Õ µ à πµ æ.» æá Ëß πµ æ å π æ» π πµ ÿ Õπ

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1 Õ µ à πµ æ.» À «æ â æá Ëß πµ æ å π æ» π πµ ÿ Õπ àõ» ßæ π π È ªìπ «Àåµâπ ÿπ πµ π ÿ Õß ÕߺŸâ Àâ Õ µ à πµ «æ â πõµàõ ß π π À«à ß Õπ π - ÿπ π 2557 ««âõ Ÿ ªïß ª 2556 π«π 3 ÿà ßæ ÿ π ß滟π å/ Ë«ª â à º ß π πµ «ÿ πµ à µõ π «Õß πµ ÿ à«âõ Ÿ µâπ ÿπ ß ÿπµ µ π π«π πµ ÿ Èߪ» µ «Õ «Ÿ µâõß «Àå âõ Ÿ ⫵ ßæ π ß â ß à ª Õ â«µâπ ÿπ ßµ ß «Õß πµ µà π µâπ ÿπ ßÕâÕ µâπ ÿπ π æ π Õß πæ Õ âõ 20 µâπ ÿπ ßµ ß «µâπ ÿπ à ß πµ ÿ à«π Ë à â«ß π ÿß ßæ Ëߪ âõ 50 Õß µâπ ÿπ à ß ÈßÀ µâπ ÿπ à «ÿ µâπ ÿπ ß ÿπ Ëß à ËÕ Õ ÿ ±å πµ ËÕ Õ µ à Õß ß æ.» à π» π È æ Ë Èπ ªìπ à«π À à øíπ µ πàπ Ëß πõ æ Ë À Á ª À«àß æ π À«àπ Èπ à Ÿß Ë ÿ «µâπ ÿπ«ÿ ÿ Õß å ª Õ Õ à ß â«π Àâµâπ ÿπ«ÿ à«π Ÿß Èπ πµâπ ÿπ ßµ ß æ ÿà πµ ª å ÕÁπ Õπ å Ëß Ÿß «à µâπ ÿπ à ßÕ à ß π ß «π π ÈÕ «ßÀ«À Õ µ Õ à ß â âπ 𠪻 Ÿπ åµ µ à à πµ æ ËÕ À â«âõ Ÿ ߪ å «æ ª ª πå À ÿà æ» Ëß ªìπµâÕß â æ Ÿ «Èß µ æ Ë â ß àß ÿ æ àõߪ ªÑÕß π Õß ÿà π È : Õ µ à πµ ª πå πµ «æ â ÿà æ» 48 π - ÿπ π 2558 Õπ àß Àâ π ÿ æ

2 Õ µ à πµ æ.» À «æ â The 2014 dental fee schedule for the Civil Servant Medical Benefit Scheme Phenkhae Lapying Dentist, Senior professional level Dental Health Bureau, Department of Health Abstract The descriptive study was to analyze itemized dental service costs on public provider viewpoint and develop dental fee schedule of Thai Civil Servant Medical Benefit Scheme to propose to Comptroller General's Department. The study was conducted during March-June Three datasets in fiscal year 2013 collected from community and central/ general hospitals were dental service quantity, material disbursement and dental personnelûs remuneration and welfare. Investment cost of standard service and national dental personnel numbers were also used. The data was verified then analyzed using descriptive statistics. The fee structure composed of itemized total direct cost, indirect cost and 20% added for future development cost. The total direct cost was summed of 50% labour cost which paid from hospital revenue, material expenditure, and depreciation costs of building and durable dental equipment. Comparing to the 2006 fee schedule of the Comptroller General Department, most service fees were higher. Orthodontic treatment with fixed appliance which proposed for cleft children had the highest fee. Collection of all components of material cost causes of its higher proportion of the direct cost structure, especially prosthetic and endodontic groups. Therefore provincial and/or regional joint procurement should be intensively extended. National monitoring center should be established to monitor service claims and provide empirical information for effective management. In addition, benefit for special need group should be revised according to their needs of intergrated specific services including some measures to increase promotion and prevention accessibility. Keywords: fee schedule, dental service, dental benefit, Civil Servant Medical Benefit Scheme, special needs group THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH April - June

3 π à à µõ π πµ 𠪻 àß â ªìπ 2 Õ À à À «ª (per capita) π ß πà ª π ÿ æ Ààß µ ( ª.) ß ª à«ßàπâ Àâ πæ πµ ઠÀ ª π ÿ æ â«πàπâ «Õ Ÿà πß ª ºŸâªÉ«πÕ (outpatient budget) ß ª àß ÿ æ ªÑÕß π (promotion and prevention budget) àøíπ ß ª à â à Ÿß (high cost care) ß ª π Ÿª ß æ àπ ß È «ß æ ËÕ Á ª À«àß æ π À«à (cleft lip and cleft palate) â«ºà µ øóôπøÿ æ Õ à ß Ÿ Ëß Ë π π µ Èß µà ªïß ª à«π ß π ß πª π ß à à µ π (fee-for-service: FFS) ÿà â â πæ ß à µà π π Õ µ «(FFS with fixed fee schedule) à«π ª πå πµ π ª π ß 3 π Õ Õπøíπ Õÿ øíπ Ÿ À π πè Èߪ ºŸâª πµπ â â Èß π Õ π ß π π π ß πª π ß â à π 300 µàõ Èß ªï à π 600 (FFS with ceiling) à«à (copay) à à«π π 2 À ª π Ë àµâõß â «Ë À Õ à «Ê Õ â Õ πà Õ à µ ˺Ÿâ Àâ Á (FFS) π FFS with fixed fee schedule Õ µ à (fee schedule) π ªìπ Õâ ßÕ ß (reference price) ªìπ «π Èß ºŸâ ÈÕ (purchaser) âõ µ π È π à à πæ ºŸâ â ß â ªìπ âõ Ÿ ª Õ µ π π Õ â æ µâõß à«π π Õ µ Ë Àπ À ÕµâÕß à«à πõ µ Ë Àπ 𠪻 Ë ÀâÕ π µà µ ª Õß (county) À Õ» (municipality) Àπ Õ µ à Õß â«à â âõ Ÿ µâπ ÿπ ªìπ π àπ «π µà fee schedule «À À Èπ ÈπµÕπ «π π 3 À πª»æ π ªìπ Õ π À ª πµâõß à à π«π Õß àõ À Õß â 4-7 «π Àπ Õ µ à «π ª π ÿ æ ªìπ µàõ Õß À«à ßµ «π«æ ºŸâ Àâ ºŸâ ÈÕ Ëß Õ ªìπ â«π Õ π À Õ Õ π â«π µâõß ªìπ Ë À æ ËÕ Àâ Èß ÕßΩÉ «ÈߺŸâ â Õ â«ªìπºÿâ ÈÕ À ÿà âõ Õ àπ ºŸâ âπâõ ÿà Õ «Èß Á ºŸâ ŸßÕ ÿ ºŸâæ Ëß ªí À â ß à«πºÿâ ß π â Õß ª π Õ π ËÕºŸâ ÈÕ à à µõ π πõ µ Ë πµ æ å Õ àõ Ÿß Àâ æ Ë â ß Õß ª π â 4-5, 8 50 π - ÿπ π 2558 Õπ àß Àâ π ÿ æ

