Reduced reimbursement for healthcare services is leading to significant losses
Published: 24 Sep 2024 at 16:30
Increasing numbers of private hospitals may opt out of the government’s social security system as they face rising losses attributed to low reimbursements for patient services. This trend has raised concerns about the future of healthcare access for many in the community.
According to the Private Hospitals Association (PHA), the number of private hospitals participating in the Social Security Office (SSO) healthcare scheme has dropped drastically from 123 to 93 over the past decade.
30 hospitals have withdrawn from the SSO due to insufficient payments for treating patients with serious conditions, resulting in significant financial strain.
The SSO health insurance scheme, which covers treatments at both public and participating private hospitals, allocates 1,808 baht for each patient for basic medical coverage for the current year, up from 1,640 baht previously. However, payments to affiliated hospitals for patients with serious or chronic health issues have been reduced under an “adjusted relative weight” formula.
In 2020, the payment for these patients was set at 12,000 baht, but it was lowered to 10,000 baht in 2022. Most recently, the payment has decreased to 7,200 baht, a move attributed to the dwindling funds available for the program.
The adjusted relative weight is a formula used to determine inpatient payments based on diagnosis-related groups, as stated by the Public Health Ministry.
PHA officials emphasize that the funding cuts are causing significant losses for affiliated private hospitals, prompting concerns that further withdrawals could occur. Such a situation would increase the burden on public hospitals, likely leading to overcrowding as more patients are redirected to these facilities.
While new private hospitals could potentially join the program, many of these are smaller establishments that lack the capacity to accommodate a large number of SSO members.
The SSO operates under the Labour Ministry, serving approximately 25 million members this year.
Public Health Minister Somsak Thepsutin indicated that addressing the concerns raised by the PHA could involve increasing budget allocations for hospitals within the SSO, though specific details on this solution have not been provided.
To date, neither the SSO nor the Labour Minister has responded to the PHA’s complaints regarding these reimbursement issues.
