Abstract
The objectives of this study were to evaluate Management of Medical Emergency
Services under Integration Management Policy, survey the member of Social Security Scheme
in term of their attitude between emergency medical service under Social Security (72 hrs.)
and Management of Medical Emergency Services under Integration Management Policy, and
work out appropriate payment method and reimbursement for eligible private hospitals that
gave provision of care to medical emergency patients. Mix method, qualitative and quantitative
were using for approach. In-depth interview were using for qualitative approach and questionnaire
were using for quantitative approach.
Policy evaluation found that for this policy follows ideology and the social justice of
Thai society, which is clearly showed in Thai Constitution and other related Acts. System
design in theory is well link systematically from input to process, output, and outcome.
However, a lot of hurdles are found at the level policy deployment. Many factors are
identified include clear assignment, appropriate resource especially reimbursement price and
asymmetrical information among staffs of social health protection schemes in different level
and beneficiaries.
The result of interview showed that when the member of Social Security Scheme
were admitted for the emergency treatment under Management of Medical Emergency
Services under Integration Management Policy. They have to reserve budget to private
hospital which provide care to them. Rate of reserve money to pay are 48.2%, the same as
the rate of not reserve money to pay (51.3%). For reserve money, it contributes to the cost
burden to patients as high as 97.6% in particular in group of income below 10,000 to 29,999
baht. The complacency of patients under Social Security Scheme between emergency
medical service under Social Security (72 hrs.) and Management of Medical Emergency
Services under Integration Management Policy were found to be similar percentage of 4.62
and 3.9, respectively.The appropriate payment method and reimbursement, payment by the Diag
Related Groups (DRGs) payment method is also appropriate in the current situation. To
propose appropriate reimbursement for private hospitals, using the reimbursement rate of
the Civil Servant Medical Benefits Scheme (CSMBS) to university hospitals, for treatment of
medical emergency patients which 17,662 baht per AdjRW, including 13,483 baht per AdjRW,
2,379 baht of labour price, and 1,800 baht of room and food prices for three days. Through
participatory approach in undertaking this project, the researchers and representatives of
private hospitals have an agreement that the appropriate imbursement rate should be
adjusted periodically in the future.
