Academic journal article Journal of Health Population and Nutrition

Predicting Treatment Cost for Bacterial Diarrhoea at a Regional Hospital in Thailand

Academic journal article Journal of Health Population and Nutrition

Predicting Treatment Cost for Bacterial Diarrhoea at a Regional Hospital in Thailand

Article excerpt

INTRODUCTION

Thailand is a Southeast Asian country with a population of 62.4 million in 2005. Acute diarrhoea is one of the most prevalent diseases in Thailand, and morbidity rate pertaining to this disease has been ranked the highest in the country since 1985. Results of an epidemiological study in four hospitals in 2005 indicated that most diarrhoea patients were children aged less than five years (35.2%). Salmonella spp. (39.9%), Vibrio parahaemolyticus (33.1%), Escherichia coli (18.0%), Shigella spp. (2.5%), and Vibrio cholerae El Tor Inaba (1.8%) were mainly responsible for the disease (1). The number of inpatients at government hospitals (80.5% of the total hospital-beds in the country in 2004) was 11,323.8 per 100,000 in 2004. Meanwhile, the numbers of inpatients suffering from typhoid, paratyphoid fever, and other Salmonella-associated infections, including other intestinal infectious diseases, was 629.7 per 100,000 people. Ninety-six deaths due to acute diarrhoea and enteric fever were reported in 2004 (2). This study was conducted as part of the project titled "Institutional cost of shigellosis in Kaengkhoi district, Saraburi province, Thailand." The project is a part of the multi-country programme sponsored by the International Vaccine Institute, South Korea. Therefore, we would like to focus on bacterial diarrhoea to compare with shigellosis.

The major health-service facilities in Thailand, in terms of the number of settings and beds, are public hospitals consisting of 725 district hospitals, 70 provincial hospitals, and 25 regional hospitals (3). The healthcare system of Thailand comprises three health insurance options: the Social Security Scheme (SSS) for private employees, the Civil Servant Medical Benefit Scheme (CSMBS) for government employees, and the Universal Health Care Scheme (UC) for the remainder of the Thai people. The UC covers approximately two-thirds of the Thai population. The payment methods for hospitals are capitation (a fixed amount per person) for the SSS and the UC and fee-for-service for the CSMBS. The major revenue of the public hospitals comes from capitation. Due to public fiscal constraints and other reasons, the Government has not always approved the capitation rate requested (4). Thus, one of the important management moves in this situation is cost-containment (5). Correspondingly, it is pivotal for hospital administrators to know the cost of treatment, including factors that contribute to this cost, and to use such information for prudent financial management. Hospital cost-analysis and cost-of-illness studies were introduced in Thailand less than a decade ago. And, in fact, a few hospitals have conducted such research. In this light, the present study is aimed at analyzing the health costs of bacterial diarrhoea at a regional hospital (Saraburi Hospital) in central Thailand. Although the study was conducted in one hospital only, it is based on the concept of 'better than nothing'.

MATERIALS AND METHODS

This incidence-based cost-of-illness study was conducted from a hospital (provider) perspective, employing a bottom-up or micro-costing approach (6). This study design measures the economic burden on patients from the starting to the end-points of their illnesses. It observes only new cases occurring within a given period and monitors them until reaching the end-point. Since the study sites are public hospitals, the study may be categorized as being from a health system perspective or public perspective.

Cost of illness is composed of direct medical costs, direct non-medical costs, and indirect costs. Direct medical costs are healthcare-related costs directly spent for the prevention, detection, treatment, continuing care, rehabilitation, and terminal care of patients. This study covers only direct medical costs or treatment costs. In a bottom-up approach, costs are collected directly from a patient sample covering individual drug-use and medical services. …

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