Abstract
Intermediate care (IMC) is a type of subacute care that intends to provide intensive
rehabilitation for post-stroke patients who need this care to prevent complication and disabilities.
This research intended to develop the IMC system for stroke patients in Bangkok Zone 5 in
accordance with the primary care reform policy of the Bangkok Metropolitan Administration. IMC
home rehabilitation is an IMC care to post-stroke patients during the 6 months golden period that
National Health Security Office (NHSO), Thailand, has enpanded their benefit beyond IMC ward
and IMC OPD. The expansion to cover IMC home rehabilitation also come with a fee schedule
remuneration of 450 baht/session for 20 sessions and additional 200 baht/session for 20 sessions
for transportation to patient’s home. However IMC home rehabilitation haven’t been covered by
both the Civil Servants Medical Benefits Scheme (CSMBS) and the Social Security Scheme (SSS).
This study collected data on the Bathel Index (BI), EQ_5D_5L, and WHO5 to compare the
physical capability, quality of life and well-being of four difference ( different) types of services,
including IMC ward, IMC OPD, IMC home rehabilitation, and a self-home-based rehabilitation.
The result showed that there is no significant difference among scores of the BI, EQ5D5L,
and WHO5 of the four groups of services. Moreover, there had been progressions in all groups
after 3-6 months follow-up.
As reimbursement for IMC home rehabilitation from NHSO is much lower than the rate
of private physiotherapist session of 1,000 baht. In this study, there is only one private clinic,
Kanok clinic, that accepted to provide IMC home rehabilitation to patients as the Kanok clinic
could control the cost of providing IMC home rehabilitation. This was because the Kanok clinic
recieved enough cases sent from two major tertiary care hospitals (three hundred of patients).
Policy recommendations are as follow: 1) two major public health insurances, the Civil Servant
Medical Benefit Scheme (CSMBS) and the Social Security Scheme (SSS), should cover the benefit
of the IMC home rehabilitation; 2) Strengthen the collaboration among tertiary, secondary, and
primary care to facilitate the flow of patients from tertiary care hospitals to primary care; 3) Raise
reimbursement of IMC home rehabilitation to be more than 800 baht/session; 4) Design new
option to hire self-employed physical therapist to increase opportunity to receive IMC home
rehabilitation for patient.
