Private hospitals threaten to quit social security system
Private Hospital Association urges the setting up of a subcommittee to evaluate and update reimbursements for services
More than 70 private hospitals nationwide have indicated they will leave the social security system if there is no increase in reimbursements from the state.
According to the Private Hospital Association (PHA), private hospitals suffered revenue loss due to the Social Security Office (SSO)’s move to lower reimbursements for some diseases in the last quarters of 2022 and 2023.
Two hospitals have confirmed they will leave the system by the end of this year - Bangkok Hospital Surat and CGH Saimai Hospital.
PHA’s former president Chalerm Harnphanich told the press on Tuesday that the association and the SSO agreed last week to set up a subcommittee to study the diagnosis-related group (DRG) formula to determine the amount of reimbursement medical service providers can receive.
With the DRG approach, the SSO groups similar types of conditions together, ranging from very serious to simple illnesses.
He said reimbursements should be updated by considering related factors, such as utilisation rate and medical service cost. He added that reimbursements on some services have not been adjusted for years.
“The subcommittee should be set up to seek a solution as soon as possible,” he said, adding that PHA’s letter to the SSO stipulated that the office should seek a solution before preparing contracts later this year.
He expects the establishment of a subcommittee and the study on reimbursement would not take long as all the information was readily available.
Chalerm went on to say that a DRG of 2 and above was previously granted 12,800 baht per level. However, he noted that reimbursement was reduced to 10,000 baht in 2022 and 7,200 baht in 2023.
Private hospitals’ revenue had declined because the DRG had not been adjusted over the past five years, while medical service costs had increased.
He said PHA wants a guarantee for diseases with a DRG of 2 and above of 15,000 baht per level. He added that another three categories of reimbursements should be adjusted - premiums, treatment for 21 chronic diseases and high cost diseases.
There was no problem for dental service because SSO guarantees reimbursement at 900 baht per year, he said.
Chalerm warned that the SS system could lose more than 70 private hospitals if no increase in reimbursements is forthcoming.
