ต้นทุนของการให้บริการส่วนบุคคลและครอบครัวที่เป็นบริการป้องกันโรค ตามชุดสิทธิประโยชน์หลักประกันสุขภาพถ้วนหน้าในโรงพยาบาลสังกัดกระทรวงสาธารณสุข / สุนีย์ สว่างศรี = Cost of preventive health service in Ministry of Health's hospital under the universal health coverage's core package / Sunee Sawangsri
The aims of this study are to assess provision and unit cost of disease prevention services under the four benefit packages of the universal health insurance program in hospital owned by the Ministry of Public Health. The fiscal year 2001 cost data (October 2000-September 2001) From the provider perspective were retrospectively collected. There were 33 cost centers of which labour costs material costs and capital costs were gathered. It was found that median direct costs (DC) of providing tuberculosis vaccine (BCG) 27.5 baht per visit, hepatitis B vaccine (HBV) 62.1 baht per visit, Diptheria Tetanus Pertussis vaccine (DTP) 31.1 baht per visit, Oral Polio vaccine (OPV) 30.2 baht per visit, Mum Measles Rubella (MMR) 62.9 baht per visit, Japanese encephalitis vaccine (JE) 75.4 baht per visit, Ditheria Tetanus (DT) 25.8 baht per visit, Tetanus vaccine (TT) 55.3 baht per visit. The proportions of operating costs (OC) per visit to direct costs per visit in providing those vaccine were 93.8, 95.6, 83.4, 92.5, 96.6, 91.8, 82.2 and 79.4 percent, respectively. The proportions of marginal costs (MG) per visit to direct costs per visit in providing those vaccine were 37.0, 88.4, 32.8, 28.6, 84.9, 69.1, 27.5,15.3 percent, respectively.The median DC of Physical examination (PE), Clinical breast examination (CBE), Screening for cervical cancer (SCC) and Laboratory tests were 66.9,42.0,88.6 and 559.1 baht per visit., respectively. The proportions of OC per visit to direct costs per visit in providing PE, CBE, SCC and Laboratory tests were 67.4, 82.1, 94.6 and58.9 percent, respectively. The proportions of MG per visit to direct costs per visit in providing PE, CBE, SCC and Laboratory tests were11.5, 57.5, 93.9 and 36.5 percent, respectively. The median DC of anti-viral drug for HIV-pregnant woman was 6,558.3 baht per visit. It OC to DC and MG were 92.3 and 99.9 percent. The median DC of fluoride supplementation for risk group, sealant and scaling were 126.9, 46.9 and 54.8 baht per visit. The proportions of OC of providing fluoride supplementation for risk groups, sealant and scaling were 85.7,88.6 and 92.8 percent, respectively. The proportions of MG of providing fluoride supplementation for risk groups, sealant and scaling were 88.7,75.6 and 86.9 percent, respectively. The costs of providing disease prevention services were not different among hospitals with different sizes, except for scaling (p = 0.05 ). Some 28.30 percent of the sampled hospitals suggested that the disease prevention package should not be the same for all hospitals The study findings could be applied in budget planning and management of the benefit package of the universal health insurance program. They also basic information for hospitals administrations in order to plan and manage for disease prevention efficiently as well as to determine guidelines to decrease costs associated with health promotion and disease prevention.
