Retrospective secondary data analysis to identify high-cost users in inpatient department of hospitals in Thailand, a middle-income country with universal healthcare coverage.

OBJECTIVES: The study aims to identify high-cost users (HCUs) in the inpatient departments of hospitals in Thailand including their common characteristics, patterns of healthcare utilisation and expenditure compared with low-cost users, and to explore potential factors associated with HCUs so the healthcare system can be prepared to support the HCUs including those who have increased chances of becoming HCUs. DESIGN AND SETTING: A retrospective secondary data analysis using hospitalisation data from Thailand's Universal Coverage Scheme (UCS) obtained from the National Health Security Office over a 5-year period from October 2014 to September 2019 (fiscal year 2014-2018). PARTICIPANTS: Study participants included Thai citizens who had at least one inpatient admission to hospitals under the UCS over the study period. RESULTS: Over the 5-year period, the top 5% of the hospitalised population (or HCUs) consumed almost 50% of the health expenditure each year. HCUs were more likely to have longer hospital stays, a higher annual number of visits and be admitted to multiple hospitals each year when compared with the low-cost users (the bottom 50% of the hospitalised population). The study further reported that the chance of becoming an HCU is associated with several factors such as increasing age, being male, having a comorbidity and being admitted to hospitals in Bangkok. CONCLUSIONS: This study confirmed that the HCU phenomenon existed in Thailand, where a majority of inpatient care spending is concentrated in the top 5% of the hospitalised population. The study findings call attention to potential initiatives that can help monitor the magnitude and trend of HCUs and develop policies to prevent HCUs.

An Implementation Framework for Telemedicine to Address Noncommunicable Diseases in Thailand.

To maintain the continuity of noncommunicable disease (NCD) services and ascertain the health outcomes of patients with NCDs during the COVID-19 (coronavirus disease 2019) outbreak in Thailand, various telemedicine services have been developed. To achieve this determination, the implementation framework has been constructed based on recommendations from multidisciplinary experts (Thai NCD Collaboration Group). Within the framework, all key elements are illustrated with their priority and expected collaborations. Ultimately, active collaborations from multi-stakeholders are vitally important to ensure that telemedicine services for NCDs will finally become practical, successful, and sustainable.

Diabetes prevention and care in the universal health coverage context: The example of Thailand.

Universal health coverage (UHC) is a key policy issue in countries of the World Health Organization (WHO) South-East Asia Region. However, despite projections of significant increases in burden, there is little protection against the financial risks associated with noncommunicable diseases (NCDs), including diabetes. Thailand achieved UHC of all 67 million of the population in 2002, under three public health insurance schemes. The country therefore provides a case-study on diabetes prevention and care in the context of UHC. Although the budget for the Thai Universal Coverage (UC) scheme, which covers nearly 80% of the population, increased significantly during 2003-2013, the proportion allocated to clinical prevention and health promotion declined from 15% to 11%. The financial case for investment in diabetes prevention is made, particularly with respect to a focus on primary care and the use of community volunteers. The UC scheme can expand to nearly 100% population coverage, with a comprehensive benefit package and financial risk protection. Although the rates of complications and fatalities in patients with diabetes have improved over the last few years, achievement of well-controlled fasting blood glucose for all patients is still the main challenge for further improvement. It is recommended that, in order to improve coverage of diabetes care and prevention, it is essential for countries in the WHO South-East Asia Region to include major NCD services, in particular primary prevention, in their UHC strategies. Since a resilient health system is key to UHC delivery, strengthening of the health workforce and infrastructure should be part of any action plan to prevent and control diabetes.

Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing.

Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser-provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite annual budget.