Assessment of emergency medical service of three schemes under the concept “medical emergency care for everybody everywhere”

Abstract

Background Thailand has three main health insurance schemes: Universal Coverage Scheme (UCS), Social Security Scheme (SSS) and Civil Servant Medical Benefit Scheme (CSMBS). Health benefits of these schemes are different, which could lead to inequity in access to care and quality of care. Medical emergency care was the first healthcare programme that was implemented towards harmonization of the three schemes. This programme was implemented since April 1, 2012. Since then, all emergency care patients were expected to be treated under the same rules without being rejected by all private hospitals. The payment mechanism used fee schedule of CSMBS for outpatient service and diagnosis related group (DRG) for inpatient service with a single base rate of 10,500 Baht per adjusted relative weight including medical instruments and drugs. The aim of the study was to assess the policy outcomes of the Emergency Medical Service focusing on private hospitals.