≈–

Ò μ“¡≈”¥—∫) πÕ°®“° –∑âÕπ∂÷ߧ«“¡®Ì“‡ªìπ¥â“π ÿ¢¿“æ·≈â«

§ « “ ¡ · μ ° μà “ ß ¢ Õ ß §à “ „ ™â ®à “ ¬ ¬— ß ‡ ªì π º ≈ ® “ ° ° “ √ ‡ ≈◊ Õ ° „ ™â

∑√—欓°√ ÿ¢¿“æÀ√◊Õ«‘∏’°“√√—°…“欓∫“≈∑’Ëμà“ß°—πμ“¡

ª√–‡¿∑¢Õß ∂“π欓∫“≈ ·≈–æƒμ‘°√√¡¢ÕߺŸâ„Àâ∫√‘°“√´÷Ëß Õ“®‡°‘¥®“°·√ß®Ÿß„®®“°«‘∏’°“√®à“¬‡ß‘π∑’Ë·μ°μà“ß°—π√–À«à“ß

√–∫∫ª≈“¬‡ªî¥¢Õß «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√°—∫

√–∫∫ª≈“¬ªî¥¢ÕßÀ≈—°ª√–°—π ÿ¢¿“æ∂â«πÀπâ“^(Û)

πÕ°®“°π’È ¢âÕ¡Ÿ≈°“√‡∫‘°®à“¬§à“√—°…“欓∫“≈¢Õß°√¡

∫—≠™’°≈“ß (√Ÿª∑’Ë Ò) · ¥ß„Àâ‡ÀÁπ«à“ „πÕ¥’μ §à“„™â®à“¬ à«π

„À≠à¢Õß√–∫∫ «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√‡ªìπ¢Õß ºŸâªÉ«¬„π ·μà¿“¬À≈—ß°“√„™â√–∫∫ DRG §à“„™â®à“¬ ”À√—∫°“√

3.2 3.5 4.3 5.1 6.0 7.9

10.0 11.2 13.6

15.5 16.4 15.3 17.1

19.2 20.5 22.7

26.0 29.4

37.0 46.5

54.9 61.3 62.2

1.7 2.0 2.3 2.8 3.4 4.0 4.8 5.6 5.9 6.2 7.0 8.1 9.5 11.4

13.9 16.9

21.9 30.8

38.8 45.5 46.6

2.6 3.1 3.6 5.1 6.6 7.2 8.8 9.9 10.6 9.0 10.1 11.1 11.0 11.3 12.1 12.4

15.1 15.616.1 15.8 15.6

2531 2533 2535 2537 2539 2541 2543 2545 2547 2549 2551 2553

15.7%

15.7%

12.5%

12.5%

19.8%

19.8%

15.2%

15.2%

- -1.8%1.8%

10.1%

10.1% 6.1%6.1% 11.7%11.7%

20.3%

20.3%

12.1%

12.1%

- -1.7%1.7%

5.8%

5.8%

12.3%

12.3%

27.5%

27.5%

6.0%6.0%

7.9%7.9%

- -7.4%7.4%

10.6%

10.6% 8.8%8.8%

8.0%8.0%

22.8%

22.8%

12.7%

12.7%

อัตราการเติบโตของคาใชจายรวม อัตราการเติบโตของคาใชจายรวม(%)(%) คาใชจายรวม (พันลานบาท) คาใชจายผูปวยนอก (พันลานบาท) คาใชจายผูปวยใน (พันลานบาท)

--มาตรการจํากัดการนอนมาตรการจํากัดการนอนรพรพ..เอกชนเอกชนเฉพาะอุบัติเหตุเฉพาะอุบัติเหตุ--ฉุกเฉินฉุกเฉิน --มาตรการจายรวมสําหรับคาหองมาตรการจายรวมสําหรับคาหอง--คาอาหารคาอาหารพิเศษพิเศษ

-

-ระบบจายตรงระบบจายตรงผูปวยนอกผูปวยนอก -

-ระบบระบบ DRG DRG ผูปวยในผูปวยใน

√Ÿª∑’Ë Ò §à“„™â®à“¬√«¡ §à“„™â®à“¬ºŸâªÉ«¬πÕ°·≈–ºŸâªÉ«¬„π ·≈–Õ—μ√“°“√‡μ‘∫‚μ √–∫∫ «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√ ÚıÛÒ-ÚııÛ

∑’Ë¡“ ¢âÕ¡Ÿ≈®“°°√¡∫—≠™’°≈“ß

√—°…“欓∫“≈ºŸâªÉ«¬„πÕ¬Ÿà„π√–¥—∫§àÕπ¢â“ߧß∑’Ë „π¢≥–∑’˧à“

√—°…“欓∫“≈ºŸâªÉ«¬πÕ°¡’°“√‡μ‘∫‚μÕ¬à“ßμàÕ‡π◊ËÕß®π Ÿß°«à“

ºŸâªÉ«¬„πμ—Èß·μàªï ÚıÙˆ ·≈–‡æ‘Ë¡¢÷Èπ„πÕ—μ√“∑’Ë√«¥‡√Á«¡“°

‚¥¬‡©æ“–Õ¬à“߬‘Ëß¿“¬À≈—ß®“°°“√„™â√–∫∫®à“¬μ√ßμ—Èß·μàªï Úıı ∑—Èßπ’È §à“„™â®à“¬¥â“π¬“¡’ —¥ à«π Ÿß∑’Ë ÿ¥ §‘¥‡ªìπ√âÕ¬≈–

¯Û ¢Õߧà“√—°…“欓∫“≈ºŸâªÉ«¬πÕ°^(Ù)

°“√§«∫§ÿ¡§à“„™â®à“¬¢Õß√–∫∫ «— ¥‘°“√√—°…“欓∫“≈

¢â“√“™°“√‡°‘¥¢÷ÈπÕ¬à“߇ªìπ√Ÿª∏√√¡À≈—ß®“°¿“«–«‘°ƒμ‘

‡»√…∞°‘®¢Õß∑«’ª‡Õ‡™’¬„πªï ÚıÙ ‚¥¬‡√‘Ë¡®“°¡“μ√°“√

¥â“πÕÿª ß§å ”À√—∫°“√‡¢â“πÕπ‚√ß欓∫“≈ ‰¥â·°à °“√„™â

∫√‘°“√‚√ß欓∫“≈‡Õ°™π‡©æ“–°√≥’Õÿ∫—쑇Àμÿ-©ÿ°‡©‘π °“√„Àâ ºŸâ„™â ‘∑∏‘¡’ à«π√à«¡®à“¬À“°μâÕß°“√πÕπÀâÕß摇»… ¡“μ√°“√

¥—ß°≈à“«∑”„Àâ√–∫∫ «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√‚¥¬

‡©æ“–Õ¬à“߬‘Ëß ”À√—∫ºŸâªÉ«¬„π¡’§à“„™â®à“¬∑’Ë≈¥≈߇ªìπ§√—Èß·√°

„π™à«ß‡«≈“ Ú ªï∂—¥¡“ (√Ÿª∑’Ë Ò) Õ¬à“߉√°Áμ“¡ „π‡«≈“μàÕ¡“

§à“„™â®à“¬∑—Èß‚¥¬√«¡·≈– ”À√—∫ºŸâªÉ«¬„π°≈—∫¡’·π«‚π⡇æ‘Ë¡

¢÷ÈπÕ’° ·¡â®–¬—߉¡à¡’°“√ªØ‘√Ÿª∑—Èß√–∫∫ ·μà¡“μ√°“√¥â“πÕÿª∑“π

‡™àπ °“√‡∫‘°®à“¬μ“¡πÌÈ“Àπ—° —¡æ—∑∏å¢Õß°≈ÿà¡«‘π‘®©—¬‚√§√à«¡

 “¡“√∂§«∫§ÿ¡§à“„™â®à“¬¢ÕߺŸâªÉ«¬„π‰¡à„Àâ‡μ‘∫‚쉥â

 ” À √— ∫ ¡ “ μ √ ° “ √ § « ∫ §ÿ ¡ §à “ „ ™â ®à “ ¬ ¥â “ π ¬ “ ¢ Õ ß ‚ √ ß æ¬“∫“≈´÷Ëß°”Àπ¥‡ß◊ËÕπ‰¢°“√ —Ëß„™â¬“∑’ˉ¡àÕ¬Ÿà„π∫—≠™’¬“À≈—°

·Ààß™“쑬—߉¡à‡ÀÁπª√– ‘∑∏‘º≈ πÕ°®“°π’È ¬—ß —ππ‘…∞“π«à“

√–∫∫®à“¬μ√ß∑’ˇæ‘Ëß¡’°“√¥”‡π‘π°“√‡¡◊ËÕ‰¡àπ“π¡“π’È¡’º≈∑”„Àâ

§à“„™â®à“¬¢ÕߺŸâªÉ«¬πÕ°‡æ‘Ë¡¢÷ÈπÕ¬à“ß√«¥‡√Á«

·¡â«à“√–∫∫ «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√®–„™â«‘∏’

