Cost Analysis of Outpatient Services for Hypertension, Heart Attack, and Stroke among Older Adults in Community Hospitals in Thailand

Utoomporn Wongsin; Passakorn Suanrueang; Tuo-Yu Chen

Authors

Utoomporn Wongsin College of Public Health, Taipei Medical University, Taiwan
Passakorn Suanrueang Division of Multidisciplinary/ Interdisciplinary, Graduate School, Srinakharinwirot University, Thailand
Tuo-Yu Chen College of Public Health, Taipei Medical University, Taiwan

Keywords:

cost analysis, hypertension, heart attack, stroke, community hospitals

Abstract

The purpose of this study was to estimate the cost of outpatient care for older patients with a primary diagnosis of hypertension, heart attack, and stroke at community hospitals in Thailand. This cross-sectional study used cost information in 2014 from four community hospitals. The hospital cost information consisted of service data, hospital statistics, and financial reports. We used the International Classification of Diseases (ICD-10), the 10^th revision coding system to identify hypertension, heart attack, and stroke. Traditional cost and the cost to charge ratio methods were used to estimate average cost per visit and cost per person-year. Inflation rate was used to report the average cost in 2021. Overall, the major costs were for labor (53%), followed by material (42%), and capital (6%). The unit cost per visit for older outpatients in 2014 was between 447-688 THB for hypertension (531-817 THB in 2021), 634-1,171 THB for heart attack (753-1,392 THB in 2021), and 611-1,238 THB for stroke (726-1,470 THB in 2021). Our cost analysis used actual cost data, which provided useful information for budgetary planning and management for outpatient care among older adults with a primary diagnosis of hypertension, heart attack, and stroke.

References

Aekplakorn W. National Health Exam Survey (NHES V) 2014 [Internet]. Health Systems Research Institute; 2014. Available from: https://www.hiso.or.th/hiso/picture/reportHealth/report/report9.pdf. (in Thai)

Roser M, Ritchie H. Burden of disease. Our World in Data [Internet]; 2016 [cited 2022 Jan 23]. Available from: https://ourworldindata.org/burden-of-disease.

Martinez R, Lloyd-Sherlock P, Soliz P, Ebrahim S, Vega E, Ordunez P, et al. Trends in premature avertable mortality from non-communicable diseases for 195 countries and territories, 1990-2017: a population-based study. Lancet Glob Health 2020;8(4): e511–23.

Institute for Health Metrics and Evaluation (IHME). GBD compare data visualization [Internet]. 2020 [cited 2021 Dec 27]; Available from: http://vizhub.healthdata.org/gbd-compare.

Zou KH, Li JZ, Salem LA, Imperato J, Edwards J, Ray A. Harnessing real-world evidence to reduce the burden of noncommunicable disease: health information technology and innovation to generate insights. Health Serv Outcomes Res Method 2021;21(1):8–20.

Karunathilake SP, Ganegoda GU. Secondary prevention of cardiovascular diseases and application of technology for early diagnosis. BioMed Research International 2018; 2018: e5767864.

Muka T, Imo D, Jaspers L, Colpani V, Chaker L, van der Lee SJ, et al. The global impact of non-communicable diseases on healthcare spending and national income: a systematic review. Eur J Epidemiol 2015;30(4):251–77.

Xiao Y. Community-based integration of management of non-communicable diseases in China. Chronic Diseases and Translational Medicine 2015;1(3):133–40.

Tam A, Mac S, Isaranuwatchai W, Bayley M. Cost-effectiveness of a high-intensity rapid access outpatient stroke rehabilitation program. International Journal of Rehabilitation Research 2019;42(1):56–62.

Kamel H, Hegde M, Johnson DR, Gage BF, Johnston SC. Cost-effectiveness of outpatient cardiac monitoring to detect atrial fibrillation after ischemic stroke. Stroke 2010;41(7):1514–20.

International Health Policy Program, Ministry of Public Health. Burden of disease and injuries of Thai population in 2014 – burden of disease [Internet]. 2020 [cited 2021 Sep 18]. Available from: http://bodthai.net/en/download/burden-of-diseases-and-injuries-of-thai-population-in-2014-english-report-151118-np_final/. (in Thai)

National Health Security Act B.E. 2545 (2002) [Internet]. (Nov. 11, 2002) [cited 2023 Feb 22]. Available from: https://eng.nhso.go.th/view/1/NationalHealthSecurityActB.E.2545/EN-US.

