Direct Medical Cost in Patients with Asthma in a Community Hospital in Thailand

Abstract

Objective: To determine direct medical cost in asthmatic patients in a small community hospital in Kanchanaburi. Methods: This study was a descriptive research that collected retrospective data from the electronic database HOSxP of a 60-bed community hospital in Kanchanaburi. The inclusion criteria for patients were being diagnosed with asthma between October 1, 2013 and September 30, 2017. The primary outcome was direct medical costs by converting charges to costs using ratio of cost to charge. The secondary outcome was the receiving of medications for controlling symptoms. The study analyzed the data by fiscal year 2014 - 2017 and health benefits. Results: The study recruited 468 patients with an average age of 38.47 ± 20.56 years, 60.47% being female, 67.95% having no other chronic diseases, and 78.42% with universal coverage scheme. The average costs for the years 2014 - 2017 were 6,615 ± 9,002, 5,756 ± 6,911, 4,546 ± 8,785 and 4,557 ± 41,162 baht/patient/year, respectively. The cost of medication accounted for 36.05 - 51.14%. The average service utilization rate among outpatients tended to decrease from 5.31 ± 5.08. times/patient/year in 2014 to 3.08 ± 2.47 times/patient/year in 2017. In addition, patient with universal coverage scheme had the highest total cost of 4,938 ± 11,015 baht/patient/year, followed by those with social security and civil servant medical benefit schemes. Patients tended to receive less inhaled corticosteroid to control symptoms with the rate of 70.12% in 2014 to 59.17% in 2017. Conclusion: In 2014-2017, the total direct medical costs of asthma patients in this hospital tended to decrease every year. The overall cost of outpatients, both in medication and non-medication costs, tended to decrease. However, cost for inpatient tended to increase. When comparing among health schemes, patients with social security schemes had the highest service rates and total outpatient costs, but there were no utilization of inpatient service at all in this group. Patients with universal coverage scheme had the highest total cost and the total cost of in-patients.