Book Summary:
Thailand implemented the national 30-Baht health insurance policy in June 2001 to provide healthcare coverage (including drugs) for the uninsured population. We retrospectively assessed the impact of this policy on drug utilization in community government hospitals using computerized patient-specific data from 8 hospitals in Ubonratchatani province. Cross-sectional data from January 2000 to December 2003 included all inpatients and outpatients with bacterial pneumonia (CAP), gastrointestinal (GI) infections, diabetes (DM), and hypertension (HTN). We confirmed the internal validity of the database and conducted interviews of hospital personnel. The primary measure was drug utilization rate (DUR), measured as the Defined Daily Dose (DDD)/10,000 population/month. The secondary measures were percent prescribing appropriateness, hospital visit and admission rates. Monthly observations (N=48) were analyzed using segmented time series regression analysis (SARIMA model). Prior to the policy, the average monthly DUR of the 30-Baht group for DM, HTN, GI infections, and CAP were 2,727.8, 1,414.0, 40.3, and 7.8 DDDs/10,000 beneficiaries, hospital visit rates were 86.7, 25.8, 25.6, and 1.9 visits/10,000 beneficiaries, and hospital admission rates were 2.5 and 0.3 admissions/10,000 beneficiaries, respectively. After the policy, average monthly DUR for DM, HTN, GI infections, and CAP were 3,105.6, 2,983.5, 52.8 and 12.4 DDDs/10,000 beneficiaries, monthly hospital visit rates were 87.4, 36.2, 26.5, and 1.9 visits/10,000 beneficiaries, while admission rates for GI infections and CAP were 3.0 and 0.6 admissions/10,000 beneficiaries, respectively. Appropriate antibiotics were prescribed to less than one half of the patients with GI infections (43.4% before and 47.5% after the policy). Analysis revealed no immediate or trend effect in DUR, hospital visit/admission rates for DM, HTN, GI infections, or CAP after the 30-Baht HI policy was implemented (p>.05 for all measures). There was no significant change on the percent appropriate antibiotic prescribing for GI infections, p>.05. The study did not detect a change in drug and hospital service utilization associated with the 30-Bath HI policy, although there were positive trends in rates of drug utilization, hospital visit, and admission after the policy. Computerized hospital database prove valid and useful resource for research. |