Comparative Effectiveness of Three National Healthcare Schemes in Thailand: In-hospital Medical Expenses for Diabetes and Hypertension in 2010
Piyatat Tatsanavivat MD*, Yupa Thavornpitak MSc**, Chatlert Pongchaiyakul MD*
Affiliation : * Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ** Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
Objective : To compare the health insurance schemes regarding treatment of diabetes (DM) and hypertension (HT).
Material and Method: In-patient expense data for all ICD-10 DM and HT for 2010 were accessed from the National Health
Security Office (UC), the Social Security office (SS) and the Civil Servants Benefit System (CSMBS). Mean hospital stay,
charges and mortality rates were calculated and compared across schemes and types of hospital.
Results : Thais > 19 years accounted for 4,863,939 admissions (12.6% DM-All; 17.9% HT-All). Average admission per case
was higher for DM-All (1.66) than HT-All (1.46). CSMBS patients trended to be older than UC and SS. Most under UC were
admitted to primary care (51.9% DM-All; 50.0% HT-All) vs. tertiary under CSMBS (45.5% DM-All; 48.4% HT-All).
Median of stay under CSMBS was longer (1.3-2.0x) and charges higher (1.3-1.6x) than UC for all levels for both DM and HT.
Mortality rate under CSMBS was higher than UC in primary care for both DM and HT, while respective rates were higher
under UC than CSMBS for secondary (DM-All: 9.9 vs. 8.1; HT-All: 8.2 vs. 6.6) and tertiary care (DM-All:11.7 vs.8.6; HT-
All: 9.8 vs. 6.8).
Conclusion : Inequalities among three health insurance schemes for DM and HT including hospital charge, hospital stay and
mortality rate according to health care settings for DM and HT were shown, effectiveness improvement is needed.
Keywords : Diabetes, Hypertension, Health economy, Health insurance, Thailand
