Disparity between the Reimbursement and Unit Cost for HIV/AIDS Antiretroviral Treatment for Migrant Patients Insured in the ‘Health Insurance Card Scheme’, Thailand, 2015-2017

Abstract

The Health Insurance Card Scheme (HICS), a national insurance scheme for cross-border migrants in Thailand, provides a vast range of benefit packages, including antiretroviral treatment (ART) for HIV/AIDS. This study aimed to assess and compare the reimbursement claimed by the HICS for ART beneficiaries per person against the actual ART unit cost at district, provincial, and regional hospitals. Data were retrospectively collected from two main datasets. The first dataset was used for the calculation for ART reimbursement between 2015 and 2017. There were 148 public hospitals included in the reimbursement analysis. The second dataset was used for calculating the actual ART unit cost. Eight public hospitals were selected for unit-cost calculation. Findings showed that the average ART reimbursement amount per person per year varied between US$ 191.9 and US$ 235.1 while the actual ART unit cost ranged from average US$ 135.8 to US$ 421.0. Though the overall difference demonstrated non-statistical significance by Student t-test, this difference at provincial hospitals exhibited statistical significance (p=0.03) by Mann-Whitney U test. The Ministry of Public Health should update the fee schedule for ART reimbursement to better reflect the providers’ actual unit cost and allow the ART reimbursement rate varying by facility types instead of applying the flat-rate system as per the status quo.

Keywords:  antiretroviral treatment, HIV/AIDS, migrant, health insurance, costing, reimbursement, unit cost