DOES YOUR HEALTHCARE
DEPEND ON HOW YOUR
INSURER PAYS PROVIDER?
VARIATION IN UTILIZATION AND
OUTCOEMS IN THAILAND
Sanita Hirunrassamee, Ph.D.1 and Sauwakon Ratanawijitrasin, Ph.D.2
1
Pharmacy Division,Phramongkutklao Hospital, Thailand.
2 Associate Professor, Faculty of Social Sciences and Humanities, Mahidol University, Thailand.
Close –ended
Group of
Payment
methods
UC
Schemes
General
Type of
diseases
Point of
services
OP
Capitation
Payment
methods
Epilepsy
Lung
cancer
SSS
High-cost
IP
DRG
With
Global
budget
OP
IP
Per item
per year
with
ceilin
g
(03) /
Per item
per visit
with
ceilin
g
(04-05)
DRG
With
Global
budget
General
OP
IP
Capitation
plus an
add-on
payment
relying on
UR
CSMBS
High-cost
OP
IP
Per item
per year
with
ceiling
General
OP
IP
High-cost
OP
IP
Fee-for-service
Outcome: Efficiency & Access to…
Tracer
AUGIB
Open-ended
Drug &
procedure
Drug &
procedure
New drug
Drug &
procedure
New drug
New drug &
procedure
New drug
New drug
&
New drug &
procedure
Hospitals face different
incentives & pressures from
financial mechanisms in a
multiple health insurance
environment.
What happen to access and
efficiency in this environment?
Objective:
To examine resource utilization patterns and health
outcomes under the multiple payment methods,
focusing on assessing
•Access to Medicines
•Access to Medical technologies
•Treatment outcomes (compared to CPGs)
•Efficiency in resource use
among beneficiaries of the 3 government health
insurance schemes in Thailand
Data Source
3 government hospitals
 1 tertiary care facility
 2 secondary care facilities
 FY 2003-2005 data
e-database
– Patient demographic data
– Health insurance benefits
– Items and costs of prescribed drugs and treatment
procedures
…for assessment of access to care …

Paper med. record
– Clinical outcome
…for assessment of efficiency of health care services…
Analysis
Health insurance payment
Access to care
Efficiency :Cost-effectiveness technique
• Costs = hospital costs
•Treatment Outcomes
AUGIB

evaluated at end of treatment
Epilepsy

evaluated at end of year
Lung cancer

evaluated at end of year
Health insurance
payment methods
AUGIB
UC
SSS
DRG
CAP
p value
CSMBS
FFS
Required
drugs
% of patient with PPIs
100.00% 100.00%
99.69%
0.912
H-COST &
H-TECH
EQUIP.
% of patient with
Gastroscope
53.56%
55.56%
68.55%
0.110
CAP+
DRG
CAP
FFS
12.93%
19.12%
30.73%
Per item w
ceiling
Per item w
ceiling
FFS
Epilepsy
New drugs
% of patient with New AEDs
Lung cancer
0.000*
New drugs
% of patient with
New antineoplastic drugs
19.05%
9.68%
66.92%
0.000*
H-COST &
H-TECH
EQUIP.
CT scan or MRI
59.52%
35.48%
74.62%
0.000*
Subgroup analysis
p= 0.00
UC
Efficiency
Health insurance payment methods
p value
UC
SSS
CSMBS
DRG
CAP
FFS
1,742
1,591
4,849
0.026*
Number of cured patient
97%
100%
96%
1.000
Drug cost (baht) per cured patient
1,805
1,591*
5,037
CAP+ DRG
CAP
FFS
Average drug cost (baht) per patient
5,756
9,301
5,957
0.05*
No. patient with SF
79%
64%
90%
0.000*
Drug cost (baht) per patient with SF
7,318
14,417
6,624*
Per item w
ceiling
Per item w
ceiling
FFS
Average drug cost (baht) per case
44,268
54,647
156,283
0.000*
No. success case
40%
23%
61%
0.015*
236,803
255,462
AUGIB
Average drug cost (baht) per patient
Epilepsy
Lung cancer
Drug cost (baht) per success case
110,672*
Price as major condition: limit access to care
Access to
diff
Cost /DDD
Comparator
Type
Con. AEDs
New
Comparator
New AEDs
Sig
49-251
1-31
Phenobarbital valpoic acid
New
antineoplastic
drug
Sig
8767 /1 gm
(Gemtarabine)
1048/50 mg
(doxorubicin)
Con.
antineoplastic
New
PPIs
NS
3-300
1- 37
H2 anatagionist
Required
(cimetidine, ranitidine)
Inj. PPIs
Sig
170-300
3-54
Oral PPIs
Required
Original PPIs
Sig
54-300
3-5
Local -made
Required
Gastroscope
CT scan
MRI
diff
NS
sig
sig
Charge
1500-3000
5000-8000
8000-15000