°“√®à“¬‡ß‘π§à“√—°…“欓∫“≈·∫∫√“¬∫√‘°“√À√◊Õ FFS ·μà

‰¡à¡’∞“π¢âÕ¡Ÿ≈∫—π∑÷°°“√‡∫‘°®à“¬∑’Ë√–∫ÿ√“¬≈–‡Õ’¬¥¢Õß°“√„™â¬“

À≈—°∞“π°“√«‘®—¬∑’˺à“π¡“^(ı-Ò) √–∫ÿ«à“ ·∫∫·ºπ°“√„™â¬“πÕ°

∫—≠™’¬“À≈—°·Ààß™“μ‘¢Õß ∂“π欓∫“≈¡’§«“¡·μ°μà“ß°—π

√–À«à“ß√–∫∫ª√–°—π ÿ¢¿“æÀ≈—°¢Õߪ√–‡∑»·≈–‡ªìπ‡Àμÿ  ”§—≠„Àâ§à“„™â®à“¬¥â“𬓷μ°μà“ß°—π ”À√—∫°≈ÿ࡬“´÷Ëß¡’¢âÕ∫àß

„™â‡¥’¬«°—π·≈–¡’°“√„™â∫àÕ¬ ”À√—∫ºŸâªÉ«¬πÕ° æ∫«à“ ºŸâ∑’Ë„™â  ‘∑∏‘ «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√¡’‚Õ°“ ‰¥â„™â¬“πÕ°

∫—≠™’¬“À≈—°·Ààß™“μ‘ Ÿß°«à“ºŸâ∑’ËÕ¬Ÿà„π√–∫∫À≈—°ª√–°—π

 ÿ¢¿“æ∂â«πÀπâ“·≈–√–∫∫ª√–°—π —ߧ¡ Õ¬à“߉√°Áμ“¡ ß“π

«‘®—¬‡À≈à“π’È à«π„À≠à¡’¢Õ∫‡¢μ°“√»÷°…“‡©æ“–‚√ß欓∫“≈

 —ß°—¥°√–∑√«ß “∏“√≥ ÿ¢´÷Ëß à«π„À≠àÕ¬Ÿà„π à«π¿Ÿ¡‘¿“§·≈–

∫“ß·Àà߉¡à„™àºŸâ„Àâ∫√‘°“√√“¬„À≠à¢Õß√–∫∫ «— ¥‘°“√√—°…“

欓∫“≈¢â“√“™°“√ ·≈–¬—߉¡à‰¥â§”π÷ß∂÷ߧ«“¡´—∫´âÕπ¢Õß ª√–‡¿∑°“√‡®Á∫ªÉ«¬ (casemix) μ≈Õ¥®πº≈≈—æ∏å∑“ß  ÿ¢¿“æ¢ÕߺŸâªÉ«¬ (patient outcomes)

°“√»÷°…“π’È¡’«—μ∂ÿª√– ß§å‡æ◊ËÕ«‘‡§√“–Àå ∂“π°“√≥å°“√

„™â¬“∑’Ë —¡æ—π∏å°—∫§à“„™â®à“¬¢ÕߺŸâªÉ«¬πÕ°„π‚√ß欓∫“≈∑’Ë

‡ªìπºŸâ„Àâ∫√‘°“√√“¬„À≠à¢Õß√–∫∫ «— ¥‘°“√√—°…“欓∫“≈

¢â“√“™°“√ ‚¥¬μâÕß°“√μÕ∫§”∂“¡„πª√–‡¥ÁπμàÕ‰ªπ’È (Ò)  —¥ à«π°“√„™â¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘‚¥¬√«¡¢Õß√–∫∫

‡ªìπÕ¬à“߉√·≈–¡’§«“¡·μ°μà“ß√–À«à“ß‚√ß欓∫“≈À√◊Õ‰¡à? (Ú)  —¥ à«π°“√„™â¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘·≈–¬“∑’Ë¡’ºŸâ

®”Àπà“¬√“¬‡¥’¬«„π·μà≈–°≈ÿ࡬“∑’Ë¡’¢âÕ∫àß„™â‡¥’¬«°—π ¡’§«“¡

·μ°μà“ß°—πÀ√◊Õ‰¡à? ·≈– (Û) ªí®®—¬„¥∑’Ë¡’§«“¡ ”§—≠μàÕ°“√

¥”‡π‘π°“√¢Õß‚√ß欓∫“≈„π°“√§«∫§ÿ¡§à“„™â®à“¬¥â“𬓷≈–

°“√„™â¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘? §”μÕ∫ ”À√—∫§”∂“¡

°“√«‘®—¬‡À≈à“π’È¡’§«“¡ ”§—≠μàÕ°“√°”Àπ¥¡“μ√°“√√–¬– —Èπ

„π°“√§«∫§ÿ¡§à“„™â®à“¬¥â“𬓠·≈–°“√æ—≤π“¡“μ√°“√°“√

®à“¬§à“√—°…“欓∫“≈ ”À√—∫ºŸâªÉ«¬πÕ°„πÕπ“§μ ‡æ◊ËÕ„À⇪ìπ

‰ªÕ¬à“߇À¡“– ¡·≈–‡°‘¥§«“¡¬—Ë߬◊π„π√–¬–¬“«

√–‡∫’¬∫«‘∏’°“√»÷°…“

∑’Ë¡“¢ÕߢâÕ¡Ÿ≈

 ”π—°ß“π«‘®—¬‡æ◊ËÕ°“√æ—≤π“À≈—°ª√–°—π ÿ¢¿“æ‰∑¬

( «ª°.) ‰¥â¢Õ§«“¡√à«¡¡◊Õºà“π°√¡∫—≠™’°≈“ß ®“°‚√ß æ¬“∫“≈π”√àÕß ÛÙ ·Ààß ´÷Ëߪ√–°Õ∫¥â«¬ ‚√ß欓∫“≈

¡À“«‘∑¬“≈—¬ ˜ ·Ààß ‚√ß欓∫“≈∑—Ë«‰ª·≈–‚√ß欓∫“≈»Ÿπ¬å  —ß°—¥°√–∑√«ß “∏“√≥ ÿ¢ Ò˘ ·Ààß ·≈–‚√ß欓∫“≈ —ß°—¥

°√–∑√«ß°≈“‚À¡·≈–Õ◊ËπÊ ¯ ·Ààß „Àâ àߢâÕ¡Ÿ≈„π≈—°…≥–

¬Õ¥√«¡ (aggregate)  ”À√—∫¬“·μà≈–√“¬°“√ (™◊ËÕ √Ÿª·∫∫

·≈–§«“¡·√ߢÕ߬“) ‰¥â·°à ª√‘¡“≥¬“∑’Ë —Ëß„™â ®”π«π§√—Èß

°“√ —Ëß„™â ·≈–¡Ÿ≈§à“∑’Ë‚√ß欓∫“≈‡√’¬°‡°Á∫„π√–∫∫®à“¬μ√ß

ÒıÛ

√–À«à“ß μÿ≈“§¡ ÚııÒ - °√°Ø“§¡ ÚııÚ ‚√ß欓∫“≈

‡À≈à“π’È¡’ºŸâªÉ«¬πÕ° ‘∑∏‘ «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√„™â

∫√‘°“√¡“°°«à“ Ò, §√—Èß „πªï ÚııÒ

‚√ß欓∫“≈®”π«π ÛÒ ·Ààß  “¡“√∂„Àâ¢âÕ¡Ÿ≈¥—ß°≈à“«

‰¥â ·μà‡¡◊ËÕμ√«® Õ∫¡Ÿ≈§à“¬“μ“¡¢âÕ¡Ÿ≈∑’ˉ¥â√—∫¢Õß·μà≈–‚√ß æ¬“∫“≈°—∫¢âÕ¡Ÿ≈¬Õ¥√«¡°“√‡∫‘°®à“¬ºà“π ”π—°ß“π°≈“ß  “√ π‡∑»∫√‘°“√ ÿ¢¿“æ ( ° .) æ∫§«“¡·μ°μà“ß Ÿß°«à“ +

√âÕ¬≈– Û „π‚√ß欓∫“≈ Ù ·Ààß πÕ°®“°π’È ‚√ß欓∫“≈Õ’°

Ò ·Àà߉¡à„™â√–∫∫®à“¬μ√ß ”À√—∫¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘

¥—ßπ—Èπ ®÷߇À≈◊Õ‚√ß欓∫“≈ Úˆ ·Ààß ∑’Ë “¡“√∂„™â¢âÕ¡Ÿ≈„π

°“√«‘‡§√“–À剥â

°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈

Ò. ‡™‘ߪ√‘¡“≥

‡π◊ËÕß®“°®”π«π√“¬°“√¬“∑’ˉ¥â√—∫®“°‚√ß欓∫“≈¡’

¡“°°«à“ Õßæ—π√“¬°“√ °“√μÕ∫§”∂“¡°“√«‘®—¬ ÕߢâÕ·√°«à“

‚√ß欓∫“≈¡’°“√„™â¬“„π·≈–πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘¡“°

À√◊ÕπâÕ¬‡æ’¬ß„¥ ·≈–§à“„™â®à“¬¥â“π¬“∑’Ë Ÿßπ—Èπ‡ªìπº≈®“°°“√

„™â¬“„π°≈ÿà¡¢âÕ∫àß„™â„¥·≈–‡ªì𬓪√–‡¿∑„¥ °“√«‘‡§√“–Àåπ’È

®÷ß„À⧫“¡ ”§—≠°—∫°≈ÿ࡬“∑’Ë¡’¡Ÿ≈§à“°“√„™â Ÿß ·≈–¡’¬“„π

∫—≠™’¬“À≈—°·Ààß™“μ‘´÷Ëߺ≈‘쉥â„πª√–‡∑»‡ªìπ∑“߇≈◊Õ° ‚¥¬

‡πâπ∑’ˬ“™π‘¥√—∫ª√–∑“π

°≈ÿ࡬“‡À≈à“π’È ‰¥â·°à (Ò) ¬“„π°≈ÿà¡ angiotensin converting enzyme inhibitors (ACEI) ·≈– angiotensin- 2 receptor blockers (ARB); (Ú) ¬“§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥

