Casemix and Payment Method Development for Thai Traditional Medicine Inpatient Casemix - การพัฒนากลุ่มโรคร่วมและวิธีการจ่ายเงิน สำหรับบริการผู้ป่วยในแพทย์แผนไทย

บทคัดย่อ

              Thai traditional medicine is wisdom of Thailand, but service reimbursement still limit. This action research aimed to develop the casemix and payment method for Thai Traditional Medicine Inpatient Casemix (TTMIC). Four steps were set up as follows: (1) standard data for TTMIC development, (2) data collecting and editing, (3) classification and evaluation, and (4) cost analysis, budget expectation to pay based on TTMIC. The study was conducted from fiscal year 2012 - 2014. Eleven hospitals were voluntarily recruited to develop TTMIC. Three types of Thai traditional medicine inpatient treatment modalities were set up for inpatients including intensive treatment with Thai traditional medicine, moderate treatment with Thai Traditional Medicine, and little treatment with Thai Traditional medicine. The independent variable for classification is Thai medicine diagnosis based on ICD-10 Thai modification. Dependent variables were length of stay and standardized charge as a proxy of cost to calculate Relative Weight (RW). Data analysis used Coefficient of variation (CV) and Reduction in variance (RIV). The results showed that there were 18,198 inpatients with TTM. According to inclusion and exclusion criteria, only 16,930 inpatients data were analyzed. 96.9% of all patients came from community hospital (16,403 cases). 60.8% were women (10,293 cases). Average age was 47.2 years (SD=25.2). Average day stay in hospital was 8.3 days (SD=22.3). The patients were classified into 20 groups. Most of TTMIC groups (65.0%) had CV lower than 150% and RIV was 25.3 %. Almost of them were patients with respiratory tract disease 4,467 cases (26.4%). The TTMIC that had highest RW was patient with paralyze (3.4037). The alternative payments for Thai Traditional medicine were paid by intensive of Thai medicine treatment based on TTMIC. Firstly, pay 10,000 baht per Relative Weight (RW) for intensive Thai medicine treatment and 1,000 Baht per RW for cases with moderate Thai medicine treatment. The budget for this the first payment model was 49 million baht. Secondly, additional payment for Thai medicine treatment was 1,000 baht per RW for all. The budget used 17 million baht only for the second model. We can conclude that TTMIC was appropriate in term of clinical and statistic using this data. Therefore more attention should be paid to the payment using casemix for TTMIC should use the additional variable for classification. The important data such as diagnosis, procedure code, cost data and standard data set should be prepared, so updated TTMIC could provide the useful data for Thai medicine budget estimation and benefit packet.

Key words: Casemix, Thai traditional medicine, payment model