Beruflich Dokumente
Kultur Dokumente
2
PresentaAon
Outline
1. Introducing
Health
Policy
&
Systems
Research
(HPSR)
Purposes
of
HPSR
Dierent
kinds
of
knowledge
needed
Source: WHO )2012); de Savigny & Adam (2009); Scheerens and Bosker (1997); Pix source: humanrevod.wordpress.com
Dierent
Levels
of
Health
Systems
Source: Gilson, editor (2012). Health Policy and Systems Research: A Methodology Reader.
Health
Systems
&
Health
Policy
Terrain of Health Policy and Systems Research
Source: Gilson, editor (2012). Health Policy and Systems Research: A Methodology Reader.
What
Is
&
What
Is
Not
HPSR?
Source: Gilson, editor (2012). Health Policy and Systems Research: A Methodology Reader.
Research
Strategies
in
HPSR
Source: Gilson, editor (2012). Health Policy and Systems Research: A Methodology Reader.
Research
Strategies
in
HPSR
Source: Gilson, editor (2012). Health Policy and Systems Research: A Methodology Reader.
Example
of
HPSR:
Study
of
Healthcare
Cross-subsidizaAon
in
Thai
Public
Hospitals
Individual &
Employers
private health Commercial
insurance Insurance
(Voluntary) Companies
Medical Generalists
Motor vehicles owners Specialists & PCPs
(Mandatory by the Motor
Vehicle Victim Protection Law) Patients paying out-of-pocket
of the out-patient expenditure during the second period showed an upward trend and
had very rapid growth in the last two years, 2006 and 2007 (graph 2.5).
With respect to expenditure per patient, this study can merely consider the average in-
Study
RaAonale
patient expenditure, because of data limitations. According to data from the electronic
payment system, the average in-patient expenditure in 2003-2006 increased over time as
shown in graph 2.6.
expenditures:
26,043
30,000
20,476 22,686 21,896
25,000
16,440 17,058 19,181 16,943
20,000
15,000
13,587 15,502 15,253
17
Figure
source:
www.be2hand.com;
www.imdb.com
Literature
Review
18
Study
ObjecAves
1. To
explore
mo?va?ons
and
exis?ng
prac?ces
of
the
administrators
of
Thai
public
hospitals
that
poten?ally
can
lead
to
cross-subsidiza?on (to
use
payments
of
a
type
of
health
services
to
support
nancing
of
other
services).
2. To
develop
mental
models
of
the
administrators
of
Thai
public
hospitals
regarding
organiza?onal
responses
to
healthcare
nancing
policies.
3. To
demonstrate
an
empirical
evidence
related
to
cross-
subsidiza?on
at
the
hospital
level,
including
the
cost
dierence
and
the
dierence
of
excess
of
revenues
over
expenses
among
health
schemes.
19
Methodology:
Research
Design
No
empirical
study
of
cross-subsidiza?on
in
the
contexts
of
Thai
healthcare
system.
Concepts
from
developed
countries
such
as
the
U.S.
might
not
be
applicable
in
Thailand.
21
Source: Creswell (2009). Research design: Qualitative, quantitative, and mixed methods approaches. 3rrd ed.
Methodology:
Source
of
Data
Data
was
based
on
three
selected
public
hospitals:
Two
medical
centers
with
1,000
and
1,134
beds
One
teaching
hospital
with
1,378
beds.
Hospitals
were
purposefully
selected,
based
on
the
accessibility
to
the
hospital
administrators
and
the
availability
of
the
datasets
of
unit
cost,
claims,
and
reimbursement.
22
Methodology:
Data
QualitaAve
data:
Semi-structure
interviews
and
focus-group
interviews.
30
key
informants
who
are
responsible
for
the
administra?on
of
the
three
hospitals.
Verba?m
was
transcribed
and
analyzed
using
ATLAS.?
7.
QuanAtaAve
data:
Secondary
data
of
inpa?ent
care,
collected
at
the
pa?ent
level,
from
the
two
medical
centers.
Unit-cost,
charge,
reimbursement,
pa?ents
health
scheme,
DRG
codes,
and
basic
demographic
characteris?cs.
Analysis
was
conducted
using
Stata
12.
23
Research
Findings
25
QualitaAve
Findings
cost.
mean of totalcost
reimbursement
is
greater
than
cost,
20,000
while
reimbursement
is
lower
than
costs
for
UC
10,000
pa?ents.
Total
charge
is
set
to
0
Charge-Cost
are
posi?ve
for
all
groups,
2,000
Reimbursement
(or
charge)
is
much
lower
than
the
cost
for
UC
and
foreign
-5,000
pa?ents.
Insucient
reimbursement
Hospitals
burden
to
take
-10,000
0
-10,000
-20,000
MDC
22
=
Burns
-30,000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 28
elder
pa?ents.
This
dierence
is
0
If
there
is
cost-shi^ing
between
UC
and
OOP
pa?ents,
we
expect
to
see
(mean) charge_cost_diff_cash
a
nega?ve
rela?onship
between:
50000
(reimbursement-cost)UC
and
(charge-cost)OOP.
0
No
clear
evidence
of
-50000
ac?ve
cross-subsidiza?on.
-300000 -200000 -100000 0 100000 200000
(mean) reimb_cost_diff_UC
Reimbursement-to-Cost
RaAo
The
reimbursement-
200
reimbursement-to-cost
ra?o
greater
than
2000!!
50
0
outliers,
the
reimbursement-to-cost
15
mean of reimb_cost_ratio
cost
data.
0
38
ImplicaAons
for
Policy
and
PracAce
To
policymakers:
Demonstrates
an
empirical
evidence
of
that
current
healthcare
nancing
of
hospitals
s?ll
inappropriate/inadequate.
Suggests
that
payments
from
par?cular
payers
could
be
used
as
a
buer
for
hospitals,
poten?ally
leading
to
passive
cross-subsidiza?on
and
inequity
issues
of
healthcare
access.
Suggests
how
to
harmonize
health
funds
in
a
more
ecient
and
equitable
fashion.
39
InformaAon
Systems
for
DeterminaAon:
The
Case
of
Policies
for
Healthcare
Financing
43
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45
Q
&
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borwornsom.lee@mahidol.ac.th