4 Õ µ à πµ æ.» À «æ â À ª» Õ µ à ÿ π πæ æ.».2549 ªìπ à ÿ ÈßÀ 16 À «à πµ Õ Ÿà πà «13 πµ ª åõ Ÿà πà «2 à Õ««Õÿª å π 9 Ëß ß âª ª ÿß â ª Õ µ π À «Ë 2 âõ 9.2 æ Ë µ ËÕ Æ Õ» âõ Ÿ Ë «ß ÿ â Àπ Õ µ à Õß πæ π ß æ.» ªìπ π π π«11-12 µà ß ß à «à â ߺ µøíπ À ÕÕÿª å æ ÿ À Õ à ª πµ (dental laboratory fee) Ë πæ µâõß à Àâ Õ π πªïß ª 2556 À «æ â µ Àâ ß π π ª ª ÿßõ µ à π È Àâ «À µâπ ÿπ Ë ª Ë π ªµ µ π π ß æ å ÿ æ ËÕ â Õß πæ µ «ÿ à â à â π π πæ à ˺Ÿâ â µâõß à«à Õ π àߺ Àâ â â ß Ë ÿ æ µ π 13 ß à æ â Ë æ Ë Èππ È â«π«π ß π ˪ À â µ «ÿ æ ËÕ «ÿ «ß ß π ß ª à æ Àâ à π ªïß ª 2556 Õ À Àâ π ß π «æ ËÕ æ π À ª π ÿ æ ªìπ Àπà«ß π ß π âõ πõµàõ ß æ ËÕª ª ÿß ª πå Õ µ à ÿ Õß «æ â µ Èß ß π ª ÿ ºŸâ Ë «Àπ À Àâ â à«π â à µâπ ÿπ à ß æ ß âõ 50 Õß à ß ÈßÀ µâπ ÿπ ßÕâÕ (indirect cost: IC) à âõ 25 Õßµâπ ÿπ ßµ ß «(total direct cost: TDC) âπ ÿπ π æ π (future development cost: FDC) Ëß à π Õ π à âõ 20 Õßµâπ ÿπ ÈßÀ (Full cost: FC) 14 â π πµ ª ÿ à«à«à ß πµ æ å π À ÿ π πµ ÿ π πµ ßæ «ß滟π å/ Ë«ª ( ßæ ÿ ª ß ª πÿ Àå ÿ æ µ ) ßæ ÿ π ( Ÿß π π æ ÿ å «ππ å) ßæ» π«π 3 Èß æ ËÕ Àπ π«à Àπ π πµ ª ª ÿß À µ «æ ËÕ ªìπ Õ π «Àåµâπ ÿπ Õ µ à µàõ ª π«à π æ Àπ π â à 1. ªìπ ªìπ π ÿ Ë«ª à «àß ÿ æ ªÑÕß π π àõߪ 2. ªìπ Ë ªìπ πºÿâ «Ë ß Ÿß àπ ºŸâæ ß µ ªí ºŸâ â ß ºŸâ Ÿ Àπâ µ À Ëß ªìπµâÕß â àß ÿ æ THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH April - June

5 ªÑÕß π π àõߪ À Õ øóôπøÿ æ ªìπ æ æ ËÕ Àâ π π ª «π â â ß πª µ 3. ªìπ µ µ π π Õß«æ â«èπµõπ«µ π «ÿ µ ÈÕ Ëß «âõ 4. ß ª πå À ª π ÿ æ â«πàπâ πªí ÿ π 5. à â ß Õ π π º µ øíπ Õÿª å æ ÿ ( à ª πµ ) ÕÕ à À µ π ª πõ æ Ë πà «à Õ««Õÿª å (À «Ë 2) 6. à Õÿª å Á Ÿª Ë â µ Ÿ Àπâ àπ ºàπ (plate) Ÿ (screw) ºàπ ËÕ (membrane) ÕÕ à À µ πõ æ Ë µ πà «à Õ««Õÿª å (À «Ë 2) 7. à «à æ ß ÿ π æ ß Õ Ÿà πà «Ë 8 à µ ««π ß ß «9 À ß à «âõ πõª ª ÿß ª πå πµ ßµ ß. πõ Õ µ «À ÕßÀ «13 âõ 13.5 æ Ë π Ë ªìπ π ÿà æ» (special needs group) πõ â À µ ÿà πµ ª å À «2 âõ 9.2 ª «â πà «13 æ Ë À «à ª πµ πà «2 âõ 9.2 æ ËÕ Àâµ ß ËÕÀ «π æ «æ Ë µ µ π «æ µ Ë ªìπ π à «µ ÿª ß å» æ ËÕ«Àåµâπ ÿπ πµ Õ µ à π «æ â ªìπ» ßæ π «ßπ È «Àåµâπ ÿπ ÈßÀ (full cost) Õß πµ (itemized service) âõ Ÿ ªïß ª 2556 Õß ßæ ÿ π ß滟π å/ Ë«ª 19 Ààß â à º ß π πµ Ÿ à «ÿ πµ à µõ π «Õß πµ ÿ â Õ âõ Ÿ Õ Õπ Ëß æ π Èπ æ» π È à«âõ Ÿ ª» â à µâπ ÿπ ß ÿπµ µ π π«π πµ ÿ Èߪ» µ «Õ «Ÿ µâõß «Àå âõ Ÿ ⫵ ßæ π â à à Ë µ âõ π π À«à ß Õπ π - ÿπ π 2557 à πµ (dental fee) ª Õ â«fc «FDC ( âõ 20 Õß FC) 14 ª Àâµ «À Àπ૪ìπ 0 À Õ 5 π à ªìπ ÿà»» µ å àõß ª πµ Ÿ ÕÁπ Õπµå ª πµå ÿà æ» πµ ª å FC ª Õ â«tdc IC ( âõ 25 Õß TDC) TDC ª Õ â«µâπ ÿπ à ß (Labor cost: LC) µâπ ÿπ«ÿ(material cost: MC) µâπ ÿπ ß ÿπ (Capital cost: CC) ßπ È 52 π - ÿπ π 2558 Õπ àß Àâ π ÿ æ

