Abstract
Diagnosis related group (DRG) has been researched and developed in Thailand since the implementation of the Traffic Accident Protection Act 1992 with support from the Health Systems Research Institute (HSRI). It was aimed to be an alternative of payment apart from fee-for-service and capitation payments. The first research in public and private hospitals in 10 provinces gave about 100 DRGs covered injuries. Later research activities expanded to cover all diseases in the low income patients and finally cover all inpatients by using electronic patient data from well developed hospitals. Success of these activities proved that Thailand was able to use DRG for health financing. In 1998, the Health Insurance Office, Ministry of Public Health adopted DRG as payment method for high cost care for the low income card scheme. This decision has stimulated the flows of individual patient data from hospitals to provincial health offices and the ministry. The information assets have increased from 1.5 million patients in 1998, to 3.0 million in 1999 and more than 3.6 million in 2000.It can be concluded that DRG has brought big changes in health care in Thailand. Information technology has been used for promoting efficiency, equity and quality in health delivery. The first Thai DRG Grouper was launched in 1998 followed by version 2 in 2000. The tests of these groupers against the international groupers showed lots of improvements. When the government made a big decision to provide universal coverage to cover all Thai population in April 2002, the researchers and developers of DRG decided to develop the third version that is compatible with the patterns of diseases in Thailand, especially the tropical diseases. This activity got financial supports from the HSRI, Thailand World Health Organization Office, the Health Insurance Office, and got technical helps from more extensive groups consisting of the royal colleges, colleges and societies of health professionals. It was hoped that the 500 DRGs in version 2 would be expanded to 1,000 DRGs to better reflect different disease severity. Since DRG is the only one case mix being researched in Thailand, DRG is good only for acute inpatient episodes. There are many complex issues in health care reforms or health system developments; e.g. information technology, increasing efficiency within public sector, health care accreditation, health care decentralization, autonomous hospital, and the universal health coverage of the new government (30 baht medical care policy), etc. In the implementation of the 30 baht policy, many issues of health care reforms have been dumped to ride the wave of change. DRG was used inadvertently with decentralization policy but with less understanding. This conflicts with the recommendations of the Working Group on Universal Coverage of HSRI. The working group recommended the split of budget between ambulatory and inpatient care. The capitation payment is good for ambulatory care and DRG for inpatient care. To increase access to efficient and good quality inpatient services to all, DRG should be managed with unity at the central level under the reasonable global budget cap.
