Suriyawongpaisal Paibul, Atiksawedparit Pongsakorn, Srithamrongsawad Samrit, Thongtan Thanita
Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama 6, Ratchathewi, Bangkok, Thailand.
Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama 6, Ratchathewi, Bangkok, Thailand.
Emerg Med Int. 2018 Sep 26;2018:6470319. doi: 10.1155/2018/6470319. eCollection 2018.
Previous policy implementation in 2012 to incentivize private hospitals in Thailand, a country with universal health coverage, to provide free-of-charge emergency care using DRG-based payment resulted in an equity gap of access and copayment. To bridge the gap, strategic policies involving financial and legal interventions were implemented in 2017. This study aims to assess whether this new approach would be able to fill the gap.
We analyzed an administrative dataset of over 20,206 patients visiting private hospital EDs from April 2017 to October 2017 requested for the preauthorization of access to emergency care in the first 72 hours free of charge. The association between types of insurance and the approval status was explored using logistic regression equation adjusting for age, modes of access, systolic blood pressure, respiratory rate, and Glasgow coma scores.
The strategic policies implementation resulted in reversing ED payer mix from the most privileged scheme, having the major share of ED visit, to the least privileged scheme. The data showed an increasing trend of ED visits to private hospitals indicates the acceptance of the financial incentive. Obvious differences in degrees of urgency between authorized and unauthorized patients suggested the role of preauthorization as a barrier to the noncritical patient visiting the ED. Furthermore, our study depicted the gender disparity between authorized and unauthorized patients which might indicate a delay in care seeking among critical female patients. Lessons learned for policymakers in low-and-middle income countries attempting to close the equity gap of access to private hospital EDs are discussed.
2012年泰国曾实施一项政策，旨在激励该国拥有全民医保的私立医院使用基于疾病诊断相关分组（DRG）的付费方式提供免费急诊护理，但这导致了就医机会和自付费用方面的公平差距。为弥合这一差距，2017年实施了涉及财政和法律干预的战略政策。本研究旨在评估这种新方法是否能够填补这一差距。
我们分析了一个行政数据集，该数据集包含2017年4月至2017年10月期间前往私立医院急诊科就诊的20206多名患者，这些患者申请了在前72小时免费获得急诊护理的预先授权。使用逻辑回归方程，对年龄、就诊方式、收缩压、呼吸频率和格拉斯哥昏迷评分进行调整，探讨保险类型与批准状态之间的关联。
战略政策的实施导致急诊支付方结构发生逆转，从最具优势的方案（在急诊就诊中占主要份额）转变为最不具优势的方案。数据显示，私立医院急诊就诊人数呈上升趋势，这表明对财政激励措施的接受。已授权和未授权患者在紧急程度上存在明显差异，这表明预先授权对非危急患者前往急诊科起到了阻碍作用。此外，我们的研究描绘了已授权和未授权患者之间的性别差异，这可能表明危急女性患者在寻求治疗方面存在延迟。文中还讨论了中低收入国家政策制定者在试图缩小私立医院急诊科就医公平差距方面可吸取的经验教训。
