Abstract
Samut Sakhon, a small province in Central region has three districts, Muang, Banphaeo and
Krathumbaen. Banphaeo hospital, the first autonomous hospital in Thailand through Public
Organization Act, 2542 BE. will be financed through capitation according to population size in the
district. This will have significant changes to financing mechanism at provincial health office and
health centers in the district. The objective this study is to assess unit cost (covers labor and material
costs, excludes capital depreciation costs) of services provided by health centers in order that
Banphaeo hospital could fairly purchase care from health centers. We assess operating cost in fiscal year 2542 BE., among all health centers in the province. Staff time allocation survey was done to
allocate labor cost to various key activities of health center, material cost was directly collected for
each activities. Cost from general administration and reporting function were allocated to service
activities using simple allocation method.
Results: operating expenditure per capita population at health center was 120 Baht per year, (110
Baht from health centre and 10 Baht from District Health Office). Annual operating expenditure was
834,136 Baht per health centre, of which 56% was labor and 44% material cost. Each health center
was staffed by 4.16 health workers. Time allocation reported 22% contributed to curative services,
27% to administrative function, 18% on health promotion activities and 30% community based
services. Curative services consumed 40% of total operating expenditure, most were drugs and
supplies. Unit operating cost for curative service at health center was 59 Baht per visit (range 53 to
65), health promotion and mother child health services was 100 Baht per visit (range 88 to 120). If
cost from District Health Office was included, unit cost would increase by 9%. Unit cost was
influenced by staffing intensity, magnitude of labor cost and productivity. Unit cost is one of several
tools for proper resource allocation.
This study provides evidence on how hospital could purchase services from health center that reflects
operating cost. Several options are capitation base on population size, total cost inclusive for each
group of activities, or unit cost per service rendered. It depends on how to stimulate proper service
behavior by health center. However, current funding available at health center from central
government and local administration should be taking into account to purchase services from health
centers.
