Rapid Assessment for Resilient Recovery and ... - GFDRR

situations, and Sawanpracharak Regional Hospital in Nakhon Sawan province was closed
altogether. As a result, a number of patients were transported from those affected provinces to
Buddhachinnarat Regional Hospital, increasing the workload of Buddhachinnarat hospital
staff enormously. The hospital management team has shared that during the peak of the
flood crisis, the staff workload was so high that the cost of overtime payment to staff rose
to nearly THB 1 million per day.
The greatest losses were in terms of revenue losses, incurred as a result of hospital
closures due to floods, or the possible decrease in number of patients due to interruption
of transport services and access. It should be noted that the provider payment mechanisms
of two public health insurance schemes in Thailand helped reduce the amount of revenue
losses. The UC scheme, which covers 75 percent of the Thai population, provides capitation
payment for outpatient treatment, while the smaller Social Security Scheme (SSS)
provides capitation payment for both outpatient (OP) and inpatient (IP) treatment. This
means that the hospitals in the schemes still receive capitation payment throughout the
duration that the hospitals were closed during the floods. Theoretically, some of the
hospitals that joined the UC scheme and were closed due to floods may be in a position
of “revenue gain”, because there are significantly less expenditures during hospital
closure, while the capitation payment for OP remains the same. As the UC scheme mainly
contracts public hospitals, the potential “revenue loss” is reduced significantly among
these hospitals, particularly for hospitals that rely on OP treatment. Nevertheless, UC does
not provide capitation for IP treatment, and part of this potential income is classified as
revenue losses. It should also be noted that CSMBS scheme payment accounts for a large
proportion of revenue of many tertiary-level public hospitals. As the CSMBS provider
payment method is fee-for-service for OP services and reimbursement per episode by
diagnosis related groups (DRGs) for IP services, the hospital does not receive any
payment while it is closed, and thus there are potential revenue losses.
Although the SSS contracts a number of private hospitals as providers, the majority of
private hospitals rely more on patients’ out-of-pocket payment and private health insurance
reimbursement for income. Thus, the total revenue losses among private hospitals as well
as private medical and dental clinics are higher than those of the public sector. In addition,
medical tourism accounts for a significant amount of profit among a number of private
hospitals in the Greater Bangkok area. Even though major medical tourism-oriented
private hospitals in central Bangkok were not flooded, there is undoubtedly a reduction in
the number of medical tourists to Bangkok in the past few months, as central Bangkok was
still at risk of flooding, and the medical tourists had the choice of travelling elsewhere for
treatment.
Generally, losses in the health sector also include costs of clearing and cleaning
operations before health facilities can resume service delivery. However, following the
discussion with PHOs as well as public and private hospital directors, it was explained
that the cleaning of post-flood hospitals and health centers is generally done by hospital
and health center staff voluntarily, and not by hiring private companies or individuals. Thus, this
was not considered as an additional cost. Another area of potential loss worth mentioning is the
shortage of drugs and rising price of some medicines/medical consumables due to supply
shortage. This happens as some factories were flooded or faced a shortage of production
materials (e.g. storage/containers), but the effect is likely to be transient and the magnitude
may not be high.
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