Unit Cost for Primary Care: A Case Study at Primary Care Unit with Joint Costs between Municipality, Regional Hospital and University

OBJECTIVE: To study unit cost and cost recovery at primary care unit (Panpee and Naresuan PCUs) in fiscal year 2005.METHOD: This was descriptive retrospective research. Research tools included financial records of cost components including capital costs, labor costs and material costs. The top-down costing method was used and the costs were grouped based on primary care activities and divided into direct costs and indirect costs. A direct distribution method was used for allocating indirect cost and a straight-line method was used for cost depreciation. For each activity, the full cost was divided by the number of service to determine the unit cost.RESULTS: The unit costs at Panpee and Naresuan primary care units were as fellows: 134.6 baht and 143.2 baht for treatment, 415.2 baht and 117.4 baht for maternal and child care, 415.2 baht and 234.2 baht for family planning, 16.6 baht and 20.2 baht for school health care, 639.8 baht and 987.4 baht for home health care, and 103.5 baht and 61.7 baht for immunization. The cost recovery for Panpee and Naresuan primary care units were 181.6 % and 228.7%.CONCLUSION: These results should be taken into account for resource allocation and enhancing efficiency in practice for health promotion and prevention.

The Results of Medical Services for Prevention and Care of Diabetes Mellitus Type 2 Patients at Primary Care Unit under Universal Coverage System

OBJECITVE: To study the results of medical services for prevention and care of diabetes mellitus type 2 patients at primary care unit.METHOD: A descriptive study was conducted from October to December, 2005. The main components of the study were budget for screening, drugs for diabetes mellitus treatment, processes of medical services for prevention and care such as screenings, treatments, referral, home visits, and health education and the results composed of fasting blood sugar, comorbidities: cholesterol, body mass index, blood pressure and behavior of diabetes mellitus patients. The data were gathered from routine reports and questionnaires with twelve providers, and 326 type 2 diabetes patients at primary care unit in 3 contracting units for primary care: Watbot, Bangkratum, and Nernmaprang. The subjects were selected by purposive sampling. The data were analyzed by descriptive statistics such as frequency, percentage, average and standard deviation.RESULTS: Expenditure for screening and patient care was 14.4% of the whole budget for prevention and promotion. Drugs such as sulphonylurea and biguanide were inadequate in some primary care units but this problem could be solved. Screening, follow-up, referral, and home visits did not perfectly follow the universal coverage guidelines for diabetes mellitus care. 35.6% patients were well controlled. Only 0.9% of the patients showed appropriate self-care behavior. Diabetes mellitus screening in 66.3% population over 40 years of age was done. However, only 65.9% of the suspected cases were confirmed, that did not meet the criteria.CONCLUSIONS: The medical services for diabetes mellitus prevention and care does not perfectly follow the universal coverage guidelines. It may be due to lack of clarity in resource allocation and standard medical services guidelines for prevention and care of diabetes mellitus.