Social Security Office, Ministry of Labour. Social Security Scheme [Internet]. 2017 [cited 2022 Jan 23]; Available from: https://www.sso.go.th/wpr/main/general/%E0%B8%81%E0%B8%AD%E0%B8%87%E0%B8%97%E0%B8%B8%E0%B8%99%E0%B8%9B%E0%B8%A3%E0%B8%B0%E0%B8%81%E0%B8%B1%E0%B8%99%E0%B8%AA%E0%B8%B1%E0%B8%87%E0%B8%84%E0%B8%A1_singleview_detail_1_188_0/435_435/?site=&page=preview&id=435.

The Comptroller General’s Department, Ministry of Finance, Thailand. Civil Servant Medical Benefit Scheme [Internet]. 2016 [cited 2022 Jan 23]. Available from: https://www.cgd.go.th/cs/internet/internet/รักษาพยาบาล.html. (in Thai)

Mitchell-Fearon K, McKoy-Davis J, Willie-Tyndale D, Abdulkadri AO, Eldemire-Shearer D. The economic burden of hypertension among older persons: lessons from a developing nation. J Public Health Dev Ctries 2017;3(1):347–57.

Suratannon S, Pavananunt P, Kongsin S, Jiamton S. Cost-effectiveness analysis of hypertensive elderly service: outpatient department and primary care unit of Hua Hin Hospital in Prachuap Khiri Khan Province, Thailand. Thai Journal of Public Health 2009;39(1):101–10. (in Thai)

National Health Security Office. Fund management manual [Internet]. 2021 [cited 2022 Feb 18]. Available from: https://hcrp.nhso.go.th/page/fund_management_manual. (in Thai)

Carroll N, Lord JC. The growing importance of cost accounting for hospitals. J Health Care Finance 2016;43(2):172–85.

Aujirapongpan S, Meesuk K, Theinsathid P, Maneechot C. Performance evaluation of community hospitals in Thailand: an analysis based on the balanced scorecard concept. Iran J Public Health 2020;49(5):906–13.

World Health Organization. ICD-10 version: 2019 [Internet]. 2019 [cited 2021 Aug 12]; Available from: https://icd.who.int/browse10/2019/en.

Ministry of Finance, Thailand. Depreciation and amortization information [Internet]. 2021 [cited 2021 Dec 1]. Available from: https://www.cgd.go.th/cs/internet/internet/edas.html?page_locale=en_US.

Thianjaruwatthana W, Sakulpanich T, Pongpattrachai D, Chiangchaisakulthai K. Guideline of unit cost for hospitals under Ministry of Public Health. Nonthaburi: Ministry of Public Health: 2001. (in Thai)

Bank of Thailand. Economic indicators [Internet]. 2021 [cited 2021 Aug 15]; Available from: https://www.bot.or.th/App/BTWS_STAT/statistics/ReportPage.aspx?reportID=409&language=th. (in Thai)

Lopetegui M, Yen PY, Lai A, Jeffries J, Embi P, Payne P. Time motion studies in healthcare: what are we talking about? J Biomed Inform 2014;49:292–9. doi: 10.1016/j.jbi.2014.02.017.

Stanton P. Managing the healthcare workforce: cost reduction or innovation. Aust Health Review 2002;25(4):92–8.

Institute of Medical Research and Technology Assessment. Literature review: the current situation and care model of non-communicable diseases 2014 [Internet]. Ministry of Public Health; 2014. Available from: http://www.imrta.dms.moph.go.th/imrta/images/doc20141107.pdf. (in Thai)

Idris Abubakar, Obansa S.A.J. An estimate of average cost of hypertension and its catastrophic effect on the people living with hypertension: patients’ perception from two hospitals in Abuja, Nigeria. IJSSER 2020;2(2):10–9.

Brouwer ED, Watkins D, Olson Z, Goett J, Nugent R, Levin C. Provider costs for prevention and treatment of cardiovascular and related conditions in low- and middle-income countries: a systematic review. BMC Public Health 2015;15(1):1183.

Zawudie AB, Lemma TD, Daka DW. Cost of hypertension illness and associated factors among patients attending hospitals in Southwest Shewa Zone, Oromia Regional State, Ethiopia. Clinicoecon Outcomes Res 2020;12:201–11.

National Institute on Aging. Heart health and aging [Internet]. National Institute on Aging 2018 [cited 2022 Feb 22]; Available from: http://www.nia.nih.gov/health/heart-health-and-aging.