(antilipids); (Û) ¬“μâ“π¢âÕÕ—°‡ ∫ (antiosteoarthritis) ª√–‡¿∑ nonsteriodal anti-inflammatory drugs (NSAID), cyclo-oxygenase (COX)-2 inhibitors ·≈– symptomatic slow-acting drug for osteoarthritis (SYSADOA); ·≈–

(Ù) ¬“≈¥°“√À≈—Ëß°√¥ (antiulcer/antisecretory drug) ª√–‡¿∑ histamine-2 receptor antagonist (H-2RA) ·≈–

proton-pump inhibitor (PPI) ´÷Ëß¡’√“¬°“√¬“∑—Èß„π·≈–

πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘ (μ“√“ß∑’Ë Ò) Ú. ‡™‘ߧÿ≥¿“æ

„π°“√μÕ∫§”∂“¡°“√«‘®—¬¢âÕ∑’Ë “¡‡æ◊ËÕÀ“ªí®®—¬

 ”§—≠„π°“√§«∫§ÿ¡§à“„™â®à“¬¥â“𬓷≈–°“√„™â¬“πÕ°∫—≠™’

¬“À≈—°·Ààß™“μ‘¢Õß‚√ß欓∫“≈ „™â«‘∏’ —¡¿“…≥å∑“ß‚∑√»—æ∑å

·∫∫‡™‘ß≈÷°μàÕºŸâ„Àâ¢âÕ¡Ÿ≈À≈—°„π‚√ß欓∫“≈π”√àÕß ÛÙ ·Ààß

√à«¡°—∫°“√ Õ∫∂“¡‡¿ —™°√„π§≥–°√√¡°“√‡¿ —™°√√¡·≈–

°“√∫”∫—¥¢Õß‚√ß欓∫“≈¥â«¬®¥À¡“¬Õ‘‡≈Á°∑√Õπ‘° å‡°’ˬ«

°—∫≈—°…≥–°“√¥”‡π‘π°“√¢Õß‚√ß欓∫“≈„πªï ÚııÚ ª√–‡¥Áπ§”∂“¡„π°“√«‘‡§√“–À凙‘ߧÿ≥¿“æ¡’‡π◊ÈÕÀ“

§√Õ∫§≈ÿ¡μàÕ‰ªπ’È (Ò) «‘∏’°“√§—¥‡≈◊Õ°√“¬°“√¬“¢Õß‚√ß æ¬“∫“≈ (Ú) °“√¥”‡π‘π°“√¢Õߧ≥–°√√¡°“√‡¿ —™°√√¡

·≈–°“√∫”∫—¥ ·≈–∫∑∫“∑∑’ˇ°’ˬ«¢âÕߢÕß·æ∑¬å ‡¿ —™°√

·≈–欓∫“≈μàÕ°“√§«∫§ÿ¡§à“„™â®à“¬¥â“π¬“¢Õß‚√ß欓∫“≈

·≈– (Û) º≈°“√¥”‡π‘π°“√ ªí≠À“∑’ˇ°‘¥¢÷Èπ ·≈–¢âÕ‡ πÕ·π–

μàÕ°“√·°â‰¢¢âÕ¡Ÿ≈∑’ˉ¥â√—∫π”¡“«‘‡§√“–Àå‡π◊ÈÕÀ“ ®—¥À¡«¥À¡Ÿà

·≈–Õ∏‘∫“¬‡æ◊ËÕ„Àâ‡ÀÁπ≈—°…≥–°“√¥”‡π‘π°“√„π¿“æ√«¡ ·≈–

ª√– ∫°“√≥å√“¬‚√ß欓∫“≈‚¥¬„™â°√≥’»÷°…“¢Õß‚√ß æ¬“∫“≈∑’˧àÕπ¢â“ߪ√– ∫§«“¡ ”‡√Á®„π°“√§«∫§ÿ¡§à“„™â®à“¬

º≈°“√»÷°…“

°“√„™â¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘: ¿“æ√«¡·≈–§«“¡

·μ°μà“ß√–À«à“ß‚√ß欓∫“≈

„πªï ÚııÚ ‚√ß欓∫“≈∑—Èß Úˆ ·Ààß ¡’°“√ —Ëß„™â¬“„Àâ

·°àºŸâªÉ«¬πÕ°„π√–∫∫®à“¬μ√ߪ√–¡“≥ ÒÙ.Ò ≈â“π„∫ —Ëß §‘¥

‡ªìπ§à“„™â®à“¬√«¡ ÒÛ,Ò¯ı ≈â“π∫“∑ ‚¥¬¡’ —¥ à«π¢Õ߬“

πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘„π¿“æ√«¡‡©≈’ˬ√âÕ¬≈– ÙÒ μ“¡

®”π«π§√—Èß°“√ —Ëß„™â ·≈–√âÕ¬≈– ˆ˜ μ“¡¡Ÿ≈§à“¬“ (μ“√“ß

∑’Ë Ú)

‡¡◊ËÕ®”·π°μ“¡ª√–‡¿∑‚√ß欓∫“≈ æ∫«à“ ‚√ß欓∫“≈

¡À“«‘∑¬“≈—¬¡’ —¥ à«π°“√ —Ëß„™â¬“πÕ°∫—≠™’¬“À≈—°œ  Ÿß∑’Ë ÿ¥

(√âÕ¬≈– Ùı) „π¢≥–∑’Ë‚√ß欓∫“≈ —ß°—¥°√–∑√«ß “∏“√≥ ÿ¢

·≈– —ß°—¥Õ◊Ëπ¡’ —¥ à«πμË”°«à“ (√âÕ¬≈– Ûı ·≈– ÙÚ μ“¡≈”¥—∫) Õ¬à“߉√°Áμ“¡  —¥ à«π¢Õß§à“„™â®à“¬¬“πÕ°∫—≠™’¬“À≈—°œ ¢Õß

‚√ß欓∫“≈ Û ª√–‡¿∑ ¡’§à“„°≈⇧’¬ß°—π (√âÕ¬≈– ˆˆ-ˆ¯)

‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫ —¥ à«π°“√„™â¬“πÕ°∫—≠™’¬“À≈—°·Ààß

™“μ‘√–À«à“ß‚√ß欓∫“≈·μà≈–·Ààß (√Ÿª∑’Ë Ú) æ∫«à“‚√ß

μ“√“ß∑’Ë Ò √“¬°“√¬“„π·≈–πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘ μ“¡°≈ÿà¡¢âÕ∫àß„™â ”§—≠

°≈ÿ࡬“ ¬“„π∫—≠™’¬“À≈—°·Ààß™“μ‘ ¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘

Ò. ¬“≈¥§«“¡¥—π‚≈À‘μ ACEI: Captopril, Enalapril ACEI: Cilazapril, Fosinopril, Imidapril, Lisinopril, Perindopril, ACEI ·≈– ARB ARB: Losartan Perindopril+Indapamide, Quinapril, Quinapril+hydrochlorothiazide

(HCTZ), Ramipril

ARB: Candesartan, Candesartan+HCTZ, Irbesartan, Irbesartan+HCTZ, Losartan+HCTZ, Olmesartan, Olmesartan+HCTZ, Telmisartan, T e l m i s a r t a n + H C T Z , V a l s a r t a n , V a l s a r t a n + A m l o d i p i n e , Valsartan+HCTZ

Ú. ¬“§«∫§ÿ¡‰¢¡—π Fenofibrate Bezafibrate

„π‡≈◊Õ¥ Simvastatin Atorvastatin, Atorvastatin+Amlodipine, Fluvastatin, Pitavastatin, Gemfibrozil Pravastatin, Rosuvastatin

Acipimox, Ezetimibe, Ezetimibe+Simvastatin

Û. ¬“μâ“π¢âÕÕ—°‡ ∫ NSAID: Diclofenac, Ibuprofen, NSAID: Ketoprofen, Loxoprofen, Mefenamic, Meloxicam, Nabumetone,

NSAID, COX-2 Indomethacin, Naproxen, Nimesulide, Sulindac, Tenoxicam, Tiaprofenic

inhibitor ·≈– Piroxicam COX-2 inhibitor: Celecoxib, Etoricoxib, Lumiracoxib, Parecoxib

SYSADOA SYSADOA: Diacerein, Chondroitin, Glucosamine, Glucosamine+

Chondroitin Hyaluronate

Ù. ¬“≈¥°“√À≈—Ëß°√¥ H-2RA: Ranitidine H-2RA: Cimetidine, Famotidine

PPI ·≈– H-2RA PPI: Omeprazole PPI: Esomeprazole, Lansoprazole, Pantoprazole, Rabeprazole

