Abstract
The rate of payment or reimbursement for health care services has been used by The Comptroller
General’s Department (CGD), Ministry of Finance of Thailand in Civil Servant Medical Benefit Scheme
since 2006. This rate does not comply with the cost of medical care services and the advancement in
medical technology. The Executive Committee of the Civil Servant Medical Benefit Scheme has resolved
to improve that public health service rate. Thus, the Health Insurance Research Office (HISRO) has been
assigned the responsibility to reviewing the reimbursement rate for health services. This review will bring
about several recommendations and modifications that are aimed to reduce the financial burden of the
reimbursements on revenues and control the costs of the drugs used. The existing reimburse rate that is
inconsistent with the operating costs.
Qualitative and quantitative analysis were used to discuss on the current data of anesthesiology
category. The first step was to conduct a focus group discussion with experts from 10 hospitals (Hospitals
under Ministry of Public Health, Ministry of Defence and Hospital Medical School) and The Royal College
of Anesthesiologists of Thailand. The second step was to consider the related items and then collected
and analyzed cost structures consist of labor cost, material cost and capital cost.
The results indicated increasing units of two services, anesthesia services and equipment usage,
from the period of 2006 to 2014. In anesthesia service, there were 8 items in 2006 and it had increased to 13
items in 2014. Meanwhile, the equipment usages cost was increased by 10 items from 6 items in 2006 to 16
items in 2014. In terms of structure cost, there are three highlighted findings. First, the total direct cost
structure equals to the sum of labor cost, material costs and capital costs. Second, the administrative cost
is accounted for 25 per cent from total direct cost. The updated price is derived from the full cost (total
direct cost structure plus 25 percent overhead). Third, the future development cost composed of the sum
of full cost and 5 percent of full cost.
The evidence suggested important findings in terms of Anaesthetic time records, at average of 1,342
hours. The average labor cost for an anesthesiologist was 11.68 baht per minute and 6.34 baht per minute
for a nurse anesthetist. In terms of material cost, the combination of anesthesia care and the basic material
used in the opening line, cost started from 1,053 baht. The equipment costs started from 490 baht per total
Anaesthetic time per 5 years. The ratio of direct cost, labor cost: material cost: capital cost by General
Anesthesia (GA), is estimated at 37:43:20, meanwhile the General Anesthesia for Complicated patient
(GA (C)) ratio is estimated at 49:35:16. Regional Anesthesia (RA) first-hours service in sequence is estimated
at 52:21:27 and Local Anesthesia with Monitored Anesthetic Care (LA with MAC) in the first-hours
service is estimated at 62:5:33.
In conclusion, this above mentioned figure of the cost structure reflects the actual cost in present
year, 2014. Labor cost recorded as the highest expenditure. However, additional cost can be requested
when necessary. It is suggested, the expensive equipment has to be separated from basic instruments and
form into new item. In addition to that, it is important and necessary to build comprehensive data for
hospital cost to improve the public health service rate. Lastly, the study recommends that the systematic
data collection and real-time data record have to be made.
