Private hospitals opting out of govt health scheme

More private hospitals may cancel their affiliation with the government social security system because of mounting losses incurred by the low reimbursement for some patient services.
Paiboon Eksaengsri, president of the Private Hospitals Association (PHA), said on Monday the number of private hospitals participating in the healthcare scheme run by the Social Security Office (SSO) had dropped from 123 to 93 in the last decade.
The 30 hospitals parted ways with the SSO because of the low payment they received for treatment of patients with serious conditions. This cost them a lot of money they were not reimbursed for.
The SSO health insurance scheme covers treatment at public hospitals and affiliated private hospitals. Payments are made from the Social Security Fund. The SSO budgets 1,808 baht for each patient for basic medical coverage since last year, up from the previous 1,640 baht, Dr Paiboon said.
But it has cut payments to affiliated hospitals for patients with serious or chronic health problems under an “adjusted relative weight” formula. Payment to affiliated hospitals under this scheme was set at 12,000 baht  “adjusted relative weight” in 2020. It was reduced to 10,000 baht in 2022.
This year the payment had been reduced in the last two months to 7,200 baht, according to the PHA. The association said this was because the fund was running out of money. 
Adjusted relative weight is a formula calculated by using a base rate for inpatient payment in diagnosis related groups, according to the Public Health Ministry.
Dr Paiboon said the budget slash was costing affiliated private hospitals dearly. Losses were mounting. 
The situation, unless rectified, would force more private hospitals to withdraw from the programme, he said. This would place an added burden on public hospitals, where patient numbers would increase. 
New private hospitals could join the programme, but most were small and could not serve a large number of SSO members, he added.
The SSO is under the Labour Ministry. It has about 25 million members this year.
Public Health Minister Somsak Thepsutin said on Tuesday the problem raised by the PHA could be solved if more budget funding was chanelled to hospitals under the SSO. But he did not provide any details.
Neither the SSO nor Labour Minister Phiphat Ratchakitprakarn have responded to the complaint raised by the PHA.