Background

Universal Coverage (UC) is a public health insurance scheme covered approximately 48.3 million of Thai population (74.3% of total) in 2011. This study aimed to categorise pattern of outpatient utilisation and examine the relationship between an annual cost of outpatient service and pattern of utilisation.

Materials and methods

Outpatient data from the National Health Security Office in 2011 were analysed, 4 provinces were picked to represent the pattern of service utilisation. The selection criteria emphasised on 1) availability of various types of hospitals in the province (health promoting, community, general/regional, university hospital; and others), and 2) the maximum utilisation rate of people in the province. Descriptive statistical analysis was employed to calculate annual utilisation. One-way analysis of variance was used to calculate the association between the annual costs per person and the pattern of service utilisation (whether rural or urban or both; and the type of hospital).

Results

Most common single users were at the health promoting hospitals (26.2%-32.3%), followed by community hospitals (17.6%-22.6%) and general/regional hospitals (2.8%-13.9%). For two-service-type users, the most common was the combination of health promoting hospitals and community hospitals (14.1%-23.5%), followed by health promoting and general/regional hospitals (2.3%-7.4%), and community hospitals and general /regional hospitals (1.5%-3.8%). For three-service-type users, most occurred at health promoting, community and general/regional hospitals (2.0%-5.0%). The other patterns were less than 1.0%. All four provinces had a similar pattern of urban (42.8%-52.0%), urban and rural (24.4%-29.8%), and rural only (19.6%-27.9%). Costs per patient per year were significantly different between those using hospital combination and geographical area. Homogeneous subsets test suggested seven utilization patterns.

Conclusions

Different pattern of outpatient utilisation should be taken into account for policy formulation of capitation payment and allocation criteria.