Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2010
Age- and sex- standardized mortality rate of cardiovascular disease (CVD) was high in Bangkok and... more Age- and sex- standardized mortality rate of cardiovascular disease (CVD) was high in Bangkok and central Thailand in the year 2000. This may partially be related to differences in risk factors. To compare prevalence of CVD risk factors among regions in Thailand in the same period. From a survey in 2000 (InterASIA) which involved 5 regions in Thailand, conventional CVD risk factors were compared multivariate-wise among regions and subsequently aligned with CVD deaths obtained within similar regions from the registry. Bangkok and a central province had a higher prevalence of the following: hypertension, elevated body mass index, large waist circumference, elevated lipid associated with low density lipoprotein cholesterol and diabetes mellitus. The Northeast had a higher prevalence of smoking, low values of high density lipoprotein cholesterol and high triglyceride. Definite regional differences existed of CVD risks and death in Thailand in 2000. Some of the metabolic risk factors may...
The government has announced a policy of emergency medical service (ems) under three
public healt... more The government has announced a policy of emergency medical service (ems) under three public health insurance schemes, consisting of the Civil Servant Medical Benefits (CS), Social Security (SS) and Universal Coverage (UC), since April 1, 2012. The objective of this policy is to reduce inequality and to enhance accessibility to EMS for medical emergency patients. The National Health Security Office (NHSO), acted as the clearing house, was assigned to reimburse, on behalf of all the 3 schemes, eligible private hospitals for provision of care to medical emergency patients. Despite the policy directives against fee collection from the patients, it is evident that, most of such private hospitals failed to comply. This deviation was perceived to be a result of inadequate reimbursement. For example, in the case of medical emergency inpatient care, the reimbursement rate is 10,500 baht per adjRW. As a result, this research aims to work out appropriate payment method and reimbursement using the Emergency Claim Online (EMCO) data set operated by the NHSO between April and June 2013 encompassing 1,257 patients from 69 eligible private hospitals. Based on the recommendation of private hospital representatives participated in this project, analysis of potential differences of the average price per adjRW across business models and hospital location (Bangkok, its vicinity or regional provinces) was performed using Kruskal- Wallis method. It was found that there were substantial price differences between private hospitals registered in Thai Security Market, general private hospitals and nonprofit private hospitals. Yet, there was no price difference across the security-market-registered private hospitals situated in different geographical areas. In contrast among the general private hospitals or the non-profit private hospitals there was price difference among different locations. A reason for the price variations might be unnecessary services i.e., over treatment and over diagnostic workup as revealed from clinical audits of a sample of 80 selected patients. Another reason might be the differences of cost management and differential pricing policy according to perceived different purchasing power of the patients. 4 In order to recommend appropriate payment rate, the actuarial technique was applied to estimate initial payment rate (Expected Value) for private hospitals in 7 subgroups with different prices in the aforementioned. The estimates are : 1) 55,435 baht per adjRW for security-market-registered private hospitals and their subsidiaries of all locations, 2) 64,426 baht per adjRW for the general private hospitals in Bangkok, 3) 33,177 baht per adjRW for the general private hospitals in the metropolitan area, 4) 30,051 baht per adjRW for the general private hospitals in the province area, 5) 45,390 baht per adjRW for the non-profit private hospitals in Bangkok, 6) 24,634 baht per adjRW for the non-profit private hospitals in the metropolitan area , and 7) 23,906 baht per adjRW for the non-profit private hospital in the province area . Without taking account of the reasons for price and practice variations as discussed, the initial price estimates could not be justified for policy recommendation. Therefore, two alternatives were considered to propose more justifiable estimates: 1) discounting price from 10 to 80 percent using those estimates as baseline and 2) using the reimbursement rate of the most generous public insurance scheme (CS) to university hospitals, considered the major competitors of private hospitals, for treatment of medical emergency patients which is 17,662 baht per adgRW, including 13,483 baht per adjRW, 2,379 baht of labor price, and 1,800 baht of room and food prices for three days. Through participatory approach in undertaking this project, the researchers and representatives of private hospitals have an agreement that the appropriate imbursement rate should be adjusted periodically in the future. In this regard, the private hospitals will be required to give transparent cost and charge structure data on a regular basis. The reimbursement will also need to address extreme outlier charge by adopting the approach of Center for Medicare and Medicaid Services.