À¡“¬‡Àμÿ: ACEI -Angiotensin converting enzyme inhibitor; ARB -Angiotensin-2 receptor blocker; NSAID -Nonsteriodal anti-inflammatory drug;

COX -Cyclo-oxygenase; SYSADOA -Symptomatic slow-acting drug for osteoarthritis; H-2RA -Histamine-2 receptor antagonist; PPI - Proton-pump inhibitor

μ“√“ß∑’Ë Ú  —¥ à«π¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘ μ“¡®”π«π§√—Èß°“√ —Ëß„™â·≈–¡Ÿ≈§à“¬“ ®”·π°μ“¡ª√–‡¿∑‚√ß欓∫“≈ ÚııÚ

√æ. ¡À“«‘∑¬“≈—¬ √æ.  “∏“√≥ ÿ¢ √æ.  —ß°—¥Õ◊Ëπ √«¡

®”π«π‚√ß欓∫“≈ (·Ààß)

ˆ ÒÛ ˜ Úˆ

Ò. ®”π«π§√—Èß°“√ —Ëß„™â √«¡ („∫ —Ëß) ı,Òˆ,ˆÒÚ Ù,Òˆ¯,¯ı Ù,¯ÒÚ,˘ı˜ ÒÙ,ÒÙÒ,ˆıÙ - ¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘ („∫ —Ëß) Ú,ÛÚ˜,¯˘˜ Ò,Ùı¯,ˆÒ Ú,Ò˜,Ò¯ ı,¯Û,ıÒˆ

-  —¥ à«π¬“πÕ°∫—≠™’¬“À≈—°œ (√âÕ¬≈–) Ùı.Ò Ûı. ÙÒ.˘ ÙÒ.

Ú. ¡Ÿ≈§à“¬“ √«¡∑—ÈßÀ¡¥ (≈â“π∫“∑) ı,˘˘˜ Ú,˜ˆ˘ Ù,ÙÒ˘ ÒÛ,Ò¯ı

- ¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘ (≈â“π∫“∑) Û,˘˜¯ Ò,¯ÛÙ Û,Ò ¯,¯ÒÚ

-  —¥ à«π¬“πÕ°∫—≠™’¬“À≈—°œ (√âÕ¬≈–) ˆˆ.Û ˆˆ.Ú ˆ˜.˘ ˆˆ.¯

Òıı

U1

U3 U2

U4

U5

U6

R1 R2

R3 R4

R5

R6

R7

P1

P2

P3

P4 P5

P6

P7 P8 P9

P10

P11

P12

P13

50 55 60 65 70 75

Baht of non-essential drugs (%)

15 20 25 30 35 40 45 50 55

Scripts of non-essential drugs (%)

สัดสวนมูลคายานอกบัญชียาหลักแหงชาติ (รอยละ)

สัดสวนจํานวนใบสั่งยานอกบัญชียาหลักแหงชาติ (รอยละ)

P – รพ. กระทรวงสาธารณสุข U – รพ. มหาวิทยาลัย

R – รพ. กระทรวงกลาโหมและอื่นๆ

√Ÿª∑’Ë Ú  —¥ à«π¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘μ“¡®”π«π„∫ —Ëß·≈–¡Ÿ≈§à“¬“ √“¬‚√ß欓∫“≈ ÚııÚ

欓∫“≈∑’Ë¡’¡Ÿ≈§à“°“√„™â¬“πÕ°∫—≠™’¬“À≈—°œ §àÕπ¢â“ßμË”

‡ªìπ‚√ß欓∫“≈¡À“«‘∑¬“≈—¬ Û ·Ààß (√âÕ¬≈– ıÒ- ıˆ) ‚√ß æ¬“∫“≈ —ß°—¥°√–∑√«ß “∏“√≥ ÿ¢ Ò ·Ààß (√âÕ¬≈– ı˜)

·≈–‚√ß欓∫“≈ —ß°—¥Õ◊Ëπ Ò ·Ààß (√âÕ¬≈– ıˆ)

¡Ÿ≈§à“°“√„™â√«¡·≈–¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘: §«“¡

·μ°μà“ß√–À«à“ß°≈ÿ࡬“

°“√«‘‡§√“–Àå¡Ÿ≈§à“¬“·≈– —¥ à«π¬“πÕ°∫—≠™’¬“À≈—°

·Ààß™“μ‘μ“¡°≈ÿà¡¢âÕ∫àß„™â¢Õ߬“ ∑”„À≥â¢âÕ¡Ÿ≈æ◊Èπ∞“π„π°“√

æ—≤π“°“√§«∫§ÿ¡§à“„™â®à“¬¥â“π¬“¢Õß√–∫∫ «— ¥‘°“√√—°…“

欓∫“≈¢â“√“™°“√ √Ÿª∑’Ë Û · ¥ß°≈ÿ࡬“‡√’¬ß≈”¥—∫μ“¡¡Ÿ≈§à“

°“√„™â„π¿“æ√«¡¢Õß‚√ß欓∫“≈∑ÿ°ª√–‡¿∑ ‚¥¬®”·π°„Àâ

‡ÀÁπ√–À«à“߬“πÕ°·≈–„π∫—≠™’¬“À≈—°·Ààß™“μ‘ æ∫«à“ „πªï ÚııÚ °≈ÿ࡬“∑’Ë¡’§à“„™â®à“¬ Ÿß ˆ Õ—π¥—∫·√° ‰¥â·°à ¬“

§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥ ¬“μâ“π¡–‡√Áß ¬“μâ“π¢âÕÕ—°‡ ∫ ¬“μâ“π

°√–¥Ÿ°æ√ÿ𠬓 ACEI-ARB ·≈–¬“≈¥°“√À≈—Ëß°√¥ μ“¡≈”¥—∫

¡Ÿ≈§à“√«¡¢Õ߬“∑—Èß ˆ °≈ÿà¡¥—ß°≈à“«§‘¥‡ªìπ —¥ à«πª√–¡“≥

√âÕ¬≈– ÙÒ ¢Õß§à“„™â®à“¬¥â“π¬“∑ÿ°√“¬°“√

‡ ¡◊Ë Õ æ‘ ® “ √ ≥ “ ≈— ° … ≥ – ¢ Õ ß ¬ “ · μà ≈ – √ “ ¬ ° “ √ μ “ ¡

§ÿ≥ ¡∫—μ‘„π∫—≠™’¬“À≈—°·Ààß™“μ‘ æ∫«à“ ¡Ÿ≈§à“¢Õ߬“πÕ°

∫—≠™’¬“À≈—°œ „π°≈ÿ࡬“∑’Ë¡’§à“„™â®à“¬ Ÿß∑—Èß ˆ °≈ÿà¡¥—ß°≈à“«

¡’ —¥ à«π∑’Ë Ÿß¡“° À“°‰¡à√«¡¬“μâ“π¡–‡√Áß´÷Ëß¡’·∫∫·ºπ°“√

√—°…“∑’˧àÕπ¢â“ß´—∫´âÕπ ·≈–¬“μâ“π°√–¥Ÿ°æ√ÿπ∑’Ë∫—≠™’¬“À≈—°

·Ààß™“μ‘©∫—∫ªí®®ÿ∫—π¬—߉¡à¡’¬“™π‘¥√—∫ª√–∑“π ®–æ∫ —¥ à«π

¢Õ߬“πÕ°∫—≠™’¬“À≈—°œ μ“¡¡Ÿ≈§à“ μ—Èß·μà √âÕ¬≈– ¯ˆ.Ù  ”À√—∫¬“§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥ √âÕ¬≈– ¯˜.¯  ”À√—∫¬“

ACEI-ARB √âÕ¬≈– ˘Û.ˆ  ”À√—∫¬“≈¥°“√À≈—Ëß°√¥ ·≈– Ÿß

∂÷ß√âÕ¬≈– ˘˜.Ú  ”À√—∫¬“μâ“π¢âÕÕ—°‡ ∫ ·¡â«à“°≈ÿ࡬“‡À≈à“

π’È®–¡’¬“„π∫—≠™’¬“À≈—°·Ààß™“μ‘∑’˺≈‘쉥â„πª√–‡∑»„Àâ‡≈◊Õ°

„™â‰¥âÀ≈“¬√“¬°“√

°“√„™â¬“∑’Ë¡’ºŸâ®”Àπà“¬√“¬‡¥’¬«·≈–À≈“¬√“¬

§”∂“¡∑’Ëμ“¡¡“ §◊Õ ‡Àμÿ„¥°≈ÿ࡬“´÷Ëß¡’ —¥ à«π¢Õ߬“

πÕ°∫—≠™’¬“À≈—°œ ∑’Ë¡“°‡À≈à“π’È®÷ß¡’§à“„™â®à“¬ Ÿß °“√®”·π°

¡Ÿ≈§à“·≈–®”π«π„∫ —Ë߬“μ“¡§ÿ≥ ¡∫—μ‘∑“ß°“√μ≈“¥¢Õ߬“

·μà≈–√“¬°“√∑’ËÕ¬Ÿà„π°≈ÿࡇ¥’¬«°—π (μ“√“ß∑’Ë Û) · ¥ß„Àâ‡ÀÁπ

§”μÕ∫¢Õߪí≠À“¥—ß°≈à“«

®“°μ“√“ß∑’Ë Û §à“„™â®à“¬√âÕ¬≈– ˘Ú.Û, ¯ˆ., ˆı. ·≈–

ÙÙ. ¢Õß°≈ÿ࡬“≈¥°“√À≈—Ëß°√¥ ¬“§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥ ¬“

