HOSPITAL BEHAVIOR AND RESPONSE OF THAI PUBLIC HOSPITALS TO HEALTH INSURANCE PAYMENT SYSTEM

Abstract

In the study on hospital behavior and response to health insurance payment system in service provision and hospital cost behavior, the data on hospital finance and healthcare utilization of patients in the Civil Servant Medical Benefits Scheme (CSMBS) of the hospitals under the Permanent Secretary Office of Ministry of Public Health from 2005 to 2010 before and after payment change from fee-for-service (FFS) to diagnosis-related-group (DRG) based payment in 2008 were employed. The findings showed an overall decrease in service intensity in term of average length of stay for CSMBS inpatient admissions and at the general and community hospitals. A decrease in the admission rate at all types of hospitals and a decrease in the proportion of CSMBS inpatient cases at the community hospitals were found. At present, the change in the proportion of CSMBS outpatient visits does not exist. In addition, an increase in the referred-out rate of CSMBS patients at the community hospitals was found. Regarding the hospital cost behavior, a decrease in hospital costs for CSMBS inpatients was found in community hospitals, but no change for general and regional hospitals. However, it is evident that short-run cost minimization behavior existed in all types of hospitals, but there is no evidence of long-run cost minimization behavior.