To determine prevalence rates of alcohol problems among emergency room patients. This was a cross... more To determine prevalence rates of alcohol problems among emergency room patients. This was a cross-sectional survey including patient interviews and record reviews. The questionnaire included the Alcohol Use Disorders Identification Test to screen for hazardous or harmful alcohol use (alcohol problems). It also contained questions regarding the chief complaint and factors precipitating the admission. Emergency rooms of three regional hospitals in Thailand. Consecutive emergency room admissions aged 14 and older, admitted from 18.00-02.00 h. Risk factors for alcohol problems included male gender, age 20-49, higher monthly income, less than university graduate education status and admission to the northeast regional ER. Among non-trauma patients, those with alcohol-related diagnoses and certain gastrointestinal disorders had the highest rates of alcohol problems. Patients with transportation injuries were twice as likely, and those with assault-, fall-, or burn-related injuries were at least three times more likely to screen positive compared to the non-injured comparison group. The estimated overall prevalence rate of alcohol problems for this population, adjusted for age and diagnostic classification, was 0.39 for males and 0.08 for females. Especially among patients with specified diagnoses, the emergency room is an ideal setting for implementing alcohol screening and intervention programmes in Thailand.
ABSTRACT This study evaluated the Alcohol Use Disorders Identification Test (AUDIT) against blood... more ABSTRACT This study evaluated the Alcohol Use Disorders Identification Test (AUDIT) against blood alcohol levels and medical diagnoses. The population under study included 695 current drinkers admitted to emergency rooms of four regional Thailand hospitals. The AUDIT positivity rate was 61% among 343 patients who drank prior to admission and 32% among 352 patients who did not drink alcohol before admission. Breath alcohol levels were positively associated with AUDIT scores. The sensitivity against a previous or current alcohol-related medical diagnosis was 89%. We concluded that the AUDIT is a satisfactory instrument for alcohol screening in this population.
Dyslipidaemia is a major risk factor for cardiovascular disease and is only detectable through bl... more Dyslipidaemia is a major risk factor for cardiovascular disease and is only detectable through blood testing, which may not be feasible in resource-poor settings. As dyslipidaemia is commonly associated with excess weight, it may be possible to identify individuals with adverse lipid profiles using simple anthropometric measures. A total of 222 975 individuals from 18 studies were included as part of the Obesity in Asia Collaboration. Linear and logistic regression models were used to assess the association between measures of body size and dyslipidaemia. Body mass index, waist circumference, waist : hip ratio (WHR) and waist : height ratio were continuously associated with the lipid variables studied, but the relationships were consistently stronger for triglycerides and high-density lipoprotein cholesterol. The associations were similar between Asians and non-Asians, and no single anthropometric measure was superior at discriminating those individuals at increased risk of dyslipidaemia. WHR cut-points of 0.8 in women and 0.9 in men were applicable across both Asians and non-Asians for the discrimination of individuals with any form of dyslipidaemia. Measurement of central obesity may help to identify those individuals at increased risk of dyslipidaemia. WHR cut-points of 0.8 for women and 0.9 for men are optimal for discriminating those individuals likely to have adverse lipid profiles and in need of further clinical assessment.
Recent estimates indicate that two billion people are overweight or obese and hence are at increa... more Recent estimates indicate that two billion people are overweight or obese and hence are at increased risk of cardiovascular disease and its comorbidities. However, this may be an underestimate of the true extent of the problem, as the current method used to define overweight may lack sensitivity, particularly in some ethnic groups where there may be an underestimate of risk. Measures of central obesity may be more strongly associated with cardiovascular risk, but there has been no systematic attempt to compare the strength and nature of the associations between different measures of overweight with cardiovascular risk across ethnic groups. Data from the Obesity in Asia Collaboration, comprising 21 cross-sectional studies in the Asia-Pacific region with information on more than 263 000 individuals, indicate that measures of central obesity, in particular, waist circumference (WC), are better discriminators of prevalent diabetes and hypertension in Asians and Caucasians, and are more strongly associated with prevalent diabetes (but not hypertension), compared with body mass index (BMI).For any given level of BMI, WC or waist : hip ratio, the absolute risk of diabetes or hypertension tended to be higher among Asians compared with Caucasians, supporting the use of lower anthropometric cut-points to indicate overweight among Asians.
