Changes in Inpatient Hospital Services During the COVID-19 Pandemic in Thailand: A Descriptive and Costing Study

Abstract

Background: The COVID-19 pandemic forced policy makers to find solutions to protect hospitals from revenue shortfalls and provide high quality of care for COVID-19 and other patients. In Thailand, hospitals have adjusted the hospital services arrangement to new normal hospital services to prevent the spread of coronavirus while maintaining essential hospital services for non-COVID-19 patients. Objective: To describe the COVID-19 patient flow and estimate the costs of the new normal hospital services implemented in six public hospitals across Thailand. Materials and Methods: The authors conducted a cross-sectional study to describe the COVID-19 patient flow in each participating hospital between January and November 2020, representing the first wave of the COVID-19 outbreak in Thailand. Data were collected from hospital staff interviews, hospital historical budget review, and hospital databases. The hospital costs of the new normal hospital services were estimated using an activity-based costing approach from the provider’s perspective. Results: The COVID-19 patients could access the new normal hospital services through three channels including 1) walk-in, 2) transfer from other hospitals, and 3) active surveillance from communities. The ratio of costs of the new normal hospital services during the COVID-19 outbreak and the normal situation were one to two times and one to five times for patients with mild infection admitted to secondary and tertiary care hospitals, respectively, but one to three times for those with moderate-to-severe infection admitted to tertiary care hospitals. Conclusion: The COVID-19 pandemic imposed additional costs to Thai hospitals. The magnitude of the incremental costs depended on COVID-19 severity and hospital level.