Abstract
This research aims to provide policy recommendations for promoting and
developing the medical food access system in Thailand over a 10-year period, based on
strategic foresight, to ensure public health security and achieve financial and institutional
sustainability, which are the ultimate goals.
The outputs of the research include: (1) operational guidelines for promoting access
to Foods for Special Medical Purposes (FSMP) products in the country, derived from
lessons learned in FSMP management both domestically and internationally, through a
review of related documents and a scoping review; (2) consensus among medical experts
using the Modified Delphi Technique, gathered through expert think tank meetings, to
establish a consistent summary of the terminology, definitions, and types of FSMP in
Thailand, specific to the disorder or disease under the indications and conditions of the
patient according to the clinical guidelines of physicians, as an input for revising the benefit
packages of the National Health Security Office (NHSO). This includes the use of the term
“Foods for Special Medical Purposes”, corresponding to the English term “Foods for
Special Medical Purposes”; (3) the development of Thailand's Access to FSMP
Framework, adopted from the World Health Organization's Six Building Blocks Health
System Framework; (4) an analysis of key drivers, which are important leverage points in
promoting access to medical food according to the STEEPV framework, which consists of
social, technological, economic, environmental, legal and policy, and values dimensions,
particularly for patients with rare diseases such as inborn errors of metabolism (IEM),
preterm infants, allergic to cow's milk patients, individuals with digestion problems, and
those experiencing malabsorption; (5) the preparation of a strategic roadmap for projecting
strategic goals, derived from analyzing the impact of key drivers over a period of 3, 5, and
10 years; (6) a synthesis of policy recommendations for promoting access to FSMP
(strategic foresight) over a 10-year period.
The drive to expand the results of this research into practical application includes
various parties bringing policy recommendations from the research findings to develop
management systems that increase patient access to medical food. This includes: (1)
reviewing laws and regulations related to the terminology, definitions, and types of FSMP,
through the specialized subcommittee under the Food and Drug Administration (FDA); (2)
establishing a central agency responsible for the effective management of the metabolic
milk supply chain; (3) the NHSO board reviewing the benefit package to ensure coverage
of supplements used in the treatment of IEM patients, semi-elemental diet and elemental
diet used in the treatment of premature infants, allergic to cow's milk patients, individuals
with digestion problems, and those experiencing malabsorption, according to the clinical
indications and conditions as advised by medical experts, allowing patients to access
essential medical food products as well as other drugs and medical supplies within the
NHSO system; (4) the FDA adjusting the criteria and procedures for registration,
considering existing medical evidence, reviewed by a committee of experts in professional
organizations (not individuals), to reduce the process of conducting new clinical trials,
thereby promoting the registration of entrepreneurs based on safe standards; (5) enabling
Thailand to produce its own medical food for example the Institute of Nutrition, Mahidol
University, to reduce risks related to access to medical food, ensuring stability and
sustainability in both the health and financial dimensions of the country; (6) the government
establishing policies to support the creation of medical food marketing mechanisms,
including tax measures for importing medical food products and promoting investment in
the industrial sector to increase market options and lower product prices; (7) supporting the
establishment of patient groups, for example, setting up a friendship therapy organization
to drive various dimensions beneficial to patients and promoting the establishment of a
“Rare Disease Care Fund” and a “Specific Health Disease Fund” by civil society or in the
form of a public-private partnership; (8) ensuring that people have access to the medical
food necessary to treat diseases and disorders that are safe, effective, and equitable.