This study determines the prevalence of metabolic syndrome (MetS) according to the International ... more This study determines the prevalence of metabolic syndrome (MetS) according to the International Diabetes Federation (IDF) and National Cholesterol Education Program III (NCEP) criteria in Thai adults. Data from a national representative sample, InterASIA study, including a total of 5305 Thai adults 35 years and older were analyzed. Overall, the age-standardized prevalence of MetS by IDF and NCEP criteria were 24.0% (men 16.4%, women 31.6%) and 32.6% (men 28.7%, women 36.4%), respectively. The difference in prevalence of MetS between genders was much greater for the IDF compared with the NCEP definition. The age-standardized prevalence rates distributed by geographic region were relatively uniform with a lowest prevalence in the northeast. Among all possible sets of components for MetS, the most common combinations were a set of low high-density lipoprotein cholesterol, high triglyceride, and hyperglycemia in men (3.9%) and a set of abdominal obesity, low high-density lipoprotein cholesterol, and high triglycerides in women (6.7%). MetS is common in Thai adults and NCEP definition captures more cases of MetS compared with the IDF definition. Implementation of programs to prevent obesity and metabolic factors along with future periodic survey to monitor the problem is crucial.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2010
Age- and sex- standardized mortality rate of cardiovascular disease (CVD) was high in Bangkok and... more Age- and sex- standardized mortality rate of cardiovascular disease (CVD) was high in Bangkok and central Thailand in the year 2000. This may partially be related to differences in risk factors. To compare prevalence of CVD risk factors among regions in Thailand in the same period. From a survey in 2000 (InterASIA) which involved 5 regions in Thailand, conventional CVD risk factors were compared multivariate-wise among regions and subsequently aligned with CVD deaths obtained within similar regions from the registry. Bangkok and a central province had a higher prevalence of the following: hypertension, elevated body mass index, large waist circumference, elevated lipid associated with low density lipoprotein cholesterol and diabetes mellitus. The Northeast had a higher prevalence of smoking, low values of high density lipoprotein cholesterol and high triglyceride. Definite regional differences existed of CVD risks and death in Thailand in 2000. Some of the metabolic risk factors may...
The government has announced a policy of emergency medical service (ems) under three
public healt... more The government has announced a policy of emergency medical service (ems) under three public health insurance schemes, consisting of the Civil Servant Medical Benefits (CS), Social Security (SS) and Universal Coverage (UC), since April 1, 2012. The objective of this policy is to reduce inequality and to enhance accessibility to EMS for medical emergency patients. The National Health Security Office (NHSO), acted as the clearing house, was assigned to reimburse, on behalf of all the 3 schemes, eligible private hospitals for provision of care to medical emergency patients. Despite the policy directives against fee collection from the patients, it is evident that, most of such private hospitals failed to comply. This deviation was perceived to be a result of inadequate reimbursement. For example, in the case of medical emergency inpatient care, the reimbursement rate is 10,500 baht per adjRW. As a result, this research aims to work out appropriate payment method and reimbursement using the Emergency Claim Online (EMCO) data set operated by the NHSO between April and June 2013 encompassing 1,257 patients from 69 eligible private hospitals. Based on the recommendation of private hospital representatives participated in this project, analysis of potential differences of the average price per adjRW across business models and hospital location (Bangkok, its vicinity or regional provinces) was performed using Kruskal- Wallis method. It was found that there were substantial price differences between private hospitals registered in Thai Security Market, general private hospitals and nonprofit private hospitals. Yet, there was no price difference across the security-market-registered private hospitals situated in different geographical areas. In contrast among the general private hospitals or the non-profit private hospitals there was price difference among different locations. A reason for the price variations might be unnecessary services i.e., over treatment and over diagnostic workup as revealed from clinical audits of a sample of 80 selected patients. Another reason might be the differences of cost management and differential pricing policy according to perceived different purchasing power of the patients. 4 In order to recommend appropriate payment rate, the actuarial technique was applied to estimate initial payment rate (Expected Value) for private hospitals in 7 subgroups with different prices in the aforementioned. The estimates are : 1) 55,435 baht per adjRW for security-market-registered private hospitals and their subsidiaries of all locations, 2) 64,426 baht per adjRW for the general private hospitals in Bangkok, 3) 33,177 baht per adjRW for the general private hospitals in the metropolitan area, 4) 30,051 baht per adjRW for the general private hospitals in the province area, 5) 45,390 baht per adjRW for the non-profit private hospitals in Bangkok, 6) 24,634 baht per adjRW for the non-profit private hospitals in the metropolitan area , and 7) 23,906 baht per adjRW for the non-profit private hospital in the province area . Without taking account of the reasons for price and practice variations as discussed, the initial price estimates could not be justified for policy recommendation. Therefore, two alternatives were considered to propose more justifiable estimates: 1) discounting price from 10 to 80 percent using those estimates as baseline and 2) using the reimbursement rate of the most generous public insurance scheme (CS) to university hospitals, considered the major competitors of private hospitals, for treatment of medical emergency patients which is 17,662 baht per adgRW, including 13,483 baht per adjRW, 2,379 baht of labor price, and 1,800 baht of room and food prices for three days. Through participatory approach in undertaking this project, the researchers and representatives of private hospitals have an agreement that the appropriate imbursement rate should be adjusted periodically in the future. In this regard, the private hospitals will be required to give transparent cost and charge structure data on a regular basis. The reimbursement will also need to address extreme outlier charge by adopting the approach of Center for Medicare and Medicaid Services.
