Background: The tiered sugar-sweetened beverage (SSB) tax was implemented in Thailand to encourage industries to reduce sugar content in beverages, and consequently reduce sugar consumption in the population. The aim of the study is to explore the expected impact of the new SSB tax policy in Thailand, a middle-income country in Asia, and other alternative policies on oral health outcomes as measured by the prevalence and severity of dental caries among the Thai population. Methods: A qualitative system dynamics model that captures the complex interrelationships among SSB tax, sugar consumption and dental caries, was elicited through participatory stakeholder engagement. Based on the qualitative model, a quantitative system dynamics model was developed to simulate the SSB tax policy and other alternative scenarios in order to evaluate their impact on dental caries among Thai adults from 2010 to 2040. Results: Under the base-case scenario, the dental caries prevalence among the Thai population 15 years and older, is projected to increase from 61.3% in 2010 to 74.9% by 2040. Implementation of SSB tax policy is expected to decrease the prevalence of dental caries by only 1% by 2040, whereas the aggressive policy is projected to decrease prevalence of dental caries by 21% by 2040. Conclusions: In countries where a majority of the sugar consumed is from non-tax sugary food and beverages, especially Asian countries where street food culture is ubiquitous and contributes disproportionately to sugar intake, SSB tax alone is unlikely to have meaningful impact on oral health unless it is accompanied with a comprehensive public health policy that aims to reduce total sugar intake from non-SSB sources.

Sugar-sweetened beverage tax (SSB tax) has been proposed in Thailand in an attempt to reduce sugar content in beverages and sugar consumption among the Thai population. However, it is uncertain if the SSB tax will translate into lower sugar consumption and consequently improve dental caries. This paper aims to elicit and represent the complex dynamic relationships between SSB tax, sugar consumption, and dental caries in Thailand. A group model building approach, based on the systems modelling methodology of system thinking, was used to engage stakeholders to develop a causal loop diagram (causal map) to elucidate the dynamic interrelationships of SSB tax on sugar consumption and dental caries. The causal loop diagram identified seven balancing feedback loops and one reinforcing feedback loop. The balancing loops operate to reduce the prevalence of dental caries and the impact of SSB tax on SSB consumption, while the reinforcing loop operates to maintain the share of SSB consumption among the Thai population. The main insight from this study suggests that implementing SSB tax alone will not achieve the desired oral health outcomes, without combining it with other non-tariff interventions-such as oral health education and improved access to oral health services.

Purpose The purpose of this paper is to estimate the changes of dental caries status among Thai adults and elderly under the different policy options using system dynamics modeling. Design/methodology/approach A multi-sector system dynamics model was developed to capture the dynamic interrelationship between dental caries status changes and oral health behavior – including self-care, dental care utilization and sugar consumption. Data used to populate the model was obtained from the Thai national oral health survey in 2000, 2006, 2012 and Thailand Official Statistics Registration. Three policy scenarios were experimented in the model: health promotion policy, dental personnel policy and affordable dental care service policy. Findings Dental caries experiences among Thai adults and elderly were projected to increase from now to 2040, as the elderly population increases. Among all policies experimented herein, the combined policies of health promotion, increased affordability and capacity of dental health service were found to produce the highest improvement in dental caries status with 3.7 percent reduction of population with high decayed, missing and filled teeth (DMFT) and 5.2 percent increase in population with very low DMFT. Originality/value This study is the first comprehensive simulation model that attempts to explore the dynamic interrelationship among dental caries experiences and behavioral factors that impact on oral health outcomes. In addition, the simulation model herein offers a framework for policy experimentation that provides policymakers with additional insights to inform health policy planning.

Background System dynamics (SD) modelling can inform policy decisions under Thailand's Universal Health Coverage. We report on this thinking approach to Thailand's strategic health workforce planning for the next 20 years (2018–2037). Methods A series of group model building (GMB) sessions involving 110 participants from multi-sectors of Thailand's health systems was conducted in 2017 and 2018. We facilitated policymakers, administrators, practitioners and other stakeholders to co-create a causal loop diagram (CLD) representing a shared understanding of why the health workforce's demands and supplies in Thailand were mismatched. A stock and flow diagram (SFD) was also co-created for testing the consequences of policy options by simulation modelling. Results The simulation modelling found hospital utilisation created a vicious cycle of constantly increasing demands for hospital care and a constant shortage of healthcare providers. Moreover, hospital care was not designed for effectively dealing with the future demands of ageing populations and prevalent chronic illness. Hence, shifting emphasis to professions that can provide primary care, intermediate care, long-term care, palliative care, and end-of-life care can be more effective. Conclusions Our SD modelling confirmed that shifting the care models to address the changing health demands can be a high-leverage policy of health workforce planning, although very difficult to implement in the short term. of health workforce planning, although very difficult to implement in the short term.

Background: System dynamics modeling can inform policy decisions of healthcare reforms under Thailand’s Universal Health Coverage. We report on this thinking approach to Thailand’s strategic health workforce planning for the next 20 years.Methods: A series of group model building sessions involving 110 participants from multi-sectors of Thailand’s health systems was conducted in 2017 and 2018. Policymakers, healthcare administrators, and practitioners were facilitated to co-create a causal loop diagram representing a shared understanding of why the demands and supplies of the health workforce in Thailand can be mismatched and a stock and flow diagrams for testing the consequences of policy options.Results: Our simulation modeling found hospital utilizations created a vicious cycle of constantly increasing demands for hospital care, and hence a constant shortage of healthcare providers. Moreover, hospital care was not designed for effectively dealing with the future demands of aging populations and prevalent chronic illness. Hence, shifting emphasis to professions that can provide primary care, intermediate care, long-term care, palliative care, and end-of-life care can be more effective.Conclusions: The system dynamics modeling confirmed that shifting the care models to address the changing health demands can be a high-leverage policy of health workforce planning, although very difficult to implement in the short term.