Abstract
Laparoscopic surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions for treatment and diagnosis. As compared to larger incisions needed in traditional surgical procedures, the patients with laparoscopic surgery had smaller incisions and less blood loss which leads to better quality of life. However, laparoscopic surgery is more expensive. Currently, the reimbursement method and rate are different among health insurance schemes. Therefore, this study aims to evaluate the utilization of laparoscopic surgery between patients under Civil Servant Medical Benefit scheme (CSMBS) and those under Universal Coverage scheme (UC) as well as the cost-effectiveness and budget impact of laparoscopic surgery in health insurance system in Thailand.
The data of inpatients undergoing laparoscopic surgery obtained from the Central office for Healthcare Information (CHI) from 1 January 2005 to 31 December 2007 based on procedure code (ICD-9-CM) and principal diagnosis code of laparoscopic (ICD-10) were used to determine the access to laparoscopic surgery between the patients under CSMBS and those under UC. It was found that diseases of gallbladder and cholecystitis, diseases of gynaecology and acute appendicitis were the most dieases performing laparoscopic surgery. Patients’ health insurance is the facor associated with the access to laparoscopic surgery the most. The patients under CSMBS had significantly higher access to laparoscopic surgery compared to those under UC because the reimbursement method and rate are different among these two insurance systems. Moreover, large hospitals were more likely than small hospitals to perform the laparoscopic procedure since surgeons with expertise in laparoscopic surgery and and expensive equipments are usually in large hospitals.
The cost-effectiveness analysis of laparoscopic surgery was obtained from the study in 2005 i.e., the cost-utility of laparoscopic surgery versus conventional open cholecystectomy. It was found that the incremental cost per QALY was 144,692 Baht under government perspective and 86,464 Baht under a societal perspective. Laparoscopic surgery would be considered as a cost-effective strategy regarding to a threshold of one to three times of gross domestic product per capita recommended by the subcommittee of the development of benefit package and service system, the National Health Security Office (NHSO).
Based on the results, it was concluded that although laparoscopic surgery in cholecystectomy would be cost-effective, the patients under UC still could not appropriately access to laparoscopic surgery when compared to patients under CSMBS for the reason that the NHSO does not provide higher reimbursement rate in case of laparoscopic surgery compared to traditional surgery procedures. This reimbursement system of NHSO does not support hospitals to perform laparoscopic surgery which had higher cost but same reimbursement rate compared to traditional surgery. In order to increase the access to laparoscopic surgery, the NHSO should provide the interventions such as an increase in reimbursement rate of laparoscopic surgery compared to open surgery to hospitals by assigning the higher relative weight score or allowing patients under any Thai health insurance schemes pay the co-payment when receiving laparoscopic surgery. In addition, the Ministry of Public Health should provide financial support for the training on laparoscopic surgery to increase the number of surgeons in this field.
