Factors Affecting Per Capita Costs in Subdistrict Health Promotion Hospitals (SHPH) After Transfer to Provincial Administrative Organizations (PAO): A Study of Allocation Models in Thailand
Author(s)
Noppcha Singweratham, Ph.D.1, Tuangrat Phodha, Ph.D.2, Win Techakehakij, Ph.D.3, Pallop Siewchaisakul, Ph.D.1, Aumpol Bunpean, Ph.D.4, Sineenart Chautrakarn, Ph.D.1;
1Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand, 2Faculty of Pharmacy, Thammasat University, Khlong Luang, Pathum Thani, Thailand, 3Lampang Hospital, Lampang, Thailand, 4Kanchanabhishek Institute of Medical and Public Health Technology, Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute, Nonthaburi, Thailand
1Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand, 2Faculty of Pharmacy, Thammasat University, Khlong Luang, Pathum Thani, Thailand, 3Lampang Hospital, Lampang, Thailand, 4Kanchanabhishek Institute of Medical and Public Health Technology, Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute, Nonthaburi, Thailand
OBJECTIVES: This study aimed to compare and analyze factors affecting per capita costs in Subdistrict Health Promotion Hospitals (SHPH) after their transfer to Provincial Administrative Organizations (PAO), examining eight different allocation models. These models comprise: 1) Hospital-SHPH proportion allocation, 2) Population-based allocation, 3) SML-level allocation, 4) Allocation through Contracting Unit for Primary Care (CUP), 5) PP allocation (OP through CUP), 6) Equal allocation across all units, 7) Advance transfer (75% through CUP), and 8) Pending agreement arrangements.
METHODS: The methodology employed both top-down and micro-costing approaches, combined with a bottom-up method from a healthcare provider perspective. The study analyzed healthcare service costs and supporting resources data from the National Health Security Fund of primary healthcare service contractors and the National Health Security Office (NHSO) for service provision in 45 SHPH facilities during fiscal years 2022 and 2023.
RESULTS: The findings revealed that the unit cost for outpatient services varied by SHPH size. For physician consultations, the unit cost was 786.3 baht in 2022 and 175.1 baht in 2023. For non-physician consultations, it was 266.6 baht in 2022 and 1,189.7 baht in 2023. When analyzed by size of hospital, the center of CUP, physician consultation unit costs ranged from 61.2 to 865.3 baht in 2022 and 47.47 to 444.5 baht in 2023. Considering different allocation methods, physician consultation unit costs ranged from 0 to 4,364.0 baht in 2022 and 0 to 932.7 baht in 2023.
CONCLUSIONS: There is significant variations in unit costs across different allocation models and service types in HPH facilities following their transfer to PAO administration. Rather than SHPH size, parent hospital size and allocation methods with treatment costs, there might be other unmeasured variables may play more crucial roles in determining healthcare delivery costs.
METHODS: The methodology employed both top-down and micro-costing approaches, combined with a bottom-up method from a healthcare provider perspective. The study analyzed healthcare service costs and supporting resources data from the National Health Security Fund of primary healthcare service contractors and the National Health Security Office (NHSO) for service provision in 45 SHPH facilities during fiscal years 2022 and 2023.
RESULTS: The findings revealed that the unit cost for outpatient services varied by SHPH size. For physician consultations, the unit cost was 786.3 baht in 2022 and 175.1 baht in 2023. For non-physician consultations, it was 266.6 baht in 2022 and 1,189.7 baht in 2023. When analyzed by size of hospital, the center of CUP, physician consultation unit costs ranged from 61.2 to 865.3 baht in 2022 and 47.47 to 444.5 baht in 2023. Considering different allocation methods, physician consultation unit costs ranged from 0 to 4,364.0 baht in 2022 and 0 to 932.7 baht in 2023.
CONCLUSIONS: There is significant variations in unit costs across different allocation models and service types in HPH facilities following their transfer to PAO administration. Rather than SHPH size, parent hospital size and allocation methods with treatment costs, there might be other unmeasured variables may play more crucial roles in determining healthcare delivery costs.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR88
Topic
Health Policy & Regulatory
Topic Subcategory
Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas