Abstract
This research aims to study an impact of economic crisis towards private hospital sector and their copying mechanism. Methodologies used were document research, questionnaire survey on throughput to 75 sample hospitals, in-depth interview of medical and non-medical directors and practicing physician in sample hospitals, financial analysts, key member in Private Hospital Association and related key policy makers. The response rate of questionnaire survey on sample hospitals and their financial statements and in-depth interview of private hospitals were 38.6%, 82.6% and 41.3% respectively. In 2001,diffusion and utilization of private sector was crowed in central region and Bangkok, the capital city of Thailand. Hospitals having more than 50 beds absorbed a large share of private hospitals at 53.37%. Private hospital statistic services presented 4,569 of inpatients visit per hospital, 181.94 of outpatients visit per day per hospital and 38.76% of occupancy rate. The number of both inpatient visit and outpatient visit decreased during 1996-2001. In 2000, 72.09% of private hospitals registered as company limited and public company limited. Source of fund were from local investment. Their operating loss per hospital was at 9.5 million Baht. However, large hospitals ((200 beds) had operating profit at 20.58 million Baht. About one third of private hospitals, 35.48%, had positive working capital and current ratio. Thought large hospitals had surplus working capital, their current ratios were better than other hospitals. There were ten hospitals registered in Stock Exchange of Thailand (SET) excluding three hospitals needed debts restructuring because their operating were under requirement of SET. Income (sale revenue) and cost from providing medical services and operating profit tended to increase continually in hospitals registered in SET. During economic crisis, however, they started to be difficulty with loss net profits. They coped with crisis by organization and/or debts restructuring leading to positive net profit in 2001. Since private hospitals invested more in fix assets than in equities their efficiency ration was > 1.0 and affected their working capital during the crisis. Economic impacts toward private hospitals were decreasing in number of inpatients (76.99% of total private hospitals) and outpatients (69.33%). Small hospitals were affected more than large hospitals. Decreasing in consumers’ purchasing power and civil service medical benefit scheme affected hospitals having main revenue from out-of-pocket. They had to lower ward services and be contracted hospital in Social Security Scheme. All private hospitals had interest burden especially in 1998-2001. Interest burden varied with the hospital size. The larger hospital was the more interest burdened. Private hospitals’ copings to economic crisis were down sizing and permanent shutdown. One year after crisis, 6 hospitals downed sizing and 43 hospitals shutdown. Number of medical and non-medical staffs decreased insignificantly but they received lower return. Most private hospitals increase their revenue by launching delivery package and medical check up. New competitors were hard to entry to the private hospital industry due to high investment e.g. investment in technologies and medical staffs. This let purchasers had more purchasing power. Media, private agencies and government agencies tried to increase purchasing power through legislate regulation and laws e.g. declaration of patients rights. Competitive form among private hospitals were establishing public image through providing medical care by high expert physician. Expanding market by penetrating service to middle to higher economic group was conducted. External environment e.g. National Health Act, National Security Health Act, policy on center of regional health provision and Trade liberalization may affect the performance of private hospital sector. We recommend having share resources between public and private sector, defining number and size of hospitals according to health needs are policy recommendations. There should be quality control of medical care under capitation, establishing organization to suggest investment for new entries and more coordination between public and private sectors in making policy decisions. Quality insurance program should be implement impartially between public and private sector by focusing on ultimate customer protection.
