Abstract
Background: The rapid increase in the number of the patients infected by the Coronavirus disease 2019 (COVID-19 surged) and the number of critically ill patients following the pandemic situation has an impact on the overall health care expenditures. This study examines the financial impact and health services impact during the COVID-19 pandemic. The findings from this study are important information for health policy decision makers in considering financial management to ensure efficiency of providing health services at hospitals that will be beneficial the entire hospital and reduce inequality in people's access to health services. Methods: This study consists of (1) studying the financial impact and the average monthly service volume at the Outpatient Department (OPD), Inpatient Department (IPD), Emergency Department: ED) and Operating Room department (OR) separated by the 3 health insurance schemes during situation of the COVID-19 pandemic compared to normal situation. And (2) studying the concept and implementation of hospital policies to create reserve health services capacity in terms of patient care, health service system, places, personnel, drugs and medical equipment, and others in 8 hospitals that covers all levels of service facilities under the Office of the Permanent Secretary Ministry of Public Health and classified according to color zones, areas where the COVID-19 outbreak is spread in 4 regions across Thailand. Results The results were compared in 3 periods as follows: period (1) normal situation (Before the COVID-19 outbreak) for a period of 2 years, between 1 January 2018 and 31 December 2019, period (2) COVID-19 outbreak situation, for a period of 15 months, between 1 January 2020 to 31 March 2021, and period (3) during the COVID-19 pandemic situation for a period of 6 months, between 1 April to 30 September 2021. The trend of the revenue hospitals should receive per month which is the sum of the hospital service rates from patients without COVID-19, was clearly decreasing compared to monthly income before the outbreak and is related to the severity of the COVID-19 pandemic situation. However, the hospital's 7 levels of critical financial risk (Risk Scoring) during period (2) were not different from period (1) while it was decreasing during period (3). This may be due to adjustments in reimbursement rates for treatment of COVID-19 patients of all 3 health insurance funds have increased in value including donating money and/or medical equipment to the hospital. That the hospital's financial risks are no problem or have improved despite the service utilization rate and the income that should be received from providing services to patients who do not have COVID-19 disease clearly decreased because the hospitals were receiving compensation for COVID-19 patients' services has greatly increased including additional payments (add-ons) for both services in medical facilities and services at home especially during period (3). In terms of the utilization of health care services in the hospitals, there had been a change. When comparing the 3 periods mentioned above, they were found that although the number of COVID-19 patients had been still small, hospitals needed to change their service delivery model according to the lack of knowledge of COVID-19. As a result, the number of non-COVID-19 patients in hospitals during period (2) decreased. For during period (3), which was a large outbreak situation, the quantity of COVID-19 patients greatly increased while the number of non-COVID-19 patients returned to the same amount as during period (1) which was a normal situation. This change was evident in outpatient and emergency room departments. As for the volume of services received at the inpatient department and operating room department, there was no obvious change. This may be because the hospital had made the effort to maintain the potential of providing services in these two departments. However, the services in the operating room department would focus on preparing for emergency surgery (emergency surgery). Conclusion: The situation of COVID-19 pandemic affecting the health services utilization rate. Hospitals, as providers of health services, need to allocate limited resources to maintain their capacity to provide essential and urgent health services. A permanent mechanism for declaring states of emergency for emerging diseases should be established. The compensation mechanism, the medical treatment claim rates and the information system are needed to be improved for monitoring the financial situation regularly. Including preparedness planning and business sustainment plans are important factors that will help prepare healthcare facilities to deal with outbreaks of emerging infectious diseases in the future. Preparedness planning and business sustainment plans are important factors that will help prepare healthcare facilities to deal with outbreaks of emerging infectious diseases in the future.