6 Õ µ à πµ æ.» À «æ â µ ß πõª ª ÿß ª πå πµ Table A The proposition of dental benefit improvement. contents 1. Special need group 1.1 Extend scope and meaning of Category 13 code 13.5 (presented as the statement with underline) çthese items are specific for beneficiaries having maxillofacial crack or fracture, disabilities and handicaps (intellectual, learning, mental, behavior, autism and physical) that effect oral cleansing, cleft lip/ palate, oral tumor/ cancer, diseases occurred after radiotherapy, systemic diseases that deteriorate saliva glands and increase caries riské 1.2 Added items Tooth vitality test Diagnostic cast Orthodontic treatment in cleft children Obturator in cleft adults Maxillofacial prosthesis after 2. Dental prosthetic services Move çclinical feesé from Category 2 code 9.2 to Category 13: Dental services. Add çdental lab feesé in Category 2 code 9.2. Separate çcrown in permanent teethé to be çporcelain fused to metal crowné and çmetal crowné. Add çremovable partial dentureé 3. Restoration Exclude çrestore premolar and molar with bandé 4. Periodontal treatment Add çscaling upper or lower arché Add çgingivectomy or gingivoplastyé 5. Endodontic treatment Add çinternal root repair of perforation defectsé rationales Some congenital anomalies caused disable people have high carious risk and need special treatments. Some systemic diseases increase carious risk. These procedures are needed to 1) perform daily activities normally as other people. 2) improve the benefit being like that of the Universal Health Coverage System. Category 2 mentioned to expense of off-clinical procedures and accessories including dental lab fees but existing fees in code 9.2 are only clinical fees which should be presented in Category 13 instead. Dental lab fees are difference. According to professional service standard. Out of date technology. To add a code to record when patients needed to be treated only one arch. Needed in cases of severe periodontitis or further have denture wearing. Cheaper than root canal treatment. Note: dental service benefit directly presented in Category 13: (Dental services) and Category 2: (Prosthesis & accessories) code 9.2. THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH April - June

7 1) LC ª Õ â«ß π Õπ È È ß à µõ π ß πª µ Àπàß Õ ËπÊ Ë â ß π π πªïß ª 2556 à ß ªìππ (À â«220 «π 7 Ë«ß 60 π ) Ÿ â««ë π πµ µà æ à«π Ë à â«ß π ÿß Õß ßæ à âõ 50 Õßµâπ ÿπ à ß ÈßÀ µ À ß 14 2) MC æ Ÿ à Õß«ÿ Ë â π πµ Õ ªìπ«ÿ Ë â Èß «À Õ âß π âà Èßµ µ π À Õ ªìπ ËÕß Õ Ëß à Ÿ ªìπ ÿ ±å µà âß π âà ªï15 π«µâπ ÿπ ÈÕ µâπ ÿπ æ Ë â«ÿπ Èπµ à«πª» π È π «ÿ ªìπ À ««ÿ Èπ ª Õß ËÕß Õ Õÿª å (hand instruments and equipments) «ÿ π Õøíπ à ª πµ π µà À «ß π ÿà â à àß ÿ æ πµ- ªÑÕß π»» µ å àõߪ πµ Ÿ Õπ Õπ å ª πµå πµ ª å øíπ π«ÿ à «ÿ Èπ ª Õß à«π Õߪ µâõßæ «à «ÿ µà π â π Õ â ß πª à πà Õµà ß πµ ß π àπ æ æåª â««ÿõ πµ (alginate) à«à ªìπ æ æå æ ËÕ øíπ πõ À Õ æ ËÕ â ªìπ Ÿà â«ÿ à π à«πª «ÿõÿ øíπ Èπ π Õß Ÿ ËÕÿ ß Àπ πè Àπ (weight) æ ËÕª ª «ÿ Ë â ßµ ß. µ ß. ß ß â ßµâπ ÿπ«ÿ ÈßÀ «ËÕß Õ Õÿª å π Ëß à«π À ຠµ À â π À Õº À à ß «ß π» π È Àπ Õ ÿ âß π 10 ªï âß π«π 2 Èß æ µ ß. πè Àπ À ª ª «ÿ Èπ ª Õß Ë â Table B. The weight used to estimate material depletion. material weight filling materials: amalgam and tooth-colored materials for 1 surface filling 1.0 for 2 surfaces filling 1.5 for 3 surfaces filling 2.0 for 4 surfaces filling 2.5 final impression material for crown 1.0 for bridge π - ÿπ π 2558 Õπ àß Àâ π ÿ æ

