The mounting medical care cost for adult AIDS patients at the Faculty of Medicine, Siriraj Hospital: consideration for management
Suwanagool, S.; Ratanasuwan, W.; Techasathit, W.
Journal of the Medical Association of Thailand 80(7): 431-439
1997
ISSN/ISBN: 0125-2208 PMID: 9277072 Document Number: 1264
This study examines case records of adult AIDS and HIV symptomatic patients admitted to the Siriraj Hospital's Department of Medicine during January 1993 and December 1995. The study aims to determine the medical care cost of adult AIDS patients admitted to the observation room, hospital, and HIV and Counseling Clinic and to determine which factors are the most costly. An AIDS diagnosis is determined according to the Thailand Ministry of Health protocols. Costs include medication cost, facility cost, and testing in 1995 baht prices. Government-supplied medicines are not included in the cost. AIDS cases numbered 196, 227, and 182 adult persons in the respective years 1993, 1994, and 1995. The median CD4 lymphocyte count was 59 cells/mm. The median duration of visit was 14 days. AIDS patients occupied 5.4-7% of inpatient admission beds. 17.6-18.8% of patients were readmitted during the year. 26.4% to 33.7% died before discharge. The leading cause of admission was tuberculosis cryptococcal meningitis, pneumocystis carinii pneumonia, diarrhea, salmonellosis, and toxoplasmosis. The number of AIDS cases admitted to the observation room for 2-5 days increased from 572 cases in 1993 to 1205 cases in 1995. However, due to space limitations, only 15% of AIDS patients under observation were admitted to the hospital in 1995. About 600 cases each year were followed up for complications. Medical care costs were 1452 baht/day/patient for admissions; 1509 baht/day/patient in an observation room; and 1132 baht/month/patient for HIV counseling care. The average cost for all adult AIDS patients/year rose from 18,726,176 baht to 26,812,204 baht during 1993-95. Medicine costs almost tripled for treating cryptococcoses. Treatment costs are lower in provincial hospitals. There is a need for the establishment of a referral network, hospice care, and low costs for treatment.
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