ACEI-ARB ·≈–¬“μâ“π¢âÕÕ—°‡ ∫ μ“¡≈”¥—∫ ‡°‘¥®“°°“√„™â

¬“∑’Ë¡’°“√ºŸ°¢“¥„π∑âÕßμ≈“¥‡π◊ËÕß®“°¡’ºŸâ®”Àπà“¬√“¬‡¥’¬«

‚¥¬‡©æ“–¬“≈¥°“√À≈—Ëß°√¥·≈–¬“§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥´÷Ëß

§à“„™â®à“¬¢Õ߬“∑’ËÕ¬ŸàπÕ°∫—≠™’¬“À≈—°·Ààß™“쑇°◊Õ∫∑—ÈßÀ¡¥

‡°‘¥®“°√“¬°“√¬“∑’Ë¡’ºŸâ®”Àπà“¬√“¬‡¥’¬« À“°æ‘®“√≥“μ“¡

®”π«π§√—ÈߢÕß°“√ —Ëß„™â¬“„π·μà≈–°≈ÿà¡ æ∫«à“  —¥ à«π„∫ —Ëß

¬“∑’Ë¡’ºŸâ®”Àπà“¬√“¬‡¥’¬«Õ¬Ÿà√–À«à“ß√âÕ¬≈– ÙÒ ∂÷ß√âÕ¬≈– Ùı

´÷Ëß¡’§à“„°≈⇧’¬ß°—π·≈–μË”°«à“ —¥ à«πμ“¡§à“„™â®à“¬ · ¥ß«à“

ªí≠À“§à“„™â®à“¬¥â“π¬“¢Õß√–∫∫ «— ¥‘°“√√—°…“欓∫“≈

¢â“√“™°“√‡°‘¥®“°√“§“μàÕ„∫ —Ë߬“∑’Ë·æß ‚¥¬¡’μâπ‡Àμÿ®“°

°“√ —Ëß„™â¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘∑’Ë¡’ºŸâ®”Àπà“¬√“¬‡¥’¬«

„π¢≥–∑’Ë°“√„™â¬“„π∫—≠™’¬“À≈—°œ ‰¡à„™àªí≠À“‡æ√“–‡°◊Õ∫

∑—ÈßÀ¡¥‡ªìπ¬“∑’Ë¡’ºŸâ®”Àπà“¬À≈“¬√“¬

ªí®®—¬ ”§—≠¢Õß°“√§«∫§ÿ¡§à“„™â®à“¬·≈–°“√„™â¬“πÕ°

∫—≠™’¬“À≈—°·Ààß™“μ‘¢Õß‚√ß欓∫“≈

®“°°“√ ”√«®¡“μ√°“√§«∫§ÿ¡§à“„™â®à“¬¥â“π¬“¢Õß‚√ß æ¬“∫“≈ æ∫«à“ ‚√ß欓∫“≈∑ÿ°·Ààß ‰¥â¡’°“√¥”‡π‘π¡“μ√°“√

Õ¬à“ß„¥Õ¬à“ßÀπ÷ËßÕ¬Ÿà·≈â« ´÷Ëß à«π„À≠à„™â¡“μ√°“√À≈“¬Õ¬à“ß

√à«¡°—𠇙àπ °“√®—¥´◊ÈÕ√«¡ ”À√—∫¬“∑’Ë¡’¡Ÿ≈§à“°“√„™â Ÿß °“√

§«∫§ÿ¡®”π«π√“¬°“√¬“∑’Ë¡’„™â °“√¢Õ§«“¡√à«¡¡◊Õ®“°·æ∑¬å

°“√°”Àπ¥‡ß◊ËÕπ‰¢°“√ —Ëß„™â·≈–®à“¬¬“ ‚¥¬‡©æ“–¬“∑’Ë¡’ºŸâ

®”Àπà“¬√“¬‡¥’¬«À√◊Õ¬“μâπ·∫∫∑’Ë¡’√“§“·æß ¡“μ√°“√∑’Ë‚√ß

906.1 142.4

0 . 3 5 5 3

. 3 3 4

8 . 0 2 4

. 8 2 7

4 . 1 1 9

. 7 5 5

3 . 4 6 8

. 2 6 4

1 . 3 3 1

. 3 8 4

0 . 2 6 2 3

. 8 9 1

4 . 9 3 1

. 2 9 3

24.3 301.7

69.3 182.5

114.6 19.4 109.4 5.8 53.1 8.8 8.511.7

0 100 200 300 400 500 600 700 800 900 1,000

Expenditure (million Baht) Antilipid

Anticancer Antiosteoarthritis Antiosteoporosis ACEI-ARB Antiulcer Antidiabetic AntiHBV Antiplatelet Antiasthma DMARD Antipsychotic Muscle relaxant Hemostatic

Non-essential drug Essential drug

มูลคา (ลานบาท)

ยานอกบัญชียาหลักฯ ยาในบัญชียาหลักฯ

√Ÿª∑’Ë Û ¡Ÿ≈§à“°“√„™â¬“„π·≈–πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘ μ“¡°≈ÿà¡¢âÕ∫àß„™â∑’Ë¡’§à“„™â®à“¬ Ÿß ÚııÚ

Òı˜

欓∫“≈‡≈◊Õ°„™â¡“°∑’Ë ÿ¥ §◊Õ °“√®”°—¥¡Ÿ≈§à“/ª√‘¡“≥∑’Ë —Ëß„™â

„π·μà≈–§√—Èß ‚¥¬Õ“®„™â√à«¡°—∫‡°≥±åμ“¡¿“«–∑“ߧ≈‘π‘°

¢ÕߺŸâªÉ«¬ À√◊Õ§ÿ≥ ¡∫—μ‘¢ÕߺŸâ —Ëß„™â‡ªìπ°“√‡©æ“– Õ¬à“߉√

°Áμ“¡ §«“¡‡¢â¡ß«¥„π°“√ªØ‘∫—μ‘¡—°¢÷ÈπÕ¬Ÿà°—∫π‚¬∫“¬¢ÕߺŸâ

∫√‘À“√·≈–§«“¡‡¢â¡·¢ÁߢÕߧ≥–°√√¡°“√‡¿ —™°√√¡·≈–

°“√∫”∫—¥¢Õß‚√ß欓∫“≈

·¡â«à“‚√ß欓∫“≈∑’Ë∑”°“√»÷°…“®–√“¬ß“π«à“¡’¡“μ√°“√

§«∫§ÿ¡§à“„™â®à“¬ ·μàº≈°“√«‘‡§√“–À凙‘ߪ√‘¡“≥¢â“ßμâπ´÷Ëßæ∫

°“√„™â¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘„π —¥ à«π∑’Ë Ÿß –∑âÕπ∂÷ß

§«“¡‰¡à¡’ª√– ‘∑∏‘º≈¢Õß¡“μ√°“√∑’Ë°≈à“«¡“·≈â« ¥—ßπ—Èπ „π  à«ππ’È®÷߇ πÕ°√≥’»÷°…“ªí®®—¬∑’ˇÕ◊ÈÕμàÕ§«“¡ ”‡√Á®¢Õß°“√

¥”‡π‘π°“√§«∫§ÿ¡§à“„™â®à“¬„π‚√ß欓∫“≈¡À“«‘∑¬“≈—¬·Ààß Àπ÷Ëß´÷Ëß¡’°“√„™â¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘„π —¥ à«π∑’ËμË”

°«à“‚√ß欓∫“≈Õ◊ËπÊ

®“°°“√ —¡¿“…≥凙‘ß≈÷° æ∫«à“ ‚√ß欓∫“≈·Ààßπ’È¡’ºŸâ

∫√‘À“√∑’Ë„À⧫“¡ ”§—≠°—∫°“√§«∫§ÿ¡§à“„™â®à“¬¥â“π¬“π“π¡“

·≈â«·≈–‡ªìπ‰ªÕ¬à“ßμàÕ‡π◊ËÕß §≥–°√√¡°“√‡¿ —™°√√¡·≈–

°“√∫”∫—¥¢Õß‚√ß欓∫“≈¡’§«“¡‡¢â¡·¢Áß„π°“√§—¥‡≈◊Õ°¬“

‡ ¢â “ ‚ √ ß æ ¬ “ ∫ “ ≈ ‚ ¥ ¬ æ‘ ® “ √ ≥ “ ∑—È ß ¥â “ π § « “ ¡ ª ≈ Õ ¥ ¿— ¬ ª√– ‘∑∏‘º≈·≈–§«“¡§ÿâ¡§à“®“°À≈—°∞“πÕâ“ßÕ‘ß∑’Ëπà“‡™◊ËÕ∂◊Õ ¡’