To determine prevalence rates of alcohol problems among emergency room patients. This was a cross... more To determine prevalence rates of alcohol problems among emergency room patients. This was a cross-sectional survey including patient interviews and record reviews. The questionnaire included the Alcohol Use Disorders Identification Test to screen for hazardous or harmful alcohol use (alcohol problems). It also contained questions regarding the chief complaint and factors precipitating the admission. Emergency rooms of three regional hospitals in Thailand. Consecutive emergency room admissions aged 14 and older, admitted from 18.00-02.00 h. Risk factors for alcohol problems included male gender, age 20-49, higher monthly income, less than university graduate education status and admission to the northeast regional ER. Among non-trauma patients, those with alcohol-related diagnoses and certain gastrointestinal disorders had the highest rates of alcohol problems. Patients with transportation injuries were twice as likely, and those with assault-, fall-, or burn-related injuries were at least three times more likely to screen positive compared to the non-injured comparison group. The estimated overall prevalence rate of alcohol problems for this population, adjusted for age and diagnostic classification, was 0.39 for males and 0.08 for females. Especially among patients with specified diagnoses, the emergency room is an ideal setting for implementing alcohol screening and intervention programmes in Thailand.
ABSTRACT This study evaluated the Alcohol Use Disorders Identification Test (AUDIT) against blood... more ABSTRACT This study evaluated the Alcohol Use Disorders Identification Test (AUDIT) against blood alcohol levels and medical diagnoses. The population under study included 695 current drinkers admitted to emergency rooms of four regional Thailand hospitals. The AUDIT positivity rate was 61% among 343 patients who drank prior to admission and 32% among 352 patients who did not drink alcohol before admission. Breath alcohol levels were positively associated with AUDIT scores. The sensitivity against a previous or current alcohol-related medical diagnosis was 89%. We concluded that the AUDIT is a satisfactory instrument for alcohol screening in this population.
Dyslipidaemia is a major risk factor for cardiovascular disease and is only detectable through bl... more Dyslipidaemia is a major risk factor for cardiovascular disease and is only detectable through blood testing, which may not be feasible in resource-poor settings. As dyslipidaemia is commonly associated with excess weight, it may be possible to identify individuals with adverse lipid profiles using simple anthropometric measures. A total of 222 975 individuals from 18 studies were included as part of the Obesity in Asia Collaboration. Linear and logistic regression models were used to assess the association between measures of body size and dyslipidaemia. Body mass index, waist circumference, waist : hip ratio (WHR) and waist : height ratio were continuously associated with the lipid variables studied, but the relationships were consistently stronger for triglycerides and high-density lipoprotein cholesterol. The associations were similar between Asians and non-Asians, and no single anthropometric measure was superior at discriminating those individuals at increased risk of dyslipidaemia. WHR cut-points of 0.8 in women and 0.9 in men were applicable across both Asians and non-Asians for the discrimination of individuals with any form of dyslipidaemia. Measurement of central obesity may help to identify those individuals at increased risk of dyslipidaemia. WHR cut-points of 0.8 for women and 0.9 for men are optimal for discriminating those individuals likely to have adverse lipid profiles and in need of further clinical assessment.
