Abstract
According to Thailand’s financial crisis many years ago, Thailand has dramatically developed new budgetary resources allocation system for public health finance through capitation payment for out-patient group and DRG relative weight to purchase inpatient care for in-patient group. However, this new system was likely to create moral hazards. For example, service providers give low quality medical service to patients, or accept only low-risk patients, and reject chronic patients like psychiatric patients. This study has a main purpose to analyze 30 baht service patterns provided by hospitals and taken by psychiatric patients in Thailand. Also, this research shall encompass to its continuing effects and adjustments by hospitals under health department of Thailand’s Northern region during budgetary year 2001-2002.Methodology This retrospective narrative study collected and collated information from in-patients in all public psychiatric hospitals during budgetary year 2001-2002. Studying tools consist of in-patient data report, 12 file database or other compatible systems, budgetary fund & use report (Sor Jor Ro Ngor 1031), supporting fund (Sor Jor Ro Ngor 1032), and fund from Sor Por Ro Ngor 102. Data have been analyzed by software programs e.g. SPSS/FW, Visual Foxpro, Excel, and Arc View. Results This study has been classified into 2 parts as follows: Part I: According to psychiatric Service Pattern during budgetary year 2001-2002, there were 720 and 985 public psychiatric hospitals which have in-patient services in 2001 and 2002, respectively, In each year, there were over 70,000 psychiatric in-patients which mostly use psychiatric services in primary hospitals approximately 57 %, followed by hospitals under mental health department (36%), other hospitals with psychiatric service (6%), and medical school (1%), respectively. In 2001, there were totally 387 Thai psychiatric doctors who approximately 80% have worked with public sector. Practical psychiatric doctors working with in-patient departments under public sector were only 211 which was accounted for MMM doctor to population ratio of 0.34:100,000 population. Our finding reveals that psychiatric doctors are imbalance distributed evidencing from over half lived and worked in Bangkok Metropolitan. Additionally, provincial cross services were as high as 30% as public health district cross services were only 14%. Provinces with high psychiatric service record usually the ones that have psychiatric hospitals in the area. Most found diseases are Schizophrenia and Acute Psychotic Disorders, followed by Substance-Related Disorders, Anxiety Disorders, and Mood Disorders, respectively. Part II: From effect & adjustment study of hospitals under mental health department in Thailand’s Northern region during year 2001-2002, there were a total of 3 public psychiatric hospitals: Suan Prung Psychiatric Hospital, Nakornsawan Psychiatric Hospital, and Northern Child Development Center. These hospitals had a proportion of using budgetary fund of 80%-90% as capital return from service change is approximately 14-37%. In board perspective, supporting fund is likely to increase, During this study, budgetary fund support was insignificantly different. Hospitals have been adjusting their systems to 30-Baht policy by tight debt-following policy and diminishing length of stay for in-patients.Discussion Currently, public health district cross services has recording high. This might come from the following reasons: an inequilibrium distribution of psychiatric doctors and hospital, reputation-lead-people to special hospitals. 30-Baht policy’s implementation drove changes on behavior of service use & take pattern by pattern by patients and by service providers as follows: primary and secondary hospitals increased number of in-patients, length-of-stay, and individual service charges. Contrarily, number of patients, length-of-stay, and individual service charges in hospitals under mental health department was declined. Evidenced from hospitals in Thailand’s Northern Region, financial difficulties have slightly affected due to stable budgetary fund supported in year 2001-2002 even service charges collected from UC program being less in comparison with previous level. More significantly, dig-to earth practical adjustments have been implemented. Minimizing length-of-stay effect has drastically reduced service costs and expenses. However, due to short-period data collection under this study and disease not lead to death soon or immediate cure, so this research cannot be totally concluded at this stage, Further study should be extended and further study in patient’s perspective is worthy for exploration.
