Profit, payment and pharmaceutical practices: perspectives from hospitals in Bangkok.

Means by which to improve the quality of care offered in the private sector have received increasing interest. This paper considers the influences upon hospital physician prescribing practices. It presents data on drug management practices and prescribing patterns in a sample of private for-profit, private non-profit and public hospitals in Bangkok. Clear differences emerge in prescription patterns between the different groups of hospitals: public hospitals exhibit greater use of essential drugs and generic prescribing than either group of private hospital, and prescriptions at private for-profit hospitals tended to have more essential drugs and drugs prescribed by generic name than non-profit hospitals. Prescribing patterns in public hospitals are probably largely explained by national government policy on pharmaceutical procurement. In contrast, prescribing patterns in private for-profit hospitals appear heavily influenced by pressure upon management to contain costs, in circumstances where high drug costs cannot be passed on to purchasers. Hence hospital management have developed policies encouraging the use of generic drugs and essential drugs. These same financial pressures also explain some less desirable forms of behaviour in private for-profit hospitals such as prescribing courses of antibiotic treatment of extremely short duration. Possible measures which government may take to encourage appropriate prescribing within private hospitals are discussed.

The social security scheme in Thailand: what lessons can be drawn?

The Social Security Scheme was launched in 1990, covering formal sector private employees for non-work related sickness, maternity and invalidity including cash benefits and funeral grants. The scheme is financed by tripartite contributions from government, employers and employees, each of 1.5% of payroll (total of 4.5%). The scheme decided to pay health care providers, whether public or private, on a flat rate capitation basis to cover both ambulatory and inpatient care. Registration of the insured with a contractor hospital was a necessary consequence of the chosen capitation payment system. The aim of this paper is to review the operation of the scheme, and to explore the implications of capitation payment and registration for utilisation levels and provider behaviour. A key weakness of the scheme's design is suggested to be the initial decision to give employers not employees the responsibility for choosing the registered hospitals. This was done for administrative reasons, but it contributed to low levels of use of the contractor hospitals. In addition, low levels of use were also probably the result of the potential for cream skimming, cost shifting from inpatient to ambulatory care and under-provision of patient care, though since monitoring mechanisms by the Social Security Office were weak, these effects are difficult to detect conclusively. Mechanisms to improve utilisation levels were gradually introduced, such as employee choice of registered hospitals and the formation of sub-contractor networks to improve access to care. A beneficial effect of the capitation payment system was that the Social Security Fund generated substantial reserves and expenditures on sickness benefits were well stabilised. The paper ends by recommending that future policy amendments should be guided by research and empirical findings and that tougher monitoring and enforcement of quality of care standards are required.

A multicenter study on hip fractures in Thailand.

The present study is a multicenter study on hip fractures aimed at estimating the incidence among Thais. It also describes treatment modalities, associated medical care costs, complications, outcome of orthopedic care, length of stay in hospitals and duration of delay in seeking orthopedic care after occurrence of fractures. An extremely low hip fracture incidence of 7.05 per 100,000 population was found. Hip fracture was shown to increase steeply with age. An average of 26.44 days of delay in seeking orthopedic care following occurrence of hip fractures was reported. In contrast to the belief in Western countries that almost all hip fractures will seek orthopedic care, 7.8 per cent of these Thai cases denied orthopedic care during admission to hospitals. Median of charge to patients was 11205.00 baht, over one fourth of the national income per capita (36,563).

Late reduction of dislocated elbow. Need triceps be lengthened?

We compared the results in two groups of patients with late reduction of posterior elbow dislocations, one of which had lengthening of the triceps (group A, n = 36) and the other did not (group B, n = 34). The elbows had all been dislocated for more than one month and less than three months. The patients in group B had better clinical results and significantly less postoperative flexion contracture (p < 0.05).

Precaution against nosocomial spread of cholera in Udornthanee Hospital.

From February to April 1988, there was an outbreak of cholera in Udornthanee Province. One hundred and twenty-four culture-documented cases were admitted into Udornthanee Hospital. Prevention of nosocomial spread of V. cholerae was done by the implementation of proper practices, surveillance culture and routine surveillance. There was no nosocomial spread of V. cholerae to patients or medical personnel. It was also shown that these practices were effective in prevention of contamination of the environment. It is concluded that simple measures are effective in the prevention of spread of V. cholerae in health care settings.