Service System and Payment Methods for Medical Rehabilitation Service in Thailand - ระบบบริการและการจ่ายเงินสำหรับบริการฟื้นฟูสมรรถภาพทางการแพทย์ประเทศไทย

Abstract

        This literature review was aimed at explaining overall service system and payment methods for medical rehabilitation in Thailand and payment methods in the United State, Australia, and Japan. The study reviewed literatures from journals and other resources; reports, books, and electronic database that could be accessed free of charge.

        The less priority of rehabilitation service relative to acute care in Thai health care system, lack of inpatient beds, the number of practitioners, the amount of budget, and the mechanism of payment were the limitations for medical rehabilitation services in Thailand. Capitation and fee-for-service were payments for ambulatory rehabilitation service in Thailand. In the US, payment method for ambulatory rehabilitation services was capitation through managed care system. Per episodes and per diem prospective payment system based on casemix classification were payment methods in Australia. In Japan, fee -for-service on the national fee schedule was the payment for outpatient rehabilitation services. For inpatient rehabilitation services in Thailand, the payment was based on Diagnosis Related Group (DRG) with ceiling for facilities in the Universal Coverage Scheme (UCS) and Civil Servant Medical Benefit Scheme (CSMBS), and capitation for Social Security Scheme (SSS). In the US and Australia, the payments were per episodes prospective payment system based on the Casemix Group (CMG), the Australian Sub-acute and Non-acute Patient classification (ANSNAP), and the Casemix and Rehabilitation Funding Tree (CRAFT). Each casemix system required specific data for classifying patients to predict resource needed, such as, diagnosis that led to disability (rehabilitation impairment category), functional status including motor and cognitive, patient age and comorbidity. In Japan, the fee-for-service on the national fee schedule was the payment separated from acute care. This review can provide evidence relevant to further develop appropriate options of service system and payment mechanism in medical rehabilitation service in Thailand.

Key words: medical rehabilitation, rehabilitation casemix, payment method