8 Õ µ à πµ æ.» À «æ â µ ß. ß â ßµâπ ÿπ«ÿ Table C. The structure of material cost. services material instrument intra oral extra oral preparation preparation dental lab fee simple extraction, surgery, irrigation, debridement bony impaction, complicate tooth extraction tooth filling endodontic treatment gross scaling, periodontal treatment temporary plate removable partial denture fixed prosthesis post and core orthodontic treatment ËÕ â ⫵âõß àß â ß «Õ à ÈÕ ËÀπà«à ß Õß ßæ µ µ π «ÿ µ ÈÕ ËÕß Õ Õ Ÿ âß π âõ à ß æ ß«π 2 Èß àππ È æ ËÕ Àâ Õ ÿ µâπ ÿπ π ß À ËÕß Õ ª πµå Ë «À «Ÿ À ππè (P10) Àπ Õ ÿ âß π 2 ªï àπ «â À «Õ Á«(aeroter) à«π â À «Õ â (contra angle) â À «Õµ ß (straight handpiece) ÿ Õ µàßøíπª Õ (micromotor) Àπ Õ ÿ âß π 5 ªï âß π«π 2 Èß 3) CC Õ à ËÕ ÕßÕ Ë â π Àâ à «à Ë π ÿ ±å πµ π«à ËÕ â««âπµ ß (straight line method) ÕÀ à ËÕ π«π à πµ Õ Õ ÿ âß π Àπ૪ìπ µàõπ à ËÕ ÕßÕ Ëß Õ ÿ â ß π 25 ªï à 10,000 µàõµ ß µ 16 π πµ 1 Ÿπ µ âæ Èπ ˪ 16 µ ß µ (4 µ x 4 µ ) À ÿ ±å πµ π ªìπ 2 ÿà Õ ÿ ±å ß â à Ÿπ µ øíπ (master dental unit) ËÕßπ Ëß «π à ÈÕ µ Èß µä (autoclave) ÿ ±å æ â à ËÕߪíòπ Õ (amalgamator) ËÕß ß π Õÿ øíπ à«π ËÕß Ÿ À ππè Õ ÿ âß π 7 ªï16 ªï 220 «π «π 15 Èß ªìπ à ËÕ π«π à πµ Õ Õ ÿ âß π Àπ૪ìπ µàõ Èß Õ «π «Àåµâπ ÿπ Õ µ à πµ π È ÿª â ß æ Ë 1 º» π π«µâπ ÿπ à ß æ THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH April - June

9 æ Ë 1 Õ «Àå à πµ Figure 1 Conceptual frame work of dental fee analysis Dental service fee Total direct cost (TDC) Full cost (FC) Future development cost (FDC) = 20% FC Indirect cost (IC) = 25% TDC 50% LC MC CC MC dentist assisstant dental materials instruments non drug supplies dental clinic area core equipments master unit autoclave specific equipments prosthesis lab fee (proposed in Category 2 Code 9.2) πµ æ å ºŸâ à«πµ æ å Ëß «Ÿ â ß Ë ªØ µ ß πºÿâ à«πµ æ å µà π ËÕß â âõ Ÿ æ ß 19 ßæ ß à«ßπè Àπ µ à«π πµ ÿ π ß ß æ»ÿπ å/ ßæ Ë«ª ß æ ÿ π ßµ ß 1 Ëß âõ 50 Õß à ß 9.57 µàõπ à 4.78 /π (µ ß Ë 2) «ÿª ËÕß Õ π πµ π ªìπ ÿà Ë Õ ÿ âß π 10 2 ªï π«ÿ à âß π π πõß «π«à ËÕ µ π«π Èß Õß âß π (µ ß Ë 3) µ ß 4 ß à ËÕ Ëß µ «À æ Èπ ËÕ Õß π πµ à«π ÿ ±å πµ µ π«π «π«π Èß Õß ËÕ Õ µ à Õß ß æ.» ÿà»» µ å àõߪ à æ Ë Èπ ªìπ à«π À à (µ ß Ë 5) ÿà πµ Ÿ à æ Ë Èπ ÿ (µ ß Ë 6) à ÿà ÕÁπ Õπµå à«π À à µâπ ÿπ«ÿ Ÿß «à µâπ ÿπ à ß à ß â à æ æå æ µ (pulpectomy) øíππè π (µ ß Ë 7) π ª πµå À «à ª πµ π ºàπªî (stent) æ ß ºà µ àπ ºàπ Àß Õ ª ßµ «øíπà Õª øíπ 56 π - ÿπ π 2558 Õπ àß Àâ π ÿ æ

10 Õ µ à πµ æ.» À «æ â µ ß Ë 1 π«π πµ æ å ºŸâ à«ß π πµ ß «ß ÿ Table 1 Number of dentists and dental assistants under Ministry of Public Health personnel central/ general community hospital health center all 3 facility types hospital dentist 1,170 (30.36) 2,684 (69.64) 0 3,854 (100.00) assistant 533 (42.23) 669 (53.01) 60 (4.75) 1,262 (100.00) Note: 1) numbers in parentheses are row percents 2) picked up raw data from dental personnel report 17 µ ß 2 à ß πµ ÿ Table 2 Labour costs of dental personnel personnel central/ general community sum of LC 50%LC hospital hospital dentist Baht/ minute assistant Baht/ minute dentist & assistant Baht/ minute Note: labour costs were weighted by row percents from table 1. µ ß Ë 3 µâπ ÿπ«ÿª ËÕß Õ Table 3 Instrument costs services Bath/visit normal tooth extraction or retained root removal without suturing 1.46 surgical tooth or retained root removal 5.66 surgical removal soft tissue impaction/ embedded tooth 6.80 surgical removal bony impaction/ embedded tooth root resection, retrograde, root amputation/ bicuspidization/ hemisection alveolectomy/ alveoloplasty, torectomy, ostectomy marsupialization, oroantral fistula closure, pericoronal gingival excision, biopsy of 4.78 hard/soft oral tissue, debridement and suturing, vestibuloplasty, ridge augmentation, correction of epulis/ fibrous alveolar ridge, intraoral excision/ incision and drainage of cyst/ abscess, tumor excision, sequestrectomy, maxillary sinusotomy (Caldwell luc) THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH April - June

11 µ ß Ë 3 µâπ ÿπ«ÿª ËÕß Õ(µàÕ) Table 3 Instrument costs (continued) services Baht/visit intraoral debridement, curette and dressing 2.23 amalgam filling 1 surface amalgam filling 2-4 surfaces tooth-colored filling gross pulpal debridement in permanent tooth, pulpotomy root canal treatment, apexification/ recalcification, bleaching of discolored non vital tooth, internal root repair of perforation defects pulpectomy full mouth scaling, one arch scaling 0.94 root planing/ curettage, flap operation, osseous surgery, periosurgery, crown lengthening, 2.94 mucogingival surgery acrylic based denture, obturator prosthesis/ definitive 4.41 removable partial denture stainless steel crown in deciduous tooth crown & bridge cast post & core fiber post & core fixed appliance orthodontic treatment, orthodontic treatment with surgery, obturator, 6.50 feeding aid, speech aid µ ß Ë 4 µâπ ÿπ à ËÕ Õ ÿ ±å πµ Table 4 Depreciation costs of building and durable dental equipment items price depreciation cost building (dental clinic area) 10,000 Baht/metre Baht/min master dental unit 600,000 Baht Baht/visit automatic autoclave 80,000 Baht 3.46 Baht/visit amalgamater 10,000 Baht 0.43 Baht/visit light curing machine 30,000 Baht 1.30 Baht/visit ultrasonic scaler 25,000 Baht 1.08 Baht/visit pulp vitality tester 18,000 Baht 0.78 Baht/visit 58 π - ÿπ π 2558 Õπ àß Àâ π ÿ æ

12 Õ µ à πµ æ.» À «æ â µ ß Ë 5 à»» µ å àõߪ ª Õß ß æ.» Table 5 Oral surgery fees compared to 2006 schedule of Comptroller General Department code items unit time (min) Tooth and root tooth extraction tooth complicated tooth extraction with surgical removal tooth Surgical extraction retained root tooth soft tissue impact tooth tooth partial bony impact/ embedded tooth tooth complete bony impact/ embedded tooth tooth ,131 1, Other surgical procedures root resection: anterior teeth tooth root resection: posterior teeth tooth retrograde filling: anterior teeth tooth ,222.41,467 1, retrograde filling: posterior teeth tooth , ,401.61,682 1, root amputation/ bicuspidization/ hemisection tooth Other oral tissues marsupialization site oroantral fistula closure (not included soft tissue graft) site excision of pericoronal gingival tooth biopsy of oral (hard/soft) tissue site debridement and suturing visit alveolectomy/ alveoloplasty for denture wearing site vestibuloplasty site ridge augmentation site ,002 1, correction of epulis, fibrous alveolar ridge site torectomy, ostectomy: upper arch arch torectomy, ostectomy: lower arch arch excision of cyst or abscess <1.5 cm site excision of cyst or abscess >1.5 cm site intraoral excision of tumor <1.5cm site intraoral excision of tumor >1.5cm site intraoral incision and drainage of abscess site extraoral incision and drainage of abscess site sequestrectomy site maxillary sinusotomy (cald well luc) visit ,025 1, Treatment of maxilla, mandible & alveolar fractures intra arch ie. subluxation visit fracture mandible: closed reduction visit ,010 1, fracture maxilla: closed reduction visit ,010 1, alveolar fracture: closed reduction arch Correction or repair procedures frenectomy, frenoplasty site sialolithotomy visit % LC MC CC TDC FC Operation Proposed Fee* Fee* 2006 Fee* THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH April - June

13 µ ß Ë 5 à»» µ å àõߪ ª Õß ß æ.». 2549(µàÕ) Table 5 Oral surgery fees compared to 2006 schedule of Comptroller General Department (continued) code items unit time (min) Miscellaneous procedures intraoral irrigation visit topical medication of dry socket visit curettage visit wound dressing with coe-pack: without splint visit wound dressing with coe-pack: with splint visit stop disorder bleed with avogel, gel foam visit surgical stent: upper/lower arch *not included expenses of plates, screws, splint and dantal lab fee 50% LC MC CC TDC FC Operation Proposed Fee Fee* 2006 Fee* (mucogingival surgery: coronally or apically positioned flap procedure (CPFP, APFP)) Ë à ß(µ ß Ë 8) πõß «π π ÿà æ» À «à ª πµ â«æ «à æ ß 3 Ë à ß Õ ÈÕ àß à«π âß π«øíπ (off arch bar) ÈÕ «µ ß (removal suspension wire) ÈÕ ºàπ Ÿ/ «(plate and screw/wire removal) À ß Á Èπ Àπâ µ À (µ ß Ë 9) ËÕ «à ª πµ ÿà πµ ª å Õ ÈßÀ µâπ ÿπ«ÿ Ÿß «à µâπ ÿπ à ß à Ë ß Õ øíπ Õ â πõ 1-5 Ë Õ øíππè π Ëß à à ª πµ (µ ß Ë 10) Õ ª º» π È ªìπ à«πàπ Ëß Õß æ π âõ πõµàõ ß π æ ª ª ÿß ª πå æ À â âõ Ÿ ªïß ª 2556 â â À «Õ µ à πµ- æ.» µà «µ µà ß π 3 ª Õ ««µâπ ÿπ«ÿ πµ- ÿ Õß åª Õ Õ à ß π à À µ πµ ª å à ª πµ π º µøíπ Õÿª å π àõß ª ÕÕ π à «à à æ ß π πõ àõߪ «Àåµâπ ÿπ πµ π µà Õ «âº µà ß π Èπ Õ ««À àß âõ Ÿ Ë â» Ëß π«π à «Àåµâπ ÿπ Ë Èß π πµ µàõ Èß (unit cost) À Õ ÿà 21 ªí À À Õß «Àå µâπ ÿπ π πª» Õ ß æ πâõ Ààß Ë Á âõ Ÿ â â«π» π È ß à«ßπè Àπ âõ Ÿ à ß 19 ß æ Àâ ªìπ âõ Ÿ ª» æ ËÕ Àâ â à â ß «ªìπ ß Ë ÿ µ «Õ âõ Ÿ à ß 19 ßæ æ «à 60 π - ÿπ π 2558 Õπ àß Àâ π ÿ æ

14 Õ µ à πµ æ.» À «æ â µ ß Ë 6 à πµ Ÿ ª Õß ß æ.» Table 6 Restoration fees compared to 2006 schedule of Comptroller General Department code items unit time (min) temporary stop/ pulp capping tooth amalgam filling 1 surface tooth amalgam filling 2 surfaces tooth amalgam filling 3 surfaces tooth amalgam filling 4 surfaces, overlay tooth tooth colored filling 1 surface tooth tooth colored filling 2 surfaces tooth tooth colored filling 3 surfaces tooth tooth colored filling 4 surfaces, onlay tooth % LC MC CC TDC FC Operation Proposed Fee Fee µ ß Ë 7 Õ µ à ÕÁπ Õπµå ª Õß ß æ.» Table 7 Endodontic service fees scompared to 2006 schedule of Comptroller General Department code items unit time (min) pulpal debridement tooth pulpotomy: deciduous teeth tooth pulpotomy: permanent teeth tooth , ,209 1, pulpectomy: anterior deciduous teeth tooth pulpectomy: posterior deciduous teeth tooth root canal treatment: anterior teeth tooth , , ,896 1, root canal treatment: premolar (1-3 roots) tooth , , ,640 2, root canal treatment: molar (1-4 roots) tooth , , , , ,398 3, apexification/ recalcification visit ,179 1, bleaching of discolored tooth after RCT visit added item internal root repair of perforation defects tooth , ,282 1,280-50% LC MC CC TDC FC Operation Proposed Fee Fee µ ß Ë 8 à ª πµå ª Õß ß æ.» Table 8 Peridontal service fees compared to 2006 schedule of Comptroller General Department code items unit time (min) full mouth scaling FM root planing/ curettage quadrant flap operation site % LC MC CC TDC FC Operation Proposed Fee Fee 2006 Fee 2006 Fee 2006 Fee THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH April - June

