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Budget impact analysis of the new reimbursement policy for day surgery in Thailand

Authors Suphanchaimat R, Thungthong J, Sriprasert K, Tisayaticom K, Limwattananon C, Limwattananon S

Received 2 September 2018

Accepted for publication 25 January 2019

Published 6 March 2019 Volume 2019:12 Pages 41—55

DOI https://doi.org/10.2147/RMHP.S186196

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Kent Rondeau


Rapeepong Suphanchaimat,1,2 Jutatip Thungthong,3 Kriddhiya Sriprasert,3 Kanjana Tisayaticom,1 Chulaporn Limwattananon,4 Supon Limwattananon4

1International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand; 2Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand; 3National Health Security Office, Bangkok, Thailand; 4Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand

Introduction: In 2017 the Thai Ministry of Public Health proposed a new financing mechanism to promote day surgery under the Universal Coverage Scheme – the main public insurance arrangement for Thais. The key feature of the policy is health facilities performing day surgery can claim the treatment expense based on relative weight (RW) instead of adjusted RW (adjRW). Procedures for 12 diseases (so-called “candidate procedures”) are eligible for the new reimbursement. The objective of this study was to assess the current day surgery situation in Thailand and analyze potential budget impact from the new policy.
Methods: A quantitative cross-section design was employed. Individual inpatient records of the Universal Coverage Scheme during 2014–2016 were analyzed. Descriptive statistics and simulation analyses were applied. The analyses were divided into three subtopics: 1) case volume and expense claim, 2) utilization across facilities, and 3) case mix index and budget impact.
Results: Overall, day surgery accounted for 4.8% of admissions with candidate procedures. Inguinal hernias, hemorrhoids, and common bile duct stones caused the largest sum of admission numbers and admission days. Currently, the annual reimbursement for candidate procedures treated as inpatient cases is around 290.8 million Baht (US$ 8.8 million), with about 12.4 million Baht (US$ 0.38 million) for day surgery cases. If all candidate procedures were performed as day surgery and diagnostic-related groups (DRG) version 6 was applied, the incremental budget would amount to 1.9 million Baht (US$ 58,903).
Conclusions: The new reimbursement policy will likely lead to minimal budget burden. Even in the case of maximal uptake of the policy, the needed budget would increase by just 15%. The marginal budget increment was explained by the infinitesimal RW–adjRW difference. Apart from the financial measure, other qualitative aspects of the policy, such as infrastructure and health staff readiness, should be explored.

Keywords: day surgery, inpatient, budget impact, case mix index, Thailand

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