Cost Variations in Outpatient and Inpatient Services among Three Health Insurance Schemes in Thai Public Hospitals

Abstract

This study presents findings on cost variations using clinical-case level microdata from public hospitals under the Office of the Permanent Secretary, Ministry of Public Health. The objective was to evaluate differences in costs of health utilizations of 3 universal health coverage schemes, including universal coverage scheme (UCS), civil servant medical benefit scheme (CSMBS), and social security scheme (SSS).  The microdata covered 252 million outpatient visits and 12 million inpatient admissions in the budget year 2019 (B.E. 2562). 

The average costs of outpatient and inpatient utilizations were econometrically controlled for 140 disease categories using principal  diagnosis codes  (ICD-10), as well as factors such as age, gender, service time, hospital stay, and health region. The linear regression analysis computed  the average costs independently for different healthcare facilities, encompassing primary, first-level secondary, second-level secondary, third-level secondary, and tertiary care levels. 

Results show that the average outpatient costs for CSMBS beneficiaries were higher than those of UCS by around 16-30 percent and those of SSS by around 25-30 percent in the secondary and tertiary hospitals. However, the outpatient costs at the primary care hospitals were similar across different health insurance schemes. Inpatient reimbursements based on the diagnosis-related groups (DRG) might  confound in similarity of inpatient costs compared to outpatient costs. Nevertheless, the differences on average inpatient costs were around 25 percent in the third-level secondary and tertiary hospitals. Therefore, the research findings emphasize the importance of the integration goal of the three schemes of UHC in compliance with the Sections 9 and 10 of the National Public Health Security Act B.E.  2545 (A.D. 2002).