Recent estimates indicate that two billion people are overweight or obese and hence are at increa... more Recent estimates indicate that two billion people are overweight or obese and hence are at increased risk of cardiovascular disease and its comorbidities. However, this may be an underestimate of the true extent of the problem, as the current method used to define overweight may lack sensitivity, particularly in some ethnic groups where there may be an underestimate of risk. Measures of central obesity may be more strongly associated with cardiovascular risk, but there has been no systematic attempt to compare the strength and nature of the associations between different measures of overweight with cardiovascular risk across ethnic groups. Data from the Obesity in Asia Collaboration, comprising 21 cross-sectional studies in the Asia-Pacific region with information on more than 263 000 individuals, indicate that measures of central obesity, in particular, waist circumference (WC), are better discriminators of prevalent diabetes and hypertension in Asians and Caucasians, and are more strongly associated with prevalent diabetes (but not hypertension), compared with body mass index (BMI).For any given level of BMI, WC or waist : hip ratio, the absolute risk of diabetes or hypertension tended to be higher among Asians compared with Caucasians, supporting the use of lower anthropometric cut-points to indicate overweight among Asians.
This study determines the prevalence of metabolic syndrome (MetS) according to the International ... more This study determines the prevalence of metabolic syndrome (MetS) according to the International Diabetes Federation (IDF) and National Cholesterol Education Program III (NCEP) criteria in Thai adults. Data from a national representative sample, InterASIA study, including a total of 5305 Thai adults 35 years and older were analyzed. Overall, the age-standardized prevalence of MetS by IDF and NCEP criteria were 24.0% (men 16.4%, women 31.6%) and 32.6% (men 28.7%, women 36.4%), respectively. The difference in prevalence of MetS between genders was much greater for the IDF compared with the NCEP definition. The age-standardized prevalence rates distributed by geographic region were relatively uniform with a lowest prevalence in the northeast. Among all possible sets of components for MetS, the most common combinations were a set of low high-density lipoprotein cholesterol, high triglyceride, and hyperglycemia in men (3.9%) and a set of abdominal obesity, low high-density lipoprotein cholesterol, and high triglycerides in women (6.7%). MetS is common in Thai adults and NCEP definition captures more cases of MetS compared with the IDF definition. Implementation of programs to prevent obesity and metabolic factors along with future periodic survey to monitor the problem is crucial.
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Papers by Paibul Suriyawongpaisal
public health insurance schemes, consisting of the Civil Servant Medical Benefits (CS), Social
Security (SS) and Universal Coverage (UC), since April 1, 2012. The objective of this policy is
to reduce inequality and to enhance accessibility to EMS for medical emergency patients.
The National Health Security Office (NHSO), acted as the clearing house, was assigned to
reimburse, on behalf of all the 3 schemes, eligible private hospitals for provision of care to
medical emergency patients.
Despite the policy directives against fee collection from the patients, it is evident that, most
of such private hospitals failed to comply. This deviation was perceived to be a result of
inadequate reimbursement. For example, in the case of medical emergency inpatient care,
the reimbursement rate is 10,500 baht per adjRW. As a result, this research aims to work out
appropriate payment method and reimbursement using the Emergency Claim Online (EMCO)
data set operated by the NHSO between April and June 2013 encompassing 1,257 patients
from 69 eligible private hospitals.
Based on the recommendation of private hospital representatives participated in this project,
analysis of potential differences of the average price per adjRW across business models and
hospital location (Bangkok, its vicinity or regional provinces) was performed using Kruskal-
Wallis method. It was found that there were substantial price differences between private
hospitals registered in Thai Security Market, general private hospitals and nonprofit private
hospitals. Yet, there was no price difference across the security-market-registered private
hospitals situated in different geographical areas. In contrast among the general private
hospitals or the non-profit private hospitals there was price difference among different
locations. A reason for the price variations might be unnecessary services i.e., over treatment
and over diagnostic workup as revealed from clinical audits of a sample of 80 selected
patients. Another reason might be the differences of cost management and differential
pricing policy according to perceived different purchasing power of the patients.
4
In order to recommend appropriate payment rate, the actuarial technique was applied to
estimate initial payment rate (Expected Value) for private hospitals in 7 subgroups with
different prices in the aforementioned. The estimates are : 1) 55,435 baht per adjRW for
security-market-registered private hospitals and their subsidiaries of all locations, 2) 64,426
baht per adjRW for the general private hospitals in Bangkok, 3) 33,177 baht per adjRW for the
general private hospitals in the metropolitan area, 4) 30,051 baht per adjRW for the general
private hospitals in the province area, 5) 45,390 baht per adjRW for the non-profit private
hospitals in Bangkok, 6) 24,634 baht per adjRW for the non-profit private hospitals in the
metropolitan area , and 7) 23,906 baht per adjRW for the non-profit private hospital in the
province area . Without taking account of the reasons for price and practice variations as
discussed, the initial price estimates could not be justified for policy recommendation.
