Economic impact of investment in maternal and newborn health care under the National Health Security Scheme of Thailand
y | 31 ago 2017
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Article Category: Brief communication (Original)
Publicado en línea: 31 ago 2017
Páginas: 65 - 72
DOI: https://doi.org/10.5372/1905-7415.1101.540
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© 2017 Pacharawan Khusakunrat, Jiruth Sriratanaban
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Pairwise univariate linear regression analyses of the year-on-year changes of the failure costs and the year-on-year changes in prevention costs and appraisal costs (n = 75 provinces in Thailand)
| Year-on-Year | Regression coefficient ( | 95% Confidence intervals | ||
|---|---|---|---|---|
| Lower | Upper | |||
| 2008 vs 2007 | –1.16 | –1.44 | –0.72 | 0.002 |
| 2009 vs 2008 | –1.28 | –1.84 | –0.62 | <0.001 |
| 2010 vs 2009 | –1.12 | –1.73 | –0.74 | <0.001 |
| 2011 vs 2010 | –0.47 | –1.62 | +0.68 | 0.43 |
Cost variables and data analyses
| Variables | Data | Source | Analytical method | Data collection |
|---|---|---|---|---|
| P1a: Cost of care based on benefit packages (e.g. antenatal care, family planning, post-natal care, vaccine) | Value of budget allocation for providing services according to benefit package | Budget allocation according to benefit package report | Summation of prevention–promotion–Express Demand budget allocation per province | NHSO budget allocation |
| P1b: Reimbursement for prenatal complications | Reimbursement according to DRG compared with adjusted RW | In-patient database according to DRG | Summation of reimbursement with adjusted RW standard price NHSO paid out each year | Collect from NHSO reimbursement |
| P2a: Investment in service infrastructure | Investment budget | MOPH’s health-resource database | Standard price from Budget Bureau | Bureau of Policy and strategy MOPH |
| P2b: Health personnel | Salaries of obstetric health personnel | Specialist payment record | Annual summation of medical staff payment | Data from Bureau of Policy and Strategy, MOPH |
| A1: Cost according to service quality indicators | Payment made to service units based on quality indicators | Pay for performance | Expense according to quality indicators | NHSO annual budget allocation |
| EF1: Cost from comprehensive obstetric service with complications or newborn service with complications | Reimbursement according to DRG compared with adjusted RW | In-patient database according to DRG | Summation of reimbursement with adjusted RW standard price NHSO paid out each year | Collect from NHSO reimbursement |
| EF2: Liabilities according to NHSO Act | Payment for Liabilities | Liabilities fund | Summation of total Liabilities | NHSO’s Law Office |
Amount of budget by type of Cost of Quality (US$ per Universal Coverage per person per year)
| Type | Categories | 2007 Mean (min, max) n = 75 | 2008 Mean (min, max) n = 75 | 2009 Mean (min, max) n = 75 | 2010 Mean (min, max) n = 75 | 2011 Mean (min, max) n = 75 | |
|---|---|---|---|---|---|---|---|
| CoQ | Total cost of quality (CoQ = P+A+F) | 10.31 (6.45, 16.97) | 12.47 (6.61, 18.64) | 12.76 (8.15, 19.10) | 12.98 (9.45, 18.76) | 14.87 (6.64, 21.27) | |
| P | Prevention cost (P=P1+P2) | 7.77 (4.12, 14.48) | 9.63 (4.39, 17.52) | 9.81 (5.61, 15.78) | 9.41 (6.36, 14.55) | 11.69 (4.73,18.27) | |
| P1 | Operating cost (P1=P1a+P1b) | 4.16 (2.15, 5.32) | 5.43 (3.15, 6.32) | 5.59 (3.26, 6.38) | 5.88 (3.75, 6.47) | 8.04 (5.18, 8.98) | |
| P1a | Benefit package: Prevention and prenatal care | 1.13 (0.70, 2.36) | 1.19 (0.94, 2.45) | 1.25 (1.00, 2.61) | 1.27 (1.09, 2.52) | 1.32 (1.30, 2.98) | |
| P1b | Reimbursement for prenatal complications | 3.03 (1.70, 3.36) | 4.34 (2.14, 5.17) | 4.34 (2.13, 4.61) | 3.91 (1.09, 4.52) | 4.98 (1.94, 5.11) | |
| P2 | Spending on service infrastructures (P2=P2a+P2b) | 3.61 (1.44, 4.45) | 4.20 (2.12, 5.06) | 4.23 (1.24, 5.09) | 3.52 (2.14, 4.25) | 3.65 (1.09, 4.56) | |
| P2a | Cost for specialist health personnel | 1.42 (1.06, 4.32) | 2.77 (1.15, 3.11) | 3.11 (1.53, 3.21) | 1.85 (1.14, 3.18) | 1.26 (1.02, 2.97) | |
| P2b | Investment for equipment | 2.29 (1.03, 4.15) | 1.53 (1.25, 3.24) | 1.12 (1.03, 2.15) | 2.67 (1.94, 3.97) | 2.39 (1.94, 3.28) | |
| A | Appraisal cost | ||||||
| A1 | Cost of pay for performance | 0.63 (0.33, 1.03) | 0.60 (0.24, 0.73) | 0.60 (0.33, 1.24) | 1.19 (0.55, 1.48) | 0.63 (0.33, 0.82) | |
| F | Failure Cost (F=EF1+EF2) | 1.92 (1.06, 3.67) | 2.24 (1.06, 4.18) | 2.35 (1.30, 4.61) | 2.48 (1.45, 4.64) | 2.56 (1.58, 4.61) | |
| EF1 | DRG-based payment for inpatient care | 1.83 (1.00, 3.55) | 2.18 (1.06, 4.15) | 2.27 (1.30, 3.48) | 2.39 (1.45, 3.55) | 2.47 (1.58, 4.12) | |
| EF2 | Liabilities | 0.09 (0.00, 0.11) | 0.06 (0.00, 0.03) | 0.08 (0.00, 0.11) | 0.07 (0.00, 0.09) | 0.09 (0.00, 0.09) |