15 µ ß Ë 8 à ª πµå ª Õß ß æ.» (µàõ) Table 8 Peridontal service fee compared to 2006 schedule of Comptroller General Department (continued) code items unit time (min) osseous surgery site crown lengthening tooth mucogingival surgery (periodontitis): CPFP, APFP site mucogingival surgery (periodontitis): FGG with stent site * 1,290* mucogingival surgery (periodontitis): GTR site ,161 1, periodontal splint site occlusal adjustment: limited visit occlusal adjustment: complete visit treatment hypersensitive tooth with topical substance tooth periodontal dressing visit added items 1) gingivectomy or gingivoplasty tooth ) upper or lower arch scaling arch ** - * not included dental lab fee making a stent which should be in Category 2 code 9.2 **actual reimburse fee should not higher than a half of full mouth scaling fee to prevent intentional scaling only one arch. 50% LC MC CC TDC FC Operation Proposed Fee Fee µ ß Ë 9 à ÿà æ» ª Õß ß æ.» Table 9 Special need services fees compared to 2006 schedule of Comptroller General Department code items unit time (min) 50% LC MC CC TDC FC Operation Fee* feeding aid piece , , , speech aid* piece , full mouth topical fluoride visit tooth reimplantation and/or stabilization tooth of accidentally avulsed or displaced tooth (splinting composite wire/ arch bar) off arch bar visit removal suspension wire visit plate and screw/wire removal visit obtulator prosthesis: surgical* piece obtulator prosthesis: definitive* piece , , , , , added items 1) dental pulp vitality tests visit ) dental diagnostic casts visit ) tooth transplantation tooth ) obtulator prosthesis, definitive with CD piece , , , ,604 1,500 5,600 - (adult) Lab Fee Proposed Fee* 2006 Fee 2006 Fee* 62 π - ÿπ π 2558 Õπ àß Àâ π ÿ æ

16 Õ µ à πµ æ.» À «æ â µ ß Ë 9 à ÿà æ» ª Õß ß æ.» (µàõ) Table 9 Special need services fee compared to 2006 schedule of Comptroller General Department (continued) code items unit time (min) µ ß Ë 10 Õ µ à πµ ª å ª Õß ß æ.» Table 10 Prosthesis fees Compared to 2006 schedule of Comptroller General Department fee code 5) obtulator prosthesis: definitive with PDe (adult) piece 370 1, , , ,025 1,150 3,025-6) fixed appliance orthodontic tx.: cleft children* person 435 2, , , , , ,440-7) removable appliance orthodontic tx.: cleft person , , ,370 - children** * not included expenses of plate, screw, splint, dantal fee lab making stent, and orthodontic accessory which should be in Category 2 code 9.2. ** not included dental lab and expenses of plate and screw items Unit time (min) 9.2 Dentures 9202 acrylic based complete denture: upper or lower piece , ,491 1,700 3,190 2, acrylic based complete denture: upper &lower set , ,662.42, ,494 3,200 5,690 4, temporary plate 1-5 teeth piece ,100 1, temporary plate 6 teeth piece ,150 2,030 1, stainless steel crown tooth metal crown: permanent teeth tooth , ,038.42, , ,860 2,100 porcelain fused to metal crown: permanent teeth tooth , ,038.42, ,058 1,050 4,100 2, bridge piece ,227.11, ,829.23, ,244 3,500 7,740 6, cast post & core tooth ,290 1,000 former items without sub-code repair fix prosthsis tooth repair TP, RPD, CD: add tooth, wire piece tissue conditioner piece reline denture base piece rebase complete denture piece , ,640 - added items 1. removablepartial denture 1-5 teeth piece , ,309 1,750 3, removablepartial denture 6 teeth piece ,069.01, ,604 2,450 4,050 - a) should be established in Category 13 b) should be added in Category 2 code 9.2 c) not included dental lab fee and expenses of plate and screw 50% LC 50% LC MC CC TDC FC Operation Fee* MC CC TDC FC Operation Fee a) Lab Fee Proposed Fee* 2006 Fee* lab Proposed 2006 Fee s) Fee Fee c) THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH April - June

