Health Service Utilization of the Patients under the Social Security Scheme, Newly Registered in 2004 at Srinagarind Hospital

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.