ABSTRACT
Background: In 2004, most medical-school hospitals in Thailand stopped taking new registrations for the social security scheme because the scheme was predominantly used by persons with severe or chronic diseases. Srinagarind Hospital itself initiated a private clinic network in order to increase admissions eligible for funding under the social security scheme, but also found expenditure is increasing.Objective: To determine the proportion of the utilization of health services of the group that was new for Srinagarind Hospital, but previously registered at other hospitals(nfs group), compare to all new registrants .Design: Descriptive studySetting: Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, ThailandSubjects: Between May 1 and July 31 2004, 113 persons came for treatment at Srinagarind Hospital.Results: We found that the nfs group accounted for 57.4% (95% CI : 48.3, 66.5 )of the number of health visits of all new registrants but 84.2% (95% CI : 77.5, 90.9 ) of the total expenditures. By contrast, the new and never registered anywhere else’ group (nn group) accounted for 43% of the number of health visits of all new registrants but only 16% of the expenditures. Age and sex were not statistically significant factors when comparing the two groups. The nfs/nn ratio was 3.92 (i.e. 6,921.4 vs. 1,763.5 Baht) for the treatment cost per patient and 5.11 (i.e. 21.5 and 4.2%) for the inpatient admission rate.Conclusion: The study confirms an existing of the selection bias by patients with expensive and chronic diseases for healthcare provided by the social security scheme. Further study is needed to get the appropriate risk adjustment figures to make the scheme more efficient.
ABSTRACT
Rationale: Stroke or the disease of cerebral blood vessel, or paralysis is a prevalent disease and a major public health problem of Thailand. Stroke is a chronic disease with prolonged development at all stages that leads to the paralytic state, the state that prevents the patient from doing their daily routine and thus have to rely on the others. This means an additional expense both from treatment at hospital and home care. The study of Neurological Institute in 1995 reported that the average expense of outpatients which involved transportation cost to receive their treatment at the hospital was 1,400 baht per person per day. Such expense has not been studied at Srinagarind Hospital before.Objective: To study the average direct and indirect expenses of the stroke outpatients at Srinagarind Hospital during the first trimester of 2008. Study design: Descriptive researchSetting: The Outpatient Department, Srinagarind Hospital, Faculty of Medicine, Khon Kaen UniversityMethods: 237 new and former stroke outpatients aged over 20 years old who received treatment from January 1 to March 31, 2008. The research tool was questionnaire.Results: The stroke outpatients in the sample group are from 20 to 91 years old, or an average age of 64+12.8 years. The most diagnosis result reveals cerebral infarction (31.6 percent), with a Modified Rankin Score of 1. Concurrent diseases diagnosed include hypertension, Dyslipidemia, and diabetes, respectively. The result shows the direct and indirect expenses of the outpatients’ final visit to the hospital. For the direct expense, the average cost of food is 172.89 baht, the average two-way transportation cost is 517.68 baht, and the average accommodation cost is 625.50 baht. As for the indirect expense, it was found that the outpatients take a two-day leave from work at a maximum, with a loss of an average of 500 baht of income per day. When the outpatients come to the hospital, they are accompanied by 1-3 relatives or an average of 1.16 persons, causing an average reduction of income of 489.15 baht per day. The average total direct and indirect expense becomes 1,959.85 baht per day per one outpatient.Conclusion: The expense of each stroke outpatient at Srinagarind Hospital is as high as 1,959.85 baht per day. Most of these expenses are accommodation, transportation, and a loss of income from work. It is recommended that community servicing be established in order to lessen the expense of stroke outpatients by not having to travel to the hospital.Keywords: expense of stroke and outpatient