The Need for Rehabilitation Care of Sub-acute and Non-acute Inpatients in Thailand - ความจำเป็นด้านบริการฟื้นฟูสมรรถภาพทางการแพทย์ของผู้ป่วยในระยะเฉียบพลันและไม่เฉียบพลันในประเทศไทย

Abstract

The recent casemix payment in Thailand focused on acute care that may minimize the importance
of rehabilitation services to sub-acute and non-acute patients (SNAPs).
This study was aimed at determining the proportion of SNAPs to the total inpatients and
examining the required budget to provide rehabilitation care in hospital for stroke patients.
Based on all patients discharges in 2009 (5,945,740 cases), a total of 3,663,773 inpatient data
from 1,035 hospitals were studied after excluding patients who were less than 18 years, who died in
hospital or were transferred from or to another hospital. Principal diagnoses according to the rehabilitation
impairment categories (RIC) were used to estimate the size of potential SNAP. Data on
rehabilitation procedure was the actual rehabilitation services provided. Data analysis used frequency,
percentage, chi-square test and student‘s t-test.
The results showed that of all admissions, 16.6 percent were potential SNAPs according to
principal diagnoses at discharge, only 7.4 percent (50,332 cases) had rehabilitation procedure. More
than half of the patients, who were potential SNAP, were cardiac disorders (24.5%), pulmonary
disorders (24%), and stroke (9.7%). Percentage of patients who got rehabilitation services were
41.6 for lower extremity fracture, 25.8 for other orthopedic conditions, 22.7 for Major multiple
trauma (MMT), 27.6 for MMT with brain and spinal cord conditions, 17 for other MMT, 27.2 for
traumatic spinal cord and 14.5 for non-traumatic spinal cord, these numbers are very low. Moreover,
only 10.6 percent of all stroke patients (65,615 cases) had rehabilitation care in hospital
(compared with the reportedly normative rate of 70%). With the acute casemix payment system,
big hospitals in Bangkok provided the highest proportion of rehabilitation services for stroke (18.9%)
with 27.2 days stayed in hospital, while only 3.1 percent of stroke patients in community hospitals
got rehabilitation service with 9.7 days stayed in hospital. Patients in Civil Servant Medical Service
Scheme got more rehabilitation than patients in Universal Coverage Scheme. Estimated budget
of rehabilitation for 70 percent of all stroke admissions was 432.9 million Baht.
In conclusion, under the casemix payment not recognizing SNAP, only a few inpatients who
needed rehabilitation services were reported to access these services. The SNAP payment should
be considered to promote access to rehabilitation care in hospital.
Key words: sub-acute and non-acute, rehabilitation, casemix