Economic Burden from Providing Care to Migrant Patients: a Case Study of Phaholpolpayuhasena Hospital, Kanchanaburi

Abstract

Kanchanaburi province borders with Myanmar and a large number of migrants are cared for at Phaholpolpayuhasena Hospital. Financial expenses in providing care to migrant patients were analyzed. The study population was inpatients and outpatients at the hospital during fiscal year 2017. Data collec­tion techniques involved a questionnaire, interviews and document reviews of medical records for the previous year. A convenience sampling method was employed. Total sample size was 519 (412 outpatients and 107 inpatients). Of the 412 outpatients, 305 had no admissions during the previous year, while 107 had been admitted in the hospital. The results showed that 18.4% of the outpatients and 38.3% of the inpatients were not medically insured. When classifying patients according to the most costly disease group, cancer comprised the highest proportion in the outpatient sample at 63,459 (SD 82,872) baht per person per year. For communicable diseases, the largest group in the inpatient sample cost 43,100 (SD 53,384) baht per person per year. Costs of medical treatment and expenses, as quoted by the hospital, were averaged at 15,757 baht per person per year for outpatients, with inpatients at 35,280 baht per stay. Results from focus group discussions with various stakeholders showed that expenditures of Phaholpolpayuhasena Hospital, Samutsakhon Hospital, Krathumbaen Hospital, and this research study in terms of relative weight greater than or equal to 2 units were 19.2%, 5.3%, 2.4% and 23.4%, respectively, while in terms of relative weight greater than or equal to 4 units were 5.8%, 1.9%, 1.2% and 3.7%, respective­ly. The top 5 outpatient diseases were cancer, trauma, non-communicable diseases, neonatal problems, and obstetrics, while the top 5 inpatient medical departments which admitted high numbers of migrant patients were medicine, surgery, obstetrics, orthopedics, and pediatrics, respectively.

Results can be used to formulate a support policy to mitigate the cost burdens incurred by hospitals in border provinces. A policy of cooperation with neighboring countries should be proposed by the Ministry of Public Health to develop adequate medical facility capacities and also review the cost of the health insurance card scheme for migrants to reflect the cost of medical treatment. Most importantly, a policy should be implemented to adjust budget allocations to border province hospitals to cover the cost of treating migrant patients.