Situation of medical service utilization among the insured according to the Social Security Act 1990 : a case study at Chulalongkorn Hospital

Abstract

The objective of this study was to assess the situation of medical service utilization of the insured at Chulalongkorn Hospital according to the Social Security Act 1990. The study was performed during May to October 1997. Number of insured workers, nature of diseases treated and information about medical cost were collected by medical record surveys. Patient satisfaction and medical service problems were assessed by questionnaire interviewing. As outpatient, 8,707 insured workers used at least one visit with a total of 22,556 visits. The use rate among users were 2.59 visits per person. Outpatient services utilization rate was 294.2 episodes/ 1000 persons. The 5 leading diagnostic groups were respiratory system (13.2%), followed by musculoskeletal and connective tissue (11.5%), endocrine and metabolic system (9.9%), circulatory system (8.2%), and skin disease (7.2%). An average medical cost per visit was 338.80 baht, cost per case was 877.67 baht. Of which 85.78% was drugs, 7.38% was radiological investigation, 6.75% was laboratory,0.06% was EKG, and 0.03% was medical supplies. As inpatient, 427 insured workers used at least one admission with a total of 505 admissions. The use rate among users were 1.18 visits per person. Inpatient service utilization rate was 6.59 episodes/1000 persons. The 5 leading diagnostic groups were digestive system (14.7%), followed by genitourinary system (13.1%), circulatory system (11.1%), neoplasms (10.9%), and musculoskeletal and connective tissue (8.5%). An average medical cost per admission was 6,582.85 baht, cost per case was 7,767.76 baht. Of which 51.76% was drugs, 5.95% was radiological investigation, 3.81% was laboratory, 0.05% was EKG, and 38.43% was medical supplies. The degree of patient satisfaction was in farely level (3.50 ± 0.43). About 98.4 % were moderately to high satisfied. The patient satisfaction with waiting time was the lowest while the hospital service system was the highest. This study provides the basic information for managerial the quality of hospital services and service pricing which could be used as a guideline for considering to estimate resource requirements for delivery of the service.