Inthira Kanchanaphibool , PhD and Sanita Hirunrassamee , PhD

1. Impacts of Direct Fee-For-Service Payment Insurance on Access and Use of Drug: An Interrupted Time Series Study on Diabetic Care InthiraKanchanaphibool, PhD and SanitaHirunrassamee, PhD

2. Health Insurance in Thailand • Outpatient care – 3 major schemes • Some people who do not use their insurance paid Out-Of-Pocket (OOP) – FFS payment

3. Direct Payment Policy – CSMBS Outpatient Care • Former payment: • Advance paid by officers, and then reimbursed from the government • A policy change since July, 2006: • Direct-FFS payment from the government to hospitals • To reduce a financial burden of beneficiaries • To obtain e-health care utilization data submitted from hospitals for reimbursement Do the change in the reimbursement policy affect the consumption of healthcare resources?

4. Objectives • To determine access and use of drugs before and after the implementation of direct-FFS payment for CSMBS beneficiaries to the hospital • To compare these changes over time with other health insurance schemes Tracer  Diabetes outpatient care (chronic disease)

5. Methods • Longitudinal quasi-experimental analysis with an interrupted time series design • A 1,200-bed public hospital with tertiary care services • All diabetic outpatients with antidiabetic drugs during 2005 – 2009 (5 years) from e-prescription database • Outcome measurements - before and after the direct-FFS payment policy implemented • Number of patients accessed to antidiabetic drugs • Average charge of antidiabetic drugs/patient/month • Segmented regression analysis: levels and trends

6. Number of patients accessed to antidiabetic drugs Direct-FFS

7. Average charge of antidiabetic drugs perpatient (Baht) per month Direct-FFS

8. Average charge of high cost antidiabetic drugsper patient (Baht) per month Petition to ban rosiglitazone Direct-FFS

9. Summary • The direct FFS payment to hospitals for CSMBS outpatient care seems to • Extensively increase health care expenditure • Provide no changes in access to care • Discrepancies of average charge of antidiabetic drug among schemes • Inequalities • Possibility to be irrational use • over- or under-used???

10. Policy Implications • The policy of health insurance payer in reducing burden of advance payment by CSMBS patients may increase drug utilization • The hospital should consider coexisting strategies to ensure rational uses of drug needed to contain drug costs and to secure quality of care, for example • Standard treatment guidelines, medical record review, etc.