Main Article Content
Background and Objective: Cleft lip and cleft palate conditions should be treated in accordance with age in a holistic manner. This costs a great deal. Age of 0 to 5 is important for the treatment. The research aimed to study the medical expenses compensation for patients, covered by Universal Health Coverage Scheme under the National Health Security Office sent to the medical centers. The study used principles of Diagnostic Related Groups (DRG) and calculation of Relative Weight (RW) to calculate the actual expenses. To study the cost of hospitalization from birth to the ages of 4-5 years and to compare the actual cost of the medical compensation received by the medical center under the DRG in in-patients with cleft lip and cleft palate.
Method: A descriptive retrospective study was used on 120 cleft lip and palate patients of 4-5-year-old recorded in-patients at Tawanchai Center, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. Data were collected for the two months period during May- June 2012 and analyzed using Visual FoxPro and Excel
Results: According to 120 cleft lip- cleft palate patients after surgery, 57.5 % were males with cleft lip 24.2 %, cleft palate 15.0 % and cleft palate with cleft lip 60.8 %. Eighty-seven percent of them were under Universal Health Coverage for their health insurance, 12.5 % of them were using government welfare rights and 16.7 % resided inKhonKaenProvince. Maximum frequency in one patient of surgery was six times. The highest medical expense per patient was 74,760 baht. The average medical expense was in the range of 9,675-13,444 baht per visit. Receive compensation according to the relative weight multiplied by the rate of money supply levels in the region (Srinagarind Hospital is located in NHSO region 7) is calculated, equal to the actual treatment of 75.75 % (beyond the other region is 9,000 baht and in region 7 is 7,700 baht per Adj RW), so NHSO should adjust the compensation fund, appropriate for the actual treatment of the hospital is 10165:Adj RW
Conclusion: Srinagarind hospital treatment in Cleft patients should receive 10,165 baht per AdjRW compensation from NHSO.