°“√°”°—∫μ‘¥μ“¡°“√„™â¬“„À⇪ìπ‰ªμ“¡‡°≥±å¢âÕ∫àß„™â‚¥¬

‡ΩÑ“√–«—ßÕ—μ√“°“√„™â¬“∑’˺‘¥ª√°μ‘ ¡’π‚¬∫“¬™–≈Õ°“√„™â¬“„À¡à

·≈– à߇ √‘¡°“√„™â¬“μ“¡™◊ËÕ “¡—≠‚¥¬¡’°“√μ√«® Õ∫

§ÿ≥¿“æ‡æ◊ËÕ √â“ߧ«“¡¡—Ëπ„®·°àºŸâ —Ëß„™â √«¡∑—Èß¡’°“√√“¬ß“π  ∂“π°“√≥å°“√„™â¬“‡ªìπª√–®”∑—Èß„π¿“æ√«¡·≈–¬“∑’ˇªìπ

‡ªÑ“À¡“¬

 ”À√—∫¡“μ√°“√μàÕ°“√‡∫‘°®à“¬§à“¬“∑’Ë¡’§«“¡‡ ’ˬßμàÕ

°“√„™âÕ¬à“߉¡à ¡‡Àμÿ ¡º≈À√◊Õ‰¡à§ÿâ¡§à“ ‡™à𠬓ªØ‘™’«π– ¬“

√“§“·æß „π√–∫∫ «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√ ∑“ß‚√ß æ¬“∫“≈®–√—∫√Õß„Àâ‡∫‘°‰¥â°√≥’∑’ˇªìπ‰ªμ“¡‡°≥±å∑’Ëμ°≈߉«â

‡∑à“π—Èπ ¡’°“√·®âß·æ∑¬å‡ªìπ√“¬∫ÿ§§≈À“° —Ëß„™â¬“‰¡àμ√ßμ“¡

‡°≥±å ·≈–¡’°“√μ‘¥μ“¡´È”‡æ◊ËÕª√–‡¡‘π«à“°“√ —Ëß„™â¬“∑’ˉ¡à μ√ßμ“¡‡°≥±å≈¥≈ßÀ√◊Õ‰¡à

ªí®®—¬∑’ˇÕ◊ÈÕμàÕ§«“¡ ”‡√Á®¢Õß°“√¥”‡π‘πß“π¢Õß‚√ß æ¬“∫“≈μàÕ°“√§«∫§ÿ¡§à“„™â®à“¬ ‰¥â·°à §«“¡ π„®¢ÕߺŸâ∫√‘À“√

·≈–π‚¬∫“¬∑’Ë™—¥‡®π §«“¡®√‘ß®—ߢÕߺŸâ∫√‘À“√¡’º≈μàÕ°“√

μ“√“ß∑’Ë Û  —¥ à«πμ“¡¡Ÿ≈§à“·≈–®”π«π„∫ —Ë߬“¢Õß°≈ÿ࡬“§à“„™â®à“¬ Ÿß ÚııÚ

¬“„π∫—≠™’¬“À≈—°·Ààß™“μ‘ ¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘

°≈ÿ࡬“ √«¡

ºŸâ®”Àπà“¬À≈“¬√“¬ ºŸâ®”Àπà“¬√“¬‡¥’¬« ºŸâ®”Àπà“¬À≈“¬√“¬ ºŸâ®”Àπà“¬√“¬‡¥’¬«

Ò. ¬“ ACEI-ARB

- √âÕ¬≈–¢Õß¡Ÿ≈§à“¬“ ÒÚ.˜ . ÚÚ.Û ˆı. Ò

- √âÕ¬≈–¢Õß„∫ —Ë߬“ ÙÒ.Ò . ÒÛ.Ù Ùı.ı Ò

Ú. ¬“§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥

- √âÕ¬≈–¢Õß¡Ÿ≈§à“¬“ ÒÛ.˘ . . ¯ˆ. Ò

- √âÕ¬≈–¢Õß„∫ —Ë߬“ ı˜.¯ . .Ò ÙÚ.Ò Ò

Û. ¬“μâ“π¢âÕÕ—°‡ ∫

- √âÕ¬≈–¢Õß¡Ÿ≈§à“¬“ Ò.˘ . ıÙ. ÙÙ. Ò

- √âÕ¬≈–¢Õß„∫ —Ë߬“ Ú. Ò.˜ Û¯.Ò Ù.Ò Ò

Ù. ¬“≈¥°“√À≈—Ëß°√¥

- √âÕ¬≈–¢Õß¡Ÿ≈§à“¬“ ı.ˆ Ò. Ú.Ò ˘Ò.Û Ò

- √âÕ¬≈–¢Õß„∫ —Ë߬“ ı¯.˜ Ú.˜ .Ú Û¯.Ù Ò

∑”ß“π¢Õߧ≥–°√√¡°“√‡¿ —™°√√¡·≈–°“√∫”∫—¥ ºŸâ∫√‘À“√

 à«π„À≠à‰¡àÕ¬“°¢—¥·¬âß°—∫·æ∑¬åºŸâ —Ëß„™â¬“ ‡æ√“–‡°√ß«à“®–

°√–∑∫μàÕ°“√„Àâ∫√‘°“√´÷Ë߇ªìπ¿“√°‘®À≈—°¢Õß‚√ß欓∫“≈

πÕ°®“°π’È √“¬‰¥â¢Õß‚√ß欓∫“≈√—∞ ‚¥¬‡©æ“–∑’ˉ¡à‰¥â —ß°—¥

°√–∑√«ß “∏“√≥ ÿ¢ ‚√ß欓∫“≈¢π“¥„À≠à„π à«π°≈“ß ¢÷Èπ

°—∫√–∫∫ «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√‡ªìπÀ≈—° °“√ √â“ß

·√ß®Ÿß„®∑“ß°“√‡ß‘πμàÕ‚√ß欓∫“≈∑’ˇÀ¡“– ¡®–™à«¬‡æ‘Ë¡

§«“¡√à«¡¡◊Õ„π°“√§«∫§ÿ¡°“√„™â¬“πÕ°∫—≠™’¬“À≈—°œ ∑’Ë¡’

√“§“·æß·≈–„Àâº≈°”‰√ Ÿß

Õ¬à“߉√°Áμ“¡ ªí®®—¬∑’ˇªìπÕÿª √√§μàÕ§«“¡ ”‡√Á®„π

°“√¥”‡π‘π°“√§«∫§ÿ¡§à“„™â®à“¬ ‰¥â·°à °≈¬ÿ∑∏å∑“ß°“√μ≈“¥

¢Õß∫√‘…—∑¬“ ‡™àπ °“√‡¢â“∂÷ߺŸâ —Ëß„™â¬“ °“√ª√—∫‡ª≈’ˬπ º≈‘μ¿—≥±å„À¡à „π¢≥–∑’Ë√–∫∫ “√ π‡∑»¢Õß‚√ß欓∫“≈

¥â“𬓠°“√μ√«®√—°…“ ·≈–ºŸâªÉ«¬‡æ◊ËÕ°“√μ—¥ ‘π„®Õ“®‰¡à∑—π μàÕ§«“¡‡ª≈’ˬπ·ª≈ߥ—ß°≈à“«

§≥–°√√¡°“√‡¿ —™°√√¡·≈–°“√∫”∫—¥¢Õß‚√ß欓∫“≈

Õ“®∑”Àπâ“∑’Ë®”°—¥‡æ’¬ß°“√§—¥‡≈◊Õ°¬“‡¢â“-ÕÕ° À“°ºŸâ∫√‘À“√

‰¡à„À⧫“¡ ”§—≠μàÕ°“√¡’ à«π√à«¡ °“√§—¥‡≈◊Õ°¬“Õ“®‰¡à„Àâ

§«“¡ ”§—≠°—∫À≈—°∞“π‡™‘ßª√–®—°…凰’ˬ«°—∫ª√– ‘∑∏‘º≈·≈–

À≈—°§«“¡§ÿ⡧à“∑“߇»√…∞»“ μ√å πÕ°®“°π—Èπº≈ª√–‚¬™πå

®“°∫√‘…—∑¬“Õ“®∑”„Àâ°√√¡°“√∫“ߧπ¡’Õ§μ‘‚π⡇Ւ¬ß‡¢â“¢â“ß

¬“„À¡à∑’ˬ—߉¡àÕ¬Ÿà„π∫—≠™’¬“À≈—°·Ààß™“μ‘

Õÿª √√§„π¥â“πºŸâ —Ëß„™â¬“ ‰¥â·°à ∑—»π§μ‘¢Õß·æ∑¬å´÷Ëß  à«π„À≠à‡ªìπ„π∑“ß≈∫μàÕ¬“„π∫—≠™’¬“À≈—°·Ààß™“μ‘ °“√

‡¢â“„®«à“°“√§«∫§ÿ¡§à“„™â®à“¬‡ªìπ‡√◊ËÕߢÕß°“√®—∫º‘¥ §«“¡

‡™◊ËÕ«à“°“√ —Ëß„™â¬“‡ªìπÕ”π“®°“√μ—¥ ‘π„® à«π∫ÿ§§≈ „π¢≥–

∑’ˇ√◊ËÕß°“√‡ß‘π°“√§≈—߇ªìπ‡√◊ËÕߢÕߺŸâ∫√‘À“√ ·æ∑¬åÕ“®‰¡à

∑√“∫¢âÕ¡Ÿ≈‡°’ˬ«°—∫√“§“¬“∑’Ë¡’º≈μàÕ§à“„™â®à“¬„π¿“æ√«¡

·≈–‰¡à∑√“∫π‚¬∫“¬‡°’ˬ«°—∫°“√ —Ëß„™â¬“¢Õß‚√ß欓∫“≈

‚√ß欓∫“≈Õ“®¢“¥ºŸâ∑’Ë¡’§«“¡ “¡“√∂„π°“√„™â¢âÕ¡Ÿ≈

°“√¢“¥§«“¡√à«¡¡◊Õ„π°“√√–∫ÿ‡Àμÿº≈°“√ —Ëß„™â¬“πÕ°∫—≠™’