17 à ß ÿ πß π πµ à«π Ë à ß πß ª à à«π Ë à â«ß π ÿß ßæ Õ âõß À ß Ë Àπ Àâ âµâπ ÿπ à ß æ ß Ëß «Õß à ß ÈßÀ À π Õ µ à π È ª â ÈÕ Õ πµâõß âµâπ ÿπ à ß 100% À µâπ ÿπ«ÿ â âõ Ÿ à «ÿµ æ ÿ Õß ÿà ß π πµ ß æ»ÿπ å Ëß π«π Èß æ Èπ π æ ß æ ËÕ Àâ â âõ Ÿ µâπ ÿπ«ÿ Ë ª æ À ßæ º ß π πâõ «ÿ ß À ÕÀ ß πª µâπ ÿπ«ÿª ËÕß Õ ( Ëß «ß π Ÿß) µ ÿ ËÕß Õ µ π π æ ËÕ Àâ â ßµâπ ÿπ ß Ë ÿ ªí À «º π ª Õßµâπ ÿπ ËÕß Õ À àõõ â π «µà ß π» π È ß ªìπ» Õߪ» Ë π«µâπ ÿπ«ÿ πµ Õ à ß â«π ÿ Õß åª Õ µ µ π Ë Õ π â à«πµâπ ÿπ ß ÿπ æ à ËÕ Õ ÿ ±å πµ π Ëß à«ππâõ Ë ÿ π ß â ßµâπ ÿπ ßµ ß «µâπ ÿπ«ÿ Õ ÿ ÿ Õß åª Õ Àâ à«πµâπ ÿπ«ÿ π ß â ßµâπ ÿπ ßµ ß «ª Ë π ª À π µâπ ÿπ«ÿ «à µâπ ÿπ à ß «µâπ ÿπ«ÿª ËÕß Õ (µ ß 5-9) π ÿà πµ ª å ËÕ «à ª πµ àߺ Àâ ß à«πµâπ ÿπ «ÿ Ÿß ß âõ 80 ˵âπ ÿπ à ß à«π æ ß âõ 19 âõ âπæ π ȵà ß» Õ ËπÊ Ë ÿª«à πµ à«π µâπ ÿπ à ß Ÿß Ë ÿ 18-19, 21 Õ µ à ÿà πµ ª å Õß ß à â «à ª πµ ß ª à â à π π ËÕß ÿà πµ ª å à Ÿß ß «Àπ ß ËÕπ π Õ ÿ âß π Õß Èπøíπ ªìπ â ß «º Õ à«π À«à ߺŸâ Àâ ºŸâ â æ ËÕ «ÿâ à Õß «ÿ à â à â Õ ÿ ÿà Ë ªìπµâÕß â Õÿ øíπ 2 3 â π µâπ ÿπ â ß π µà Õÿ 4 â π Èπ ª µâπ ÿπ Ÿß «à ß «à Õÿ øíπ ªìπ 3 Õ µ â à 1 â π 2-3 â π 4 â π Èπ ª π Ë ªìπ 2 Õ µ ß πªí ÿ π ÿà æ» (À «13.5) ªìπ ÿà Ë «Ë ß ŸßµàÕ π àõߪ Õ Èß «º ª µ º µàõ π π «µ ÿ æ «µ â à ß æ Ë ªìπ π ËÕß Á ª À«àß æ π À«à «º ª µ «Àπâ Àâ Èπ ßµ «ÈßøíππÈ π øíπ ⺠ª µ ª â«øíπ Ëß æ Ë ÿ æ «µºÿâ ÿ æª µ π Èπ 22 ªìπÕ à ß ËßµàÕæ π Õß Á ÿà π È æ ËÕ Àâ ß «µ â â ߪ µ µà ««à ßµâÕß â ««à â º æ å âõ «à øíπ π Á ª µ 23 Õ â à πõ µ «À ª π ÿ æ â«πàπâ Ëß ß ª À øíπ Á ª À«àß æ π À«àµ Èß µà π Á Ÿ å π 48, π - ÿπ π 2558 Õπ àß Àâ π ÿ æ

18 Õ µ à πµ æ.» À «æ â µ Èß µàªïß ª ÿªº» à π» π È æ Ë Èπ ªìπ à«π À à ËÕ Õ µ à æ.» π ÿà»» µ å àõߪ π«π 43 â ß º π àõߪ à πâõ Ë ÿ πâõ «à à«π ºà µ Õÿ ª øíπ À ß à Ÿß Ë ÿ ÿà πµ Ÿ à æ Ë Èπ ÿ æ Õ à ß Ëß Õÿ øíπµ Èß µà 4 â π π ÿà ÕÁπ Õπµå à ß π æ æå æ µ øíππè π π ÿà ª πµå«ºà µ àπ ºàπ Àß Õ ªìπ «Ë à ß À ÿà πµ ª å ËÕ «à ª πµ à ß π øíπ Õ â π Õ 1-5 Ë Õ øíππè π π ÿà æ ÿà æ» π Èπ À «à ª πµ æ «à à ß æ ß 3 Õ ÈÕ àß à«π âß π«øíπ ÈÕ «µ ß ÈÕ ºàπ Ÿ «à«π øíπ µ πàπ à Ÿß Ë ÿ Õ 16,440 / π âõ πõ π ßπ «µâπ ÿπ«ÿ ÿ Õß åª Õ Àâ ß â ßµâπ ÿπ ßµ ß à«πµâπ ÿπ«ÿ Ÿß Èπ æ ÿà πµ ª å à ª πµ ÿà ÕÁπ Õπ å π Ë ª Ë π ª π π å Ë π â «ÿ πµ À À ÿ æ «ÈÕ à«ßà«à Õ µ Ëß πõ æ Ë ª æ Õßß ª â«ß «ÿ ÿ æ π â Èπß πøíπ â â«â π ß ª «æ π µ µ à â æ ËÕ Àâ âõ Ÿ ߪ å π À ª πå ß ª πõ π È ª» âõ µ à «âõπµâπ ÿπ àπ à Õÿ øíπ «àß ªìπ 3 Õ µ «æ ૪. πª Áπ â àß ÿ æ ªÑÕß π Ëß ª. ß ª ºà π Õ à ÿ æ µâπ (CUP) µà ÿà «â Õ Õÿª π â ß à ««Èß «ª ª πå π ÿà Ë «æ Ëß ªìπµâÕß â æ Õ à ß à À ª π ÿ æ â«πàπâ âõ πõ π ß«Àπà«ß π«à«π ß «àß π ππÿπ æ π» æ ßæ π ª ª ÿß âõ Ÿ Ë ªìπ «Àåµâπ ÿπ µ À»» µ å ÿ æ àõߪ æ ËÕ â π À ß ª æ ßæ Õß æ ËÕ ª πå π ª ª ÿßõ µ à πõπ µ µµ ª» Õ Õ ÿ ß Ë ªî Õ Àâ «πõ µ à π ß π «æ ËÕ æ π À ª π ÿ æ π ß» «π à πµ µâ «æ â Õ Õ ÿ æ.» ««ÿ æ. ÿ«πå ÿ ÿà æ.æ «ÿ ß«π THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH April - June

