Abstract
BackgroundThailand has reformed its healthcare to ensure fairness and universality. Previous reports comparing the fairness among the 3 main healthcare schemes, including the Universal Coverage Scheme (UCS), the Civil Servant Medical Benefit Scheme (CSMBS) and the Social Health Insurance (SHI) have been published. They focused mainly on provision of medication for cancers and human immunodeficiency virus infection. Since chronic kidney disease (CKD) patients have a high rate of hospitalization and high risk of death, they also require special care and need more than access to medicine. We, therefore, performed a 1-year, nationwide, evaluation on the clinical outcomes (i.e., mortality rates and complication rates) and treatment costs for hospitalized CKD patients across the 3 main health insurance schemes.MethodsAll adult in-patient CKD medical expense forms in fiscal 2010 were analyzed. The outcomes focused on were clinical outcomes, access to special care and equipment (especially dialysis), and expenses on CKD patients. Factors influencing mortality rates were evaluated by multiple logistic regression.ResultsThere were 128,338 CKD patients, accounting for 236,439 admissions. The CSMBS group was older on average, had the most severe co-morbidities, and had the highest hospital charges, while the UCS group had the highest rate of complications. The mortality rates differed among the 3 insurance schemes; the crude odds ratio (OR) for mortality was highest in the CSMBS scheme. After adjustment for biological, economic, and geographic variables, the UCS group had the highest risk of in-hospital death (OR 1.13;95 % confidence interval (CI) 1.07–1.20; p < 0.001) while the SHI group had lowest mortality (OR 0.87; 95 % CI 0.76–0.99; p = 0.038). The circumscribed healthcare benefits and limited access to specialists and dialysis care in the UCS may account for less favorable comparison with the CSMBS and SHI groups.ConclusionsSignificant differences are observed in mortality rates among CKD patients from among the 3 main healthcare schemes. Improvements in equity of care might minimize the differences.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1792-9) contains supplementary material, which is available to authorized users.
Highlights
Thailand has reformed its healthcare to ensure fairness and universality
Since chronic kidney disease (CKD) patients have an increased rate of hospitalization and a high risk for death [9, 10], we evaluated the nationwide healthcare data of hospitalized CKD patients in fiscal year 2010 for practice outcomes of healthcare among the 3 main health insurance schemes
Additional information obtained from the Nephrology Society of Thailand, the National Statistical Office, and the Office of the National Economic and Social Development Board, Office of the Prime Minister included: ratio of nephrologists to dialysis units/regional population and end-stage renal disease (ESRD) patients, and the reimbursement of renal replacement therapies among the different healthcare schemes
Summary
Previous reports comparing the fairness among the 3 main healthcare schemes, including the Universal Coverage Scheme (UCS), the Civil Servant Medical Benefit Scheme (CSMBS) and the Social Health Insurance (SHI) have been published. They focused mainly on provision of medication for cancers and human immunodeficiency virus infection. The 4 national healthcare insurance schemes include: (i) the Universal Coverage Scheme (UCS) provides free medical care for persons without any other insurance (i.e., > 70% of the population: the majority of farmers, low-income persons, and the unemployed); (ii) the Civil Servant Medical Benefit Scheme (CSMBS) provides free medical care for government employees and their dependents; (iii) the Social Health Insurance (SHI) scheme for private sector employees; and, (iv) private insurance. The respective proportion of national GDP of the Northeast and North is 34 and 45% [3]
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