Rehabilitation Service Development for Sub-acute and Non-acute Patients under the Universal Coverage Scheme in Thailand

Abstract

The objective of this study was to develop an appropriate payment model for sub-acute and nonacute patient (SNAP) in 4 health regions of the National Health Security Office (NHSO) in Thailand (Saraburi, Rayong, Udonthani and Songkla). Twenty-four hospitals in five provinces were recruited to develop the model. Three steps were set up as follows: (1) setting up the new service and payment system. (2) implementation of the new system (according to context of each province) and (3) evaluation. Effectiveness was assessed as gain of functional and quality of life on a Barthel Index assessment. Efficiency studies consist of time and cost of rehabilitation care per patient. Three groups of data were collected: (1) provider characteristics, (2) charateristics and clinical data of patients in the rehabilitation impairment category (stroke, traumatic and non-traumatic brain dysfunction, traumatic and non-traumatic spinal cord dysfunction, and major multiple trauma) and (3) administrative data from hospitals and the NHSO. The study was conducted during July 2013 - February 2015. Data were analyzed by using frequency, percentage, chi-square test, paired t-test, F-test, and multiple regression. It was found that the four health regions produced four different rehabilitation services and payment models. The inpatient and extended outpatient with home visit model (of Saraburi) and the extended regional to community hospital model (of Songkhla) were remarkable. Three payment methods were observed: prospective payment with global budget, outcome payment, and performance with outcome payment. Comparing functional outcome with cost of rehabilitation among 3 different payment models revealed that the outcome payment significantly increased functional status of the patients but accessibility to rehabilitation services (within the golden period in stroke patients) was still low (13.1% only). We concluded that rehabilitation service led to better outcome, but only a few inpatients who needed rehabilitation services could get access to it. Therefore more attention should be paid to improve accessibility of patients to rehabilitation services. Moreover payment method should be structured to increase effectiveness of rehabilitation outcomes.