Therefore, two alternatives were considered to propose more justifiable estimates:
1) discounting price from 10 to 80 percent using those estimates as baseline and 2) using the
reimbursement rate of the most generous public insurance scheme (CS) to university
hospitals, considered the major competitors of private hospitals, for treatment of medical
emergency patients which is 17,662 baht per adgRW, including 13,483 baht per adjRW, 2,379
baht of labor price, and 1,800 baht of room and food prices for three days.
Through participatory approach in undertaking this project, the researchers and
representatives of private hospitals have an agreement that the appropriate imbursement
rate should be adjusted periodically in the future. In this regard, the private hospitals will be
required to give transparent cost and charge structure data on a regular basis. The
reimbursement will also need to address extreme outlier charge by adopting the approach
of Center for Medicare and Medicaid Services.
public health insurance schemes, consisting of the Civil Servant Medical Benefits (CS), Social
Security (SS) and Universal Coverage (UC), since April 1, 2012. The objective of this policy is
to reduce inequality and to enhance accessibility to EMS for medical emergency patients.
The National Health Security Office (NHSO), acted as the clearing house, was assigned to
reimburse, on behalf of all the 3 schemes, eligible private hospitals for provision of care to
medical emergency patients.
Despite the policy directives against fee collection from the patients, it is evident that, most
of such private hospitals failed to comply. This deviation was perceived to be a result of
inadequate reimbursement. For example, in the case of medical emergency inpatient care,
the reimbursement rate is 10,500 baht per adjRW. As a result, this research aims to work out
appropriate payment method and reimbursement using the Emergency Claim Online (EMCO)
data set operated by the NHSO between April and June 2013 encompassing 1,257 patients
from 69 eligible private hospitals.
Based on the recommendation of private hospital representatives participated in this project,
analysis of potential differences of the average price per adjRW across business models and
hospital location (Bangkok, its vicinity or regional provinces) was performed using Kruskal-
Wallis method. It was found that there were substantial price differences between private
hospitals registered in Thai Security Market, general private hospitals and nonprofit private
hospitals. Yet, there was no price difference across the security-market-registered private
hospitals situated in different geographical areas. In contrast among the general private
hospitals or the non-profit private hospitals there was price difference among different
locations. A reason for the price variations might be unnecessary services i.e., over treatment
and over diagnostic workup as revealed from clinical audits of a sample of 80 selected
patients. Another reason might be the differences of cost management and differential
pricing policy according to perceived different purchasing power of the patients.
4
In order to recommend appropriate payment rate, the actuarial technique was applied to
estimate initial payment rate (Expected Value) for private hospitals in 7 subgroups with
different prices in the aforementioned. The estimates are : 1) 55,435 baht per adjRW for
security-market-registered private hospitals and their subsidiaries of all locations, 2) 64,426
baht per adjRW for the general private hospitals in Bangkok, 3) 33,177 baht per adjRW for the
general private hospitals in the metropolitan area, 4) 30,051 baht per adjRW for the general
private hospitals in the province area, 5) 45,390 baht per adjRW for the non-profit private
hospitals in Bangkok, 6) 24,634 baht per adjRW for the non-profit private hospitals in the
metropolitan area , and 7) 23,906 baht per adjRW for the non-profit private hospital in the
province area . Without taking account of the reasons for price and practice variations as
discussed, the initial price estimates could not be justified for policy recommendation.
Therefore, two alternatives were considered to propose more justifiable estimates:
1) discounting price from 10 to 80 percent using those estimates as baseline and 2) using the
reimbursement rate of the most generous public insurance scheme (CS) to university
hospitals, considered the major competitors of private hospitals, for treatment of medical
emergency patients which is 17,662 baht per adgRW, including 13,483 baht per adjRW, 2,379
baht of labor price, and 1,800 baht of room and food prices for three days.
Through participatory approach in undertaking this project, the researchers and
representatives of private hospitals have an agreement that the appropriate imbursement
rate should be adjusted periodically in the future. In this regard, the private hospitals will be
required to give transparent cost and charge structure data on a regular basis. The
reimbursement will also need to address extreme outlier charge by adopting the approach
of Center for Medicare and Medicaid Services.