19 æ. π µ ª Õ æ. ÿ π π æ.ª æπ å π æ å æ. ÿ π Ÿ µπ æ.ª å æß»å æ Ÿ å æ.õ π µ ÿ πæ æ. Á» ß ÿ«æ.» ªí ÿ «ß»å æ.æ ß æ µ å æ.π «å Ë ««å æ. π» æ. æ µµ π π πå π ª ÿ ª Ë π «ÀÁπ π «π À µ «πµ Õ Õ ÿ Õ à ß ŸßµàÕ æ.ª å æß»å æ Ÿ å æ.«π π å ÿ ª Ë àߪíπ âõ Ÿ «ÿ πµ Õß ßæ Ëß Á Õ à ß Õ â«π Õ Õâ ßÕ ß 1. π ß πà ª π ÿ æ Ààß µ. À ß ª æ ËÕ ÈÕ ß Ë à â à Ÿß π Ÿà ÕÀ ª π ÿ æ Ààß µ ªïß ª ππ ÿ : Àπâ æá Ëß, Ï æÿ». â ÿ æ àõߪ π à«ß»«õß À ª π ÿ æ â«πàπâ. ««ÿ 2556; 22(6): Olsson E, Stromberg Ulf. Political process and its effect on price: analysis of the effect of price setting process on public dental prices in Sweden. Master degree projection in Economics. University of Gothenburg, School of Business, Economics and Law; Decker S L. Medicaid Payment Levels to Dentists and Access to Dental Care Among Children and Adolescents. JAMA 2011; 306: Widstrom E, Seppala.... T. Willingness and ability to pay for unexpected dental expenses by Finnish adults. BMC Oral Health 2012, 12:35 doi: / [cited 2014 Sep 2]; Available from: URL: biomedcentral.com/ /12/35 6. Ramraj C, Sadeghi L, Lawrence HP, Dempster L, Quinonez, C. Is Accessing Dental Care Becoming More Difficult? Evidence from Canadaûs Middle-Income Population. PloS one 2013, 8: e [cited 2014 Sep 2]; Available from: URL: fetchobject.action?uri=info%3adoi%2f % 2Fjournal.pone &representation =PDF 7. Thompson B, Cooney P, Lawrence H, Ravaghi V, Qui_onez C. The potential oral health impact of cost barriers to dental care: findings from a Canadian population-based study. BMC oral health, 2014,14: 78. [cited 2014 Sep 2]; Available from: URL: /14/78 8. Franchi E, Bumgardner C. Importance of access to and utilization of oral health care in Pennsylvania. The Pennsylvania Association of Community Health Centers (PACHC). [cited 2014 Sep 2]; Available from: URL: 20and%20Utilization%20of%20Oral%20Health%20Care%20in%20Pennsylvania.pdf 9. ß. Õ µ à ÿ æ ËÕ â À à à æ π π Õß ß. Àπ ß Õ à«π Ë ÿ Ë 0417/«177 ß«π Ë 24 惻 π ß. ª ª ÿß â ª Õ µ à Õ««Õÿª å π ( æ Ë µ ). Àπ ß Õ à«π Ë ÿ Ë /«/249 ß«π Ë 15 Æ π - ÿπ π 2558 Õπ àß Àâ π ÿ æ

20 Õ µ à πµ æ.» À «æ â 11. «ß ÿ. Õ µ à Õß π ÿ π ß «ß ÿ ππ ÿ : ßæ æå ÿ πÿ À å µ Ààߪ» ; » ««ÿ. Àπ Õ µ à πµ Õß π ÿ π ß «ß ÿ æ.» ««ÿ 2549; 15(6): ß π ß π«æ ËÕ æ π À ª π ÿ æ. ß âõ πõµàõ ß æ ËÕª ª ÿßõ µ à ÿ æ.» Õß «æ â. 14. π ß π«æ ËÕ æ π À ª π ÿ æ. ÿªº «ÀÁπ æ ËÕ Àπ Õ π«à ª ª ÿßõ µ à ÿ µâ «æ â ªï2556 Èß Ë 1. «π Ë 13 π π 2556 ÀâÕߪ ÿ Õ «æ Èπ 5 π»π Ÿ. 15. æá Ëß. «Àåµâπ ÿπ àõ πàπ૵âπ ÿπ ÿ æ. ππ ÿ : Õ å æ ; π ß πª «ß ÿ. Àπ Õ ÿ âß π π æ å «à ËÕ Õß π ß π ª «ß ÿ. Àπ ß Õ à«π Ë /«68 ß«π Ë 17 ÿ æ π å π πµ ÿ. ß π ÿ â π πµ ÿ ª ªï 2555; æá Ëß, æ, Õ æ æ å. µâπ ÿπ ÿ æ àõߪ Õß ßæ ÿ π ßÀ«ß À à ªïß ª ««ÿ 2552; 18(5): æá Ëß. µâπ ÿπ À «ª Õß ÿ æ àõߪ π À ª π ÿ æ â«πàπâ. «πµ ÿ 2545;7(1): «. µâπ ÿπ µàõ Èß Õß â πµ π ßæ π ßÀ«ß À à. «π æπ å»» µ À ± µ ( » µ å) À «ß À à; ÿ å µµå ÿàß Õß, æá Ëß. µâπ ÿπ ÿ æ àõߪ ÿà ªïß ª «πµ ÿ 2545;7(2): Zhou Y, Wang Y, Wang XY, Voli_re G, Hu RD. The impact of orthodontic treatment on the quality of life a systematic review. BMC Oral Health 2014, 14:66. doi: / [cited 2014 Sep 2]; Available from: URL: Blanck-Lubarsch M, Hohoff A, Wiechmann D, Stamm T. Orthodontic treatment of children/ adolescents with special health care needs: an analysis of treatment length and clinical outcome. BMC Oral Health 2014, 14:67. doi: / [cited 2014 Sep 2]; Available from: URL: biomedcentral.com/ /14/ π ß πà ª π ÿ æ Ààß µ. Õ π â ª» π ß πà ª π ÿ æ Ààß µ À ±å π πß π À Õß ÿπà ª π ÿ æ Ààß µ (À «Ë 2 à«π Ë 4 æ : à â à Ÿß/Õÿ µ Àµÿ Á ªÉ«ÿ π/ æ ) π Ÿà ÕÀ ª π ÿ æ Ààß µ ªïß ª ÿß æ À π ; Àπâ π ß πà ª π ÿ æ Ààß µ. À ß ª À ª π ÿ æ â«πàπâ ªïß ª 2557 (À «2 à«π Ë 3 æ ) π Ÿà ÕÀ ª π ÿ æ Ààß µ ªïß ª ÿß æ À π ; Àπâ H E A L T H THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH April - June