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

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, Thailan

The incidence of public spending on healthcare: Comparative evidence from Asia

The article compares the incidence of public healthcare across 11 Asian countries and provinces, testing the dominance of healthcare concentration curves against an equal distribution and Lorenz curves and across countries. The analysis reveals that the distribution of public healthcare is prorich in most developing countries. That distribution is avoidable, but a propoor incidence is easier to realize at higher national incomes. The experiences of Malaysia, Sri Lanka, and Thailand suggest that increasing the incidence of propoor healthcare requires limiting the use of user fees, or protecting the poor effectively from them, and building a wide network of health facilities. Economic growth may not only relax the government budget constraint on propoor policies but also increase propoor incidence indirectly by raising richer individuals' demand for private sector alternatives. © 2007 Oxford University Press.link_to_subscribed_fulltex

Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data

Background: Conventional estimates of poverty do not take account of out-of-pocket payments to finance health care. We aimed to reassess measures of poverty in 11 low-to-middle income countries in Asia by calculating total household resources both with and without out-of-pocket payments for health care. Methods: We obtained data on payments for health care from nationally representative surveys, and subtracted these payments from total household resources. We then calculated the number of individuals with less than the internationally accepted threshold of absolute poverty (US$1 per head per day) after making health payments. We also assessed the effect of health-care payments on the poverty gap-the amount by which household resources fell short of the$1 poverty line in these countries. Findings: Our estimate of the overall prevalence of absolute poverty in these countries was 14% higher than conventional estimates that do not take account of out-of-pocket payments for health care. We calculated that an additional 2·7% of the population under study (78 million people) ended up with less than $1 per day after they had paid for health care. In Bangladesh, China, India, Nepal, and Vietnam, where more than 60$1 per day need to include measures to reduce such payments. © 2006 Elsevier Ltd. All rights reserved.link_to_subscribed_fulltex

Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data

Background: Conventional estimates of poverty do not take account of out-of-pocket payments to finance health care. We aimed to reassess measures of poverty in 11 low-to-middle income countries in Asia by calculating total household resources both with and without out-of-pocket payments for health care. Methods: We obtained data on payments for health care from nationally representative surveys, and subtracted these payments from total household resources. We then calculated the number of individuals with less than the internationally accepted threshold of absolute poverty (US$1 per head per day) after making health payments. We also assessed the effect of health-care payments on the poverty gap-the amount by which household resources fell short of the$1 poverty line in these countries. Findings: Our estimate of the overall prevalence of absolute poverty in these countries was 14% higher than conventional estimates that do not take account of out-of-pocket payments for health care. We calculated that an additional 2·7% of the population under study (78 million people) ended up with less than $1 per day after they had paid for health care. In Bangladesh, China, India, Nepal, and Vietnam, where more than 60$1 per day need to include measures to reduce such payments. © 2006 Elsevier Ltd. All rights reserved.link_to_subscribed_fulltex

Who pays for health care in Asia?

We estimate the distributional incidence of health care financing in 13 Asian territories that account for 55% of the Asian population. In all territories, higher-income households contribute more to the financing of health care. The better-off contribute more as a proportion of ability to pay in most low- and lower-middle-income territories. Health care financing is slightly regressive in three high-income economies with universal social insurance. Direct taxation is the most progressive source of finance and is most so in poorer economies. In universal systems, social insurance is proportional to regressive. In high-income economies, the out-of-pocket (OOP) payments are proportional or regressive while in low-income economies the better-off spend relatively more OOP. But in most low-/middle-income countries, the better-off not only pay more, they also get more health care

Who pays for health care in Asia?

We estimate the distributional incidence of health care financing in 13 Asian territories that account for 55% of the Asian population. In all territories, higher-income households contribute more to the financing of health care. The better-off contribute more as a proportion of ability to pay in most low- and lower-middle-income territories. Health care financing is slightly regressive in three high-income economies with universal social insurance. Direct taxation is the most progressive source of finance and is most so in poorer economies. In universal systems, social insurance is proportional to regressive. In high-income economies, the out-of-pocket (OOP) payments are proportional or regressive while in low-income economies the better-off spend relatively more OOP. But in most low-/middle-income countries, the better-off not only pay more, they also get more health care. © 2007 Elsevier B.V. All rights reserved.link_to_subscribed_fulltex