Abstract
Referring patients from community to provincial hospitals results in higher direct non-medical costs
(DNMc), which include the costs of transportation, food, accommodation, and informal caregivers. However, these costs have not yet been quantified.
This study estimates the increase in DNMc for referred ambulatory and hospitalized patients. To
approximate the DNMc of patients at community hospitals, a cross-sectional survey was conducted in
three community hospitals in Suratthani province during 16-26 February 2015. The DNMc of patients
who were referred to the Suratthani provincial hospital, were derived from previous studies which reported
the DNMc of patients at this hospital. Cost adjustment was performed using the consumer price
index, with base year 2015. T-tests were used to compare the differences between parameters, with a
significance level of 0.05.
The results showed that, for each day the patients were hospitalized at a provincial hospital, the
costs of informal caregivers were 632.90 Baht higher than those admitted to community hospitals. For
ambulatory care patients, the total DNMc of those referred to a provincial hospital were 513.40 Baht higher
than those receiving care at community hospitals.
Higher DNMc may prevent patients from accessing needed care when referred from community to
provincial hospitals. One way to mitigate this obstacle is to improve the capacity of community hospitals,
thereby reducing the need to refer patients to provincial hospitals without compromising quality of care.
