New cap for private hospital claims

The Social Security Office (SSO) will have to reimburse hospitals contracted to provide healthcare under the social security system a fixed rate of 12,000 baht per patient per year in case of high-cost treatments, the government says.
The commitment designed to help avert decisions by many private-run hospitals considering leaving the healthcare scheme by year-end, said Labour Minister Phiphat Ratchakitprakarn.
In recent years, the 12,000-baht reimbursement rate promised at the start of each year was later cut by the remaining amount of the annual budget earmarked for funding this specific part of healthcare cost reimbursements.
This reimbursement rate has not been adjusted to match inflation for the past five years, while the Private Hospital Association has previously asked the rate be adjusted to 15,000 baht.
The association says several of the 97 private hospitals under the social security system were mulling whether they should remain in the system. The minister said the SSO medical board will discuss all these proposals this Thursday, which aim to retain as many hospitals as possible in the social security system.
Sometimes, the promised 12,000 reimbursement rate was reduced later in the year to 8,000 baht, creating a level of uncertainty with which Mr Phiphat said he couldn’t agree.
As for the demanded increase to 15,000 baht, the minister said he would rather focus on ensuring the SSO eventually approves his proposal to fix the reimbursement rate at 12,000 for the whole year at this point.
He urged against comparing the basic capitation and reimbursement rates offered under the social security system against those offered under the universal healthcare scheme, operated by the National Health Security Office (NHSO).
Even though the rates offered under the social security system may be lower than those offered under the NHSO’s health scheme, the social security system does not impose a reimbursement ceiling. It usually fully compensates hospitals for extremely high-cost treatments such as heart disease, cancer and kidney disease.
Sustarum Thammaboosadee, a member of the SSO’s board who represents the employee side of this board, meanwhile, argued these private hospitals weren’t suffering losses as a result of providing care under the social security system.
She agreed that both capitation and additional healthcare cost reimbursement (fee-for-service) rates should be adjusted to keep up with changing inflation, as the SSO is considering doing.
Somchai Krajangsang, a member of a subcommittee on healthcare services under the Thailand Consumers Council, called on the SSO to adopt the NHSO’s current system of healthcare budget management.
The NHSO pays fixed capitation for basic healthcare services while operating separate sub-funds established for reimbursing hospitals for treating specific high-cost diseases such as heart disease, cancer and kidney disease, he said.