Stian Thoresen

Universal health care in Thailand: Concerns among the health care workforce

OBJECTIVE To investigate the impact of the universal health care policy from the perspective of Thai health care professionals. METHODS Semi-structured interviews with purposively selected health care professionals and key informants. RESULTS Health care professionals at public hospitals, particularly in rural areas, have experienced up to a doubling in the number of daily out-patients; many with superficial symptoms. While the improved access to health care provisions was welcomed, questions regarding the appropriateness of seeking medical advice were raised. Concern regarding equity: between the universal health care policy and two parallel public health cover schemes; rural and urban areas; and the public and private sector also emerged. There are potentials for health care professionals to congregate in the private sector and urban areas where workloads are perceived to be less demanding. CONCLUSIONS The general perception of the health care professionals interviewed suggests that although increased access and health equity was welcomed, this policy has had undesired effects and exacerbated rural-urban and public-private tensions. Universal coverage increased access to health care. However, equity may be further enhanced by consolidating the three public health covers into a single scheme and develop a parallel private income protection insurance scheme.

Successful approaches to placing and supporting apprentices and trainees with disability in Australia

This paper presents an amalgamation of three sequential research projects conducted by EDGE Employment Solutions over the past decade. The first project, commenced in 1999, was a local initiative to increase the number of apprentices and trainees with disability being supported by EDGE. The completion rate for participants in this project was equivalent to that of people without disability undertaking apprenticeships and traineeships in Australia. However, it was found that Group Training Organisations, who hire apprentices and trainees to then place them with different employers, did not have the necessary skills or resources to place and support people with disability. To fill this gap, the second research project, undertaken in 2002, surveyed all 180 Group Training Organisations operating in Australia. This was followed by a site visit of six GTOs who were most successful in their disability efforts, to discern best practice in placing and supporting apprentices and trainees with disability. The third research project, which built on the findings of the previous two projects, was initiated in 2003 and enlisted 20 Group Training Organisations and 20 Disability Employment Services from around Australia to form partnerships to capitalise on their complementary expertise and resources. Apprenticeship and traineeship completion rates for participants in the third project surpassed those for people without disability in Australia. This paper presents and discusses the successful strategies researched and developed through these three projects.

Health status and use of medications by adults with intellectual disability in Western Australia

ABSTRACT Background Evidence suggests that adults with intellectual disability (ID) are vulnerable to poor health outcomes. This paper describes the health status and medication use of adults with ID in Western Australia. Method We conducted a cross-sectional survey by interview of 328 adults with ID (M age = 37 years, range: 18–82) and their families/support persons (79% proxy or joint informants). Results Although 90% of participants reported long-term health conditions (M = 2.6, range: 0–10), including epilepsy, allergies, eczema, asthma, and mental health problems, three quarters of the participants (77%) described their health as good or very good. Younger participants (18–44 years) reported osteoporosis and stroke, conditions commonly associated with ageing, more often than the general population at those ages. Medication use was high, with 70% taking one or more medications (Mdn = 3 medications, range: 0–21). Conclusions Many participants reported that health problems affected their daily lives, yet the majority reported good health. Long-term health conditions were common and many people used several types of medications. Participants had poorer health than the Western Australian population overall. Careful monitoring of health conditions and regular review of medications are recommended to improve health outcomes for adults with ID.

Examples of individual supported living for adults with intellectual disability.

Background: This article provides a qualitative account of four models of support for adults with intellectual disability in individual supported living (ISL) arrangements. Materials and Methods: Completion of the first 50 evaluations of 150 arrangements for the third phase of the ISL project provided the examples. Results: Four approaches are described: living alone, co-residency, relationship and host family. Within each type, wide variations occur particularly based on security of tenure, formal and informal support and management variations. Conclusion: Fifty evaluations so far illustrated a wide range of approaches to ISL, providing evidence of the critical importance of the formal and informal support environment and reinforcing the contention that ISL is appropriate for people with high support needs.

Factors that affect the perceived health of adults with intellectual disability: A Western Australian study

ABSTRACT Background: Adults with intellectual disability (ID) experience poorer overall health than the wider population. Identification of personal, support service and lifestyle factors affecting health status will provide opportunities to improve health outcomes. Methods: The study was a cross-sectional survey of adults with ID. Interviews were conducted between January and July 2013. Univariate and multivariate analyses were performed using self- or proxy-reported general health as the dependent variable. Results: “Not good” health was independently associated with increasing age, financial hardship, smoking, and living in a home of their own. Physical exercise was inversely associated with not good health. Conclusions: Subjective health may be improved by attention to the factors identified in this study. This could include closer monitoring of the health of people with ID as they age and if they live in a home of their own. Similarly, targeted programs promoting physical activity and smoking reduction could improve general health for adults with ID.

A Snapshot of Intellectual Disabilities in Lao PDR: Challenges for the Development of Services.

Lao People’s Democratic Republic (PDR) has experienced significant economic growth in the last two decades. While access to education, health, and employment for people with disabilities has also improved markedly, people with intellectual disabilities are still among the most vulnerable in society. This article presents findings from a screening survey of 2469 participants, a focus group discussion with key stakeholders in intellectual disabilities, and a case study of the Association for Autism. The screening survey suggests 1.9% of working age participants (18–59) and 0.7% of children (6–17) have intellectual disabilities. The qualitative data illustrate poor understanding and stigmatization of people with intellectual disabilities, lack of services, and development of a parent association to improve the life prospects for children with autism and intellectual disabilities. People with intellectual disabilities in Lao PDR remain particularly vulnerable. Parents and other disability advocates are raising awareness and demonstrating the effectiveness of specialized services.

Pathways to Employment and Quality of Life for Apprenticeship and Traineeship Graduates with Disabilities

People with disabilities have low participation rates in employment and vocational education and training. Thirty adults with disabilities were sampled from an Australian longitudinal study of economic and social outcomes achieved by graduate apprentices and trainees. Participants were surveyed and interviewed to identify pathways from high school to 12-months post-graduation and completed the Quality of Life Questionnaire (QOL.Q). Career pathways incorporated experiences facilitating career development including continuous engagement in vocational activities and support from school personnel and external disability agencies. A year following graduation, 87% were in paid work, 53% remained with the training employer, and 40% continued with vocational education. Positive quality of life (QoL) outcomes were associated with employment, employee benefits and satisfaction with work and social connections. Our research demonstrated that apprenticeships and traineeships led to positive graduate employment outcomes and career pathways for adults with disabilities. Positive employment outcomes were associated with enhanced QoL for participants.