Abstract
The objective of this study was to develop drug reimbursement prices for National Health Security Office (NHSO) Region #13, Bangkok. Specifically, it was intended to be used for outpatient referrals, disability, accident, and emergency. Proposed models were tested with claim data of nine hospitals. This study adopted three criteria, including quality, cost containment, and sustainability, to conceptualize the framework for the eimbursement prices.Results proposed 3 different models of regressive mark-up roportion for reimbursed price setting.These 3 models were tailored for 3 different groups of drug: pharmaceutical product in general, pharmaceutical product by GMP-PICs assured manufacturers and pharmaceutical product with Narrow therapeutic index; in order to promote uses of quality assured product and maintaining quality of health care
service. The mechanism to ensure system sustainability was assigned by employing the reference prices enacted by Ministry of Public Health as the based price to calculate reimbursed price. This consistent and updated input of based price data will be promised. A number of cost containment mechanisms were also built in this model: setting single reimbursed price for one generic name of drug, assigning lower rate
of markup proportion than what Comptroller General’s Department established, regressive markup proportion for the later baht of drug price which aimed to encourage cheaper pharmaceutical products prescribing. Finally, financial impact to stakeholders was thoroughly investigated and ensured. In conclusion, this study proposed a model of pharmaceutical reimbursed price setting for cases of out outpatient referrals, disability, accident and emergency. A number of crucial mechanisms has been deliberately incorporated in the model ensuring sustainability, promoting quality of care and optimal
expenditure. This reimbursed price setting model is an applicable policy option for Thai health insurance system.
