Economic Evaluation of public/private mix management in Ban Paew community hospital, Thailand

Abstract

Thailand like many of its southeast Asians neighbors has experienced rapid socio-economic changes in the past years. This prevailing situation has contributed to the growth f a strong for-profit private health sector providing mainly curative care in private clinics and hospitals throughout the country. While the private sector is stimulating quality of health care and perhaps, economic efficiency, it is at the same time also raising serious concerns such as cost escalation, equity of health care and braindrain' from the public health sector. To overcome some of these critical issues, the government has been undertaking various health care financing reforms at different levels of the health care delivery system including public/private mix management in the hospitals. The objectives of this sutdy are to examine the characteristics of public/private mix management in Ban Paew district community hospitaland its effects on the hospital utiliaztion and cost-recovery. A chronology of events of public/private mix activities are described. The following four specific outcomes are measured to determine the effects of the P/P mixactivities: - accessibility and quality of care; - hospital utilization; - equity and efficiency of the system; - cost-recovery of the hospital. The available data strongly suggest that there have been significant improvement in all four outcome criteria especially hospital utilizaiton and cost-recovery. The findings of hospital utilization of Ban Paew are compared with a neighboring district with conventional public sector management system. It is found that Ban Paew hospital has much higher utilization rate than that of its neighbor. Conclusions are then drawn to determine the successes or failures of the present P/P mix system of Ban Paew. Finally, the experience of P/P mix management in Ban Paew has been discussed in light of its potential application to other community hospitals in the country or elsewher in the region.