การวิเคราะห์ทางการเงินของการรักษาผู้ป่วยภาวะเลือดออก ใต้เยื่อหุ้มสมองชั้นอะแรคนอยด์จากหลอดเลือดแดงโป่งพอง ในสมองแตก (ICD-10: I-60.x)

Abstract

Background: Subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm is a critical emergency associated with high treatment costs, imposing a significant financial burden on hospitals. This study aimed to analyze the cost, reimbursement, and net financial outcome of managing these patients within the context of Thailand’s healthcare reimbursement system.
Methods: A retrospective descriptive study was conducted on 217 patients with aneurysmal SAH treated at Srinagarind Hospital between January 1 and December 31, 2024. Financial data, including total hospital charges (Chart Cost) and revenue from various sources-primarily the Diagnosis-Related Group (DRG) system, along with additional payments for room charges, medical devices, and professional fees-were collected and analyzed.
Results: The total chart cost for all 217 patients was 37,716,492 THB (average: 173,808.72 THB/patient). Total reimbursement, calculated using an average base rate of 10,000 THB per Relative Weight (RW), amounted to 36,739,615 THB (average: 169,306.98 THB/patient). This resulted in a net financial loss of 976,877 THB, or an average loss of -4,501.74 THB per patient (-2.59% of cost). The deficit significantly increased to -21,633 THB per patient (-12.44%) when applying the base rate of the Universal Coverage Scheme (8,350 THB/RW), highlighting a heavy reliance on reimbursement for high-cost medical devices.
Conclusion: Under the current reimbursement framework, treating patients with aneurysmal SAH leads to a financial loss for the provider hospital. There is a pressing need to review and adjust DRG reimbursement rates to adequately reflect the true cost of care for this complex condition, thereby ensuring the financial sustainability of specialized neurovascular services.