Patterns of Outpatient Services and Charge for Patients Enrolled in the Universal Health Coverage Scheme

Abstract

Background: In 2011, the Universal Health Coverage (UHC), which is a public health insurance scheme, covered approximately 48.3 million (74.3%) of the Thai population. This study aims to examine the patterns of outpatient services and analyze the difference between mean of charge in healthcare per patient per year among the various outpatient-service patterns. Methods: The data was gathered from outpatient service providers in Chiang Mai, Khon Kaen, Lampang and Songkla in 2011. We generated thirty-one patterns of outpatient services based on five categories of existing healthcare providers: 1) Health Centers (HC); 2) Community Hospitals (CH); 3) General/Regional Hospitals (GH/RH); 4) University Hospitals (UH); and 5) Other Hospitals (OH). Descriptive statistical analysis and one-way analysis of variance (ANOVA) were used to assess the difference between mean of charge in healthcare per patient per year among the various outpatient-service patterns. Results: For those accessing a single health facility, 29.1 % occurred in HC, 19.8% occurred in CH, and 7.5% occurred in GH/RH. For those accessing two different health facilities, 20.8% occurred in HC and CH, 4.5% occurred in HC and GH/RH, and 2.1% occurred in CH and GH/RH. For those accessing three different health facilities, 2.8% occurred in HC, CH and GH/RH. Other patterns of access in outpatient service in excess of three health facilities per year were less than 1.0%. In terms of charge (per patient per year), HC generated the lowest (295.4 Baht) while both GH/RH and UH generated the highest (13,236.2 Baht). The mean of charge in healthcare services among the thirty-one patterns were significantly different. A subset of seven groups was classified that corresponded to the patterns. Conclusions: Outpatient-service patterns were consistent with policy of Universal Health Coverage Scheme (UCS). UCS patients are able to access a variety of healthcare services from primary to tertiary care. Different service patterns affected charges differently. To allocate budget and improve the payment system for outpatient services, UCS policymakers should consider the impact of patterns on outpatient services.