¬“À≈—°œ ∑”„À≡ࠓ¡“√∂π”¡“«‘‡§√“–Àå‡æ◊ËÕμ‘¥μ“¡°”°—∫‰¥â πÕ°®“°π’È°“√‰¡à¡’π‚¬∫“¬∑’Ë™—¥‡®π®“° à«π°≈“ß∑”„À⇰‘¥

§«“¡‰¡à™—¥‡®πμàÕ°“√ªØ‘∫—μ‘¿“¬„π‚√ß欓∫“≈

«‘®“√≥å·≈–¢âÕ¬ÿμ‘

„π™à«ß√–¬–‡«≈“ Ò ‡¥◊Õπ·√°¢Õߪïß∫ª√–¡“≥ ÚııÚ (μÿ≈“§¡ ÚııÒ - °√°Ø“§¡ ÚııÚ)  ∂“π欓∫“≈¢Õß√—∞

Úˆ ·Ààß ¡’§à“„™â®à“¬¥â“𬓠”À√—∫ºŸâªÉ«¬πÕ°„π√–∫∫®à“¬

μ√ߢÕß «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√§‘¥‡ªìπ¡Ÿ≈§à“°«à“

Àπ÷ËßÀ¡◊Ëπ “¡æ—π≈â“π∫“∑ ‚¥¬ª√–¡“≥ Õß„π “¡‡°‘¥®“°

°“√„™â¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘ Õ¬à“߉√°Áμ“¡  —¥ à«π°“√

„™â¬“πÕ°∫—≠™’¬“À≈—°œ ¬—ß¡’§«“¡·μ°μà“ß√–À«à“ß‚√ß欓∫“≈

‚¥¬æ∫«à“ ‚√ß欓∫“≈¡À“«‘∑¬“≈—¬ Ò ·Ààß “¡“√∂§«∫§ÿ¡

°“√„™â¬“πÕ°∫—≠™’¬“À≈—°œ ‰¥â¥’°«à“‚√ß欓∫“≈°√–∑√«ß  “∏“√≥ ÿ¢·≈– —ß°—¥Õ◊ËπÕ’°À≈“¬·Ààß

°≈ÿ࡬“∑’Ë¡’§à“„™â®à“¬‚¥¬√«¡§àÕπ¢â“ß Ÿß·≈–¡’°“√„™â¬“π Õ°∫—≠™’¬“À≈—°œ „π —¥ à«π∑’Ë Ÿß¡“° ‰¥â·°à ¬“§«∫§ÿ¡‰¢¡—π

„π‡≈◊Õ¥ ¬“μâ“π¢âÕÕ—°‡ ∫ (NSAID, COX-2 inhibitors ·≈–

SYSADOA) ¬“ ACEI-ARB ·≈–¬“≈¥°“√À≈—Ëß°√¥ (H-2RA

·≈– PPI) §à“„™â®à“¬¢Õß°≈ÿ࡬“‡À≈à“π’È à«π„À≠à‡°‘¥®“°°“√ —Ëß

„™â¬“∑’Ë¡’ºŸâ®”Àπà“¬√“¬‡¥’¬«´÷Ë߇ªìπ¬“∑’Ë¡’√“§“·æß ¥—ßπ—Èπ „π  ∂“π°“√≥åªí®®ÿ∫—π∑’Ë√–∫∫ «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√

¬—ßÕ“»—¬«‘∏’°“√®à“¬‡ß‘π§à“√—°…“欓∫“≈·∫∫ª≈“¬‡ªî¥ ”À√—∫

ºŸâªÉ«¬πÕ° ¡“μ√°“√§«∫§ÿ¡§à“„™â®à“¬¢Õß‚√ß欓∫“≈§«√„Àâ

§«“¡ ”§—≠∑’Ë°≈ÿ࡬“‡À≈à“π’È

‡¡◊ËÕæ‘®“√≥“¡“μ√°“√§«∫§ÿ¡§à“„™â®à“¬¥â“π¬“´÷Ëß¡’Õ¬Ÿà

·≈â«„π‚√ß欓∫“≈π”√àÕ߇À≈à“π’È √à«¡°—∫·∫∫·ºπ°“√„™â¬“

¢â“ßμâπ · ¥ß«à“¬—ߢ“¥ª√– ‘∑∏‘º≈ ∑—Èßπ’È “‡Àμÿ à«π„À≠à‡°‘¥

®“°¢“¥§«“¡‡¢â¡ß«¥„π°“√¥”‡π‘π°“√ ¥—ßπ—Èπ®÷ߧ«√ à߇ √‘¡

„À⇰‘¥°“√§«∫§ÿ¡§à“„™â®à“¬„π‚√ß欓∫“≈‡æ‘Ë¡¢÷Èπ‚¥¬∫—ߧ—∫

„™â¡“μ√°“√∑’Ë¡’Õ¬Ÿà‡¥‘¡ √à«¡°—∫¡“μ√°“√Õ◊ËπÊ ∑’Ë‚√ß欓∫“≈

·μà≈–·Ààß “¡“√∂¥”‡π‘π°“√‡Õß ‰¥â·°à °“√«‘‡§√“–Àå¢âÕ¡Ÿ≈

°“√ —Ëß„™â¬“¢Õß·æ∑¬å‡ªìπ√“¬∫ÿ§§≈·≈– àߢâÕ¡Ÿ≈„Àⷰຟâ Õ”π«¬°“√‚√ß欓∫“≈Õ¬à“ß ¡Ë”‡ ¡Õ§«∫§Ÿà°—∫°“√¡’·π«∑“ß

®—¥°“√∑’ˇªìπ√Ÿª∏√√¡ °“√°”Àπ¥„Àâ°“√ª√–À¬—¥§à“„™â®à“¬

¥â“π¬“¡’º≈μàÕ°“√‰¥â√—∫‡ß‘π摇»…¢Õß∫ÿ§≈“°√∑“ß°“√·æ∑¬å

„π‚√ß欓∫“≈ °“√∫√‘À“√®—¥°“√‚√§‡√◊ÈÕ√—ß„Àâ¡’ª√– ‘∑∏‘¿“æ

°“√∫—ߧ—∫·∑π¬“¥â«¬¬“™◊ËÕ “¡—≠ °“√„À⺟â·∑𬓬ÿμ‘°“√„Àâ

Òı˘

¢âÕ¡Ÿ≈μ√ß·°à·æ∑¬å„π‚√ß欓∫“≈ ·≈–°“√ à߇ √‘¡∫∑∫“∑

¢Õ߇¿ —™°√·≈–§≥–°√√¡°“√‡¿ —™∫”∫—¥„π°“√¥Ÿ·≈∫—≠™’¬“

¢Õß‚√ß欓∫“≈„Àâ‡À¡“– ¡  ”À√—∫°“√°”Àπ¥¡“μ√°“√

§«∫§ÿ¡§à“„™â®à“¬¥â“𬓄π√–¥—∫ª√–‡∑»  ‘Ëß∑’˧«√ à߇ √‘¡„Àâ

¡’‡æ‘Ë¡‡μ‘¡ §◊Õ °“√°”À𥇰≥±åÀ√◊Õπ‚¬∫“¬§«∫§ÿ¡°“√„™â

¬“∑’Ë™—¥‡®π∑’Ë ”§—≠ ‰¥â·°à °“√„™âπ‚¬∫“¬√“§“Õâ“ßÕ‘ß ”À√—∫

°“√‡∫‘°®à“¬ °“√ √â“ß√–∫∫μ‘¥μ“¡·≈–§«∫§ÿ¡°”°—∫‚¥¬

Õ“»—¬°“√ª√–¡«≈¢âÕ¡Ÿ≈°“√„™â¬“¢Õß‚√ß欓∫“≈∑’ˇ©æ“–

‡®“–®ßμàÕºŸâ —Ëß„™â√“¬∫ÿ§§≈ √–∫∫¥—ß°≈à“«μâÕßÕ“»—¬¢âÕ¡Ÿ≈∑’Ë

∂Ÿ°μâÕß·≈–‡ªìπªí®®ÿ∫—π ‚¥¬¡’‚§√ß √â“ß¡“μ√∞“π∑’Ë¡’§«“¡

≈–‡Õ’¬¥„π√–¥—∫¢Õß°“√ —Ëß„™â¬“·μà≈–§√—Èß ∞“π¢âÕ¡Ÿ≈

Õ‘‡≈Á°∑√Õπ‘° å∑’Ë‚√ß欓∫“≈∫—π∑÷°‡æ◊ËÕ°“√∫√‘À“√®—¥°“√

ª√–®”«—π§«√‰¥â√—∫°“√æ—≤π“„Àâ “¡“√∂„™â√À— ¡“μ√∞“π

‡¥’¬«°—π‰¥â ‚¥¬‡©æ“–Õ¬à“߬‘Ëß √À— ¬“·≈–«‘∏’„™â^(ÒÒ-ÒÛ) πÕ°®“°

π’È §«√¡’°“√ √â“ß·√ß®Ÿß„®·°à‚√ß欓∫“≈∑’Ë “¡“√∂§«∫§ÿ¡§à“

„™â®à“¬‰¥â¥’‡¡◊ËÕ‡∑’¬∫°—∫‚√ß欓∫“≈°≈ÿࡇ¥’¬«°—π °“√æ—≤π“

»—°¬¿“æ „π°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈‡™‘ߪ√‘¡“≥„Àâ∫ÿ§≈“°√ °“√¡’

