Variation in Drug Utilisation across Different Health Insurance Schemes in Thailand: a Meta-analysis

Abstract

Objectives: Explore national trends and variation in drug utilisation across the three different health insurance schemes including: i) the Civil Servant Medical Benefit Scheme (CSMBS); ii) the Social Security Scheme (SSS); and iii) the Universal Coverage Scheme (UC). Methods: A meta-analysis was applied to drug cost data from a purposively selected sample of four hospitals for the fiscal year 2008. A detailed drug utilisation analysis was undertaken for subjects with diabetes and hypertension. As the cost and the volume data were skewed, logarithm transformed data were used. Random-effect models were adopted to obtain a pooled estimate. Results: The highest total annual drug cost per patient under the CSMBS was THB 767.77 (log mean 2.89, 95% CI 2.23-3.24), whilst the equivalent costs for the SSS and the UC were THB 215.41 (logged mean 2.33, 95% CI 2.20-2.46) and THB 290.50 (logged mean 2.46, 95% CI 2.33-2.60) respectively. The cost of insulin preparations per diabetic patient across the three schemes was similar, while costs of oral hypoglycaemic drugs varied with the highest for the CSMBS (THB 207.80, log mean 2.32 95% CI 2.04-2.60) and the lowest THB 47.16 for the UC (log mean 1.67, 95% CI 1.32-2.03). The cost of lipid-modifying agents per hypertensive patient under the CSMBS (THB 33.55, logged mean 1.53 95% CI 1.13-1.92) was higher than for the SSS (THB 7.57, log mean 0.88 95% CI 0.541.22) and the UC (THB 8.42, logged mean 0.93 95% CI 0.75-1.10). Cost and volume prescribed per year of beta blockers were quite similar for the three schemes (CSMBS 0.76 95% CI 0.66-0.87, SSS 0.75 95% CI 0.58-0.92, UC 0.71 95% CI 0.58-0.84). Conclusions: Variations in drug utilisation across the three schemes exist. The CSMBS beneficiaries are more likely to be prescribed newer expensive drugs.