In the present study, patients who were referred from
other hospitals were significantly associated with PUP. No
previous studies have showed this data. Health services in
Thailand are mainly provided by public hospitals run by
the Ministry of Public Health, university hospitals, and the
private sector. Public health services include small health
centers covering 3000–5500 people, 10–60 bed community
hospitals covering 20,000–40,000 people, and 100–400 bed
provincial hospitals covering more than 200,000 people.16
A patient can visit any of these health services and then
be referred to a larger hospital if the condition is serious.
A number of studies concerning referral delays and secondary
care delays in health care system have been previously
reported.17,18 Data from the present study suggest that other
hospital services play a very important role in determining
the duration of system delay.