‡«∑’·≈°‡ª≈’ˬπ‡√’¬π√Ÿâ√–À«à“ß∑’¡∑”ß“π

°‘μμ‘°√√¡ª√–°“»

ºŸâπ‘æπ∏å¢Õ¢Õ∫§ÿ≥ °√¡∫—≠™’°≈“ß„π°“√ª√– “πß“π°—∫

‚√ß欓∫“≈·≈–„Àâ¢âÕ¡Ÿ≈∑’ˇªìπª√–‚¬™πåμàÕ°“√«‘®—¬ ¢Õ

¢Õ∫§ÿ≥ ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢„π°“√„À⧫“¡√à«¡¡◊Õ  π—∫ πÿπ¢âÕ¡Ÿ≈ß“π«‘®—¬∑’ˇ°’ˬ«¢âÕß ·≈–¢Õ¢Õ∫§ÿ≥‚√ß æ¬“∫“≈π”√àÕß∑’Ë„Àâ¢âÕ¡Ÿ≈‡æ◊ËÕ„™â„π°“√»÷°…“™‘Èππ’È

‡Õ° “√Õâ“ßÕ‘ß

Ò.  —¡ƒ∑∏‘Ï »√’∏”√ß «— ¥‘Ï. √–∫∫ª√–°—π ÿ¢¿“æ¢Õ߉∑¬. „π:  ÿ®√‘μ  ÿπ∑√∏√√¡ (∫√√≥“∏‘°“√). °“√∫√‘À“√°“√ √â“ßÀ≈—°ª√–°—π  ÿ¢¿“æ∂â«πÀπâ“¢Õߪ√–‡∑»‰∑¬ ÚııÙ.

Ú. °ÿ≈‡»°¢√å ≈‘¡ªî¬“°√. √–∫∫ «— ¥‘°“√√—°…“欓∫“≈¢â“√“™°“√. „π:

 ÿ®√‘μ  ÿπ∑√∏√√¡ (∫√√≥“∏‘°“√). °“√∫√‘À“√°“√ √â“ßÀ≈—°

ª√–°—π ÿ¢¿“æ∂â«πÀπâ“¢Õߪ√–‡∑»‰∑¬; ÚııÙ.

Û. Limwattananon C, Limwattananon S, Pannarunothai S, Tangcharoensathien V. Analysis of practice variation due to pay- ment methods across health insurance schemes. Country Develop- ment Partnership in Health (CDP-H): Health Financing Project.

TOR 2 Report. Nonthaburi: International Health Policy Program (IHPP) and World Bank; 2009.

ı. ®ÿÓ¿√≥å ≈‘¡«—≤π“ππ∑å,  ÿæ≈ ≈‘¡«—≤π“ππ∑å, »ÿ¿ ‘∑∏‘Ï æ√√≥“√ÿ‚≥∑—¬.

°“√‰¡à‰¥â√—∫¬“¢ÕߺŸâªÉ«¬∑’Ë√—∫°“√√—°…“®“°‚√ß欓∫“≈ √“¬ß“π°“√

«‘®—¬. ππ∑∫ÿ√’:  ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ·≈–»Ÿπ¬å«‘®—¬·≈–

μ‘¥μ“¡§«“¡‡ªìπ∏√√¡∑“ß ÿ¢¿“æ ¡À“«‘∑¬“≈—¬π‡√»«√; ÚıÙı.

ˆ. ®ÿÓ¿√≥å ≈‘¡«—≤π“ππ∑å,  ÿæ≈ ≈‘¡«—≤π“ππ∑å, Õ“√’«√√≥

‡™’ˬ«™“≠«—≤π“. °“√«‘‡§√“–Àå·≈–欓°√≥å§à“„™â®à“¬¥â“π¬“ºŸâªÉ«¬

πÕ°‚√ß欓∫“≈»Ÿπ¬å·≈–‚√ß欓∫“≈∑—Ë«‰ª „π√–∫∫ «— ¥‘°“√

√—°…“欓∫“≈¢â“√“™°“√ ·≈–À≈—°ª√–°—π ÿ¢¿“æ∂â«πÀπâ“ √“¬ß“π

°“√«‘®—¬. ππ∑∫ÿ√’:  ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢; ÚııÚ.

˜. ™ÿ≈’°√ ‡À≈à“«™‘√– ÿ«√√≥. §à“„™â®à“¬·≈–°“√„™â¬“„π»Ÿπ¬åÀ—«„® ‘√‘°‘μ‘Ï

¿“§μ–«—πÕÕ°‡©’¬ß‡Àπ◊Õ ¡À“«‘∑¬“≈—¬¢Õπ·°àπ √“¬ß“π°“√»÷°…“

Õ‘ √– À≈—° Ÿμ√«‘∑¬“»“ μ√¡À“∫—≥±‘μ  “¢“«‘™“°“√®—¥°“√

º≈‘μ¿—≥±å ÿ¢¿“æ ¡À“«‘∑¬“≈—¬¢Õπ·°àπ; ÚıÙ˜.

¯. √—μπ“ æ—π∏åæ“π‘™.  ÿ«—≤πå ®√‘¬“‡≈‘»»—°¥‘Ï, ‡æÁ≠ª√–¿“ »‘«‘‚√®πå,

·≈–§≥– Õ—μ√“°“√„™â¬“ªØ‘™’«π–‡æ◊ËÕ√—°…“‚√§μ‘¥‡™◊ÈÕ∑“߇¥‘π À“¬„® à«π∫π„π√–∫∫ª√–°—π ÿ¢¿“æ¢Õߪ√–‡∑»‰∑¬. «“√ “√

«‘™“°“√ “∏“√≥ ÿ¢ ÚıÙˆ;ÒÚ:ıÚÚ-˘.

˘. «√π—¥¥“ »√’ ÿæ√√≥, ®ÿÓ¿√≥å ≈‘¡«—≤π“ππ∑å,  ÿæ≈ ≈‘¡«—≤π“ππ∑å,

‰æ∑‘æ¬å ‡À≈◊Õ߇√◊Õß√Õß, «‘‚√®πå μ—È߇®√‘≠‡ ∂’¬√. ·π«‚πâ¡°“√„™â¬“

μ“¡π‚¬∫“¬∫—≠™’¬“À≈—°·Ààß™“μ‘¢Õß‚√ß欓∫“≈„πªí®®ÿ∫—π.

«“√ “√«‘™“°“√ “∏“√≥ ÿ¢ ÚıÙ˜;ÒÛ:Û˜-Ùˆ.

Ò.  ÿæ≈ ≈‘¡«—≤π“ππ∑å, ®ÿÓ¿√≥å ≈‘¡«—≤π“ππ∑å, »ÿ¿ ‘∑∏‘Ï æ√√≥“√ÿ‚≥∑—¬.

§à“„™â®à“¬·≈–°“√„™â¬“¢ÕߺŸâªÉ«¬∑’Ë√—∫°“√√—°…“®“°‚√ß欓∫“≈: º≈

°√–∑∫¢Õßπ‚¬∫“¬À≈—°ª√–°—π ÿ¢¿“æ∂â«πÀπâ“ √“¬ß“π°“√«‘®—¬.

ππ∑∫ÿ√’:  ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ·≈–»Ÿπ¬å«‘®—¬·≈–μ‘¥μ“¡

§«“¡‡ªìπ∏√√¡∑“ß ÿ¢¿“æ ¡À“«‘∑¬“≈—¬π‡√»«√; ÚıÙ˜.

ÒÒ.  ÿæ≈ ≈‘¡«—≤π“ππ∑å, ®ÿÓ¿√≥å ≈‘¡«—≤π“ππ∑å, »ÿ¿ ‘∑∏‘Ï æ√√≥“√ÿ‚≥∑—¬.

¢âÕ¡Ÿ≈Õ‘‡≈Á°∑√Õπ‘° å‡æ◊ËÕ«‘‡§√“–Àå°“√„™â¬“¢Õß‚√ß欓∫“≈: ‡§√◊ËÕß

¡◊Õª√–‡¡‘ππ‚¬∫“¬À≈—°ª√–°—π ÿ¢¿“æ∂â«πÀπâ“. «“√ “√«‘™“°“√

 “∏“√≥ ÿ¢ ÚıÙˆ;ÒÚ:Òˆ˘-¯Ù.

ÒÚ. Mongan JJ, Ferris TG, Lee Thomas H. Options for slowing the growth of health care costs. N Engl J Med 2008;358:1509-14.

ÒÛ. Cunningham PJ. Medicaid cost containment and access to pre- scription drugs. Health Affairs 2005;24:780-9.