Abstract:
Therapeutic drugs, a major component of outpatient care have made the utilization pattern in the
Civil Servant Medical Benefit Scheme (CSMBS) different from the Universal Health Coverage Scheme
(UCS). This study analyzed a time-series of 57 months during 2003-2007 for drug prescriptions in 6 Regional
Hospitals and General Hospitals and forecast the overall expenditure. Four therapeutic classes
with high expenditure or frequent use, including angiotensin-converting enzyme inhibitors (ACEI) and
angiotensin-2 receptor blockers (ARB); antilipids; proton pump inhibitors (PPI) and histamine-2 receptor
antagonists (H2RA); and non-steroidal anti-inflammatory drugs (NSAID) plus COX-2 inhibitor were analyzed
with respect to two expenditure components; (1) propensity to use the target drugs, which are not
covered by the National Lists of Essential Medicines or are the single-source products, and (2) the utilization
quantity. Results from the expenditure forecast before and after the CSMBS’ direct billing policy and
the UCS’ 30-Baht copay abolition policy using a segmented regression analysis revealed that the use of the
following target drugs, including ARB, non-essential antilipids, single-source PPI and COX-2 inhibitor
was associated with the total and expenditures growth of the four classes. The close-end method of provider
payment currently employed by the UCS, if applied to the CSMBS would be able to reduce 40
percent of the expenditures for PPI-H2RA and NSAID-COX-2 inhibitor to 100 percent of the expenditure
for antilipids. For the substitution measure, the degree of cost-saving would depend largely on the policy
compliance levels. With the 20 percent compliance, 8 percent of the expenditures for PPI-H2RA and NSAIDCOX-
2 inhibitor and 20 percent for antilipids could be saved. With the 80 percent compliance, the costsaving
would range from 30 percent to 80 percent.
