Costs for COVID-19 inpatients in Thailand: a case study of Ministry of Public Health Hospitals

Abstract

The objectives of this study were to analyze hospital costs for inpatients with COVID-19 in fiscal year 2021 and analyze predictive factor of the cost of inpatients with COVID-19. The costs were from the provider’s perspective and calculated using standard top-down and bottom-up methods by the HSCE program. The data were obtained from 21 voluntary hospitals under the Ministry of Public Health (MOPH) including 9 of regional hospitals, 8 of general hospitals and 4 community hospitals. Inclusion criteria for COVID-19 were inpatients with diagnoses U07.1, U07.2, B97.2 and then grouped into Thai Diagnosis Related Group (DRG) via TDRG version 6.3. The COVID-19 inpatients were classified by 6 DRG groups. Prior to the analysis, abnormal cost data were excluded, resulting in 87,145 cases for analysis. The analysis used statistical descriptive analysis e.g. percent, arithmetic mean, standard deviation (SD), median, and multiple regression analysis as statistical predictive analysis. The results showed that most of inpatients with COVID-19 were in regional hospitals, 68.6%. Overall, patients with COVID-19 spent an average of 11 days in hospital (SD=4.1). The average age of the patients was 35.1 years. The top three most frequent DRG were observation DRG group, 49,225 cases (56.5%) followed by pneumonia DRG group 21,385 cases (24.5%) and respiratory DRG group 12,271 cases (14.1%). The average and median cost per case were 22,216 baht (SD=72,135) and 13,847 baht. The highest average cost was 25,653 baht per case (SD=72,135) at general hospitals, 21,068 baht (SD=20,276) at regional hospitals, and 15,984 baht (SD=13,968) at community hospitals. The average and median costs for patients with severe DRG group were 72,327 baht per case (SD=54,027) and 61,326 baht. The average and median costs for patients with pneumonia DRG group were 31,259 baht per case (SD=46,035) and 21,900 baht. The average and median costs for patients with observation DRG group were 17,022 baht (SD=39,536) and 11,437 baht. The predictive factors of the costs of COVID-19 inpatient were hospital size, severe DRG group, age, medical supply costs, room and food costs and nursing costs. These factors were able to explain the cost of COVID-19 inpatients at 80.9% with statistical significance (p<0.001). The results of predictive factors of costs for taking care of inpatients with COVID-19 found that: (1) the general hospital would see a 28.0% increase in cost comparedto the community hospitals; (2) severe DRG group an 86.0% compared to the observation DRG group; (3) a 1 year increase in age would result in a 0.3% increase; and (4) for service factors, it was found that when only one of medical supply costs, room and food costs, and nursing cost was increasing by 1%, it would result in increasing costs 0.1%, 0.3% and 0.3% respectively. Aside from knowing the actual cost of services, the benefits from this study were used as information for requesting COVID-19 budget allocations as well as planning hospital resources. Further, the impact of factors affecting service costs could be applied to develop service efficiency to reduce the cost of providing services to COVID-19 inpatients or other infectious diseases.