Abstract
This study was aimed to estimate cost profile, unit cost and performance of public and private hemodialysis (HD) centers throughout the country for the year 2001(2544BE). A self administered questionnaire survey was distributed to the whole 170 HD centers. This is to solicit information on labor cost (including salary, wages, fringe benefit and overtime payment) and time allocation for HD center only, direct material cost for providing HD services (excluding public utilities and related drugs for the treatment of complications). We use straight line depreciation cost for capital investment in HD machines (5 years useful life) and buildings (20 years useful life).A multiple regression was used to estimate cost function of HD centersWe got 117 questionnaire returned, 69% response rate, with 108 complete forms for analysis (64%). By 2001, there were 730 machines operating, 56% owned by publicand 44% by private. Private HD centers had higher productivity (number of sessionper HD per day) than public. On cost profile, the ratio of labor cost to material cost to capital cost was 40:43:17. Total costs of public and private HD center were 273.9 and 259.7 million Baht respectively. Capital cost of public HD center was 10% higher than the private HD centers. Unit cost per HD session was 1,927 Baht in public and 1,525 Baht in private HD centers. Multiple regression demonstrated that total sessions and session per HD per day determined total cost of public and private HD centers, with R2 of 0.865.We performed breakeven analysis, the current charge per session was high enough in both public and private to perform their productivity higher than the breakeven point.Reimbursement of 1,500 Baht for social security workers was too low and that hospital set charge higher than 1,500 Baht for them. Scatter-gram where X axis represented session per HD per day and Y axis represented unit cost, demonstrated that private HD centers were more efficient than public centers.This study should provide a strong ground for further policy analysis on expansion of renal replacement therapy for the Universal Coverage scheme. In the meantime, HD centers could improve its performance through reduction of unit cost and increase productivity. To improve the performance, there was a need to solve administrative problems at micro-level, such as staff incentives.
