การใช้เครื่องสลายนิ่วในประเทศไทย ประสิทธิภาพและความเสมอภาค

Abstract

The use of extra corporeal shock wave lithotripters in Thailand: efficiency and equityBased mainly on hospital statistics, this study aims to collect(a) financial data from Extra Corporeal Shock Wave Lithotripter (ESWL) to estimate cost of production, cost behaviour, cost recovery, break-even output, (b) patient characteristics eg. domicile, payment status (insurance coverage) in order to assess the two most important societal objectives, namely ; efficiency and equity (equal access for equal needs) In 1994, there are 28 ESWLs throughout the country, of which 11 are in Bangkok (39 percent), 10 (36 percent) are in the Northeast. Of the total 28 ESWLs (39 percent) were owned by public and 17 (61 percent) by private sector. The inappropriate diffusion of ESWLs causes inmigrate patients from upcountry to use services in Bangkok, where by privated cost (in terms of time cost, transportation) is substantial. This leads to inefficiency when urinary tract stone is most prevalent in the Nartheast and the North Region. Twelve ESWL units were included in this study, of with 10 from public and 2 from private. Data from 9,626 patients from 439 momths of opeation by these 12 units were compiled. Unit cost per case is higher than net revenue generated in all ESWL units, except the cases of Ramathibodi and Veteran Hospital when private company rent ESWL to the Hospital. These two units have higher efficiency measured by higher productivities (case load per month), lower unit cost, low capital investments. They are operating at the level higher than the break-even output. We found that most of thecases, 38 percent paid from their own pockets, 35 percent were civil servant or dependants who can be fully reimbursed from the Ministry of Finance, 18 percent were low income card holders, 5 percent were deducted using slidinf scale upon the social worker's discretion. We concluded that the poor and the low income could not access as equal ESWL service as the civil servants and their dependants. This clearly reflects unequal treatment for equal needs. Case studies at Ramathibodi and Veteran hospital were very interesting in terms of efficient management. Several lesson were heavily drawn for the formulation of closer collaboration between the public and private sectors.