Unit Cost per Disease Methodology for Thailand: Micro-Costing Method

Abstract

This report presents a brief technical methodology on unit cost per disease and cost per diagnosis related group (DRG) for Thailand. Cost analysis was on provider perspective. Standard costing method and micro-costing or bottom-up approach were employed. The process started with cost per activity estimation, patient-level costing, disease costing, and DRG costing. Cost data were voluntarily collected from 13 hospitals. They were 4 regional hospitals, 1 general hospital, 7 community hospitals, and 1 specialty hospital. All data were for the fiscal year 2018 (October 2017 to September 2018). Results were presented into two parts, cost methodology prototype and cost per disease and cost per DRG. Cost analyses consisted of 2 major processes. They were hospital cost and cost center analysis using top-down costing method, and cost per disease using bottom-up method. Top-down costing included 4 steps 1) cost center identification, 2) direct cost determination, 3) indirect cost determination, and 4) total cost determination. The bottom-up costing was composed of 1) unit cost per service activity, 2) patient level costing, and finally, costs of each patient were summed up as cost per disease of outpatient visit and cost by Thai DRG version 6.2. The study also demonstrated that cost per activity such as an average bed-day (room and board) cost for common ward was 377 baht, for intensive care unit was 930 baht. An average outpatient nursing service cost was 252 baht per visit, inpatient nursing service cost was 1,055 baht per bed-day, ICU nursing service was 4,245 baht per bed-day. Metformin drug was 0.35 baht per tablet, and HbA1C was 126 baht per test. Average cost of outpatient treatment for diabetes mellitus was 1,676 baht per visit: 1,951 baht per visit for regional hospital, 1,114 baht for big community hospital, and 929 baht for small community hospital. The total cost per admission was 3,847 baht for DRG 15540 newborn admission weight > 2499 gm, 18,478 baht for DRG 14010 cesarean delivery. Costs of admission among hospital levels were still different even for common DRG 06570 infectious gastroenteritis age > 9: 9,601 baht per admission for regional hospital, 7,772 baht for big community hospital, and 8,176 baht for small community hospital. This paper demonstrated that the expanded standard cost methodology development on cost per activity estimation at patient level would be useful for studying costs of service provision of all health insurance systems in Thailand.