Pattern of OPD utilisation during the COVID-19 pandemic under the Universal Coverage Scheme in Thailand: what can 850 million records tell us?

Abstract

Background Out-patient department (OPD) is a crucial component of the healthcare systems in low- and middle-income countries including Thailand. A considerable impact of coronavirus disease 2019 (COVID-19) pandemic and its control measures, especially the lockdown, on utilisation of OPD services was expected. This study thus aims to estimate the pattern of OPD utilisation during the COVID-19 pandemic in Thailand including overall utilisation and within each sub-groups including diagnostic group, age group, and health region. Methods This study was a secondary data analysis of aggregated outpatient data from patients covered under the Universal Coverage Scheme (UCS) in Thailand over a 4-year period (2017–2020). Interrupted time series analyses and segmented Quasi-Poisson regression were used to examine the impact of COVID-19 on the overall OPD utilisation including the impact on each diagnostic group, age groups, health regions, and provinces. Results Analysis of 845,344,946 OPD visits in this study showed a seasonal pattern and increasing trend in monthly OPD visits before the COVID-19 pandemic. A 28% (rate ratio (RR) 0.718, 95% confidence interval (CI): 0.631–0.819) and 11% (RR 0.890, 95% CI: 0.811–0.977) reduction in OPD visits was observed during the lockdown and post-lockdown periods, respectively, when compared to the pre-lockdown period. Diseases of respiratory system were most affected with a RR of 0.411 (95% CI: 0.320–0.527), while the number of visits for non-communicable diseases (ICD-10: E00–E90, I00–I99) and elderly (> 60 years) dropped slightly. The post-lockdown trend in monthly OPD visits gradually increased to the pre-pandemic levels in most groups. Conclusions Thailand’s OPD utilisation rate during the COVID-19 lockdown decreased in some diseases, but the service for certain group of patients appeared to remain available. After the COVID-19 lockdown, the rate returned to the pre-pandemic level in a timely manner. Equipped with a knowledge of OPD utilisation pattern during COVID-19 based on a national real-world database could aid with a better preparation of healthcare system for future pandemics.

A Study of Managed Care Health System During Pandemic

“…From the ASEAN group of countries analyzed in this study, compared to Indonesia, Thailand has lower cases of covid19. This can be seen in Thailand, which experienced a decrease in visits by around 2/3 of the number of patients with respiratory problems in outpatient departments at hospitals, which means that the recommendation to wear masks in public spaces has a positive impact [18].…”

Utilisation of and factors associated with non-COVID-19 healthcare services in public facilities amongst cross-border migrants in Thailand, 2019–2022

“…The largest drop in OP utilisation was noticed in respiratory diseases (ICD-10: J00–J99). Meanwhile, the numbers of OP visits for metabolic diseases (ICD-10: E00–E90), diseases of the circulatory system (I00–I99), and obstetric conditions (ICD-10: O00-O99) during the post-lockdown period were not significantly different from the pre-pandemic period [ 17 ]. Arsenault et al investigated the effect of COVID-19 on service disruption in ten countries (Chile, Ethiopia, Ghana, Haiti, Lao People’s Democratic Republic, Mexico, Nepal, South Africa, South Korea and Thailand).…”

“…A stark contrast in the size of the registered migrant population between Greater Bangkok and other regions with relatively similar hospitalisation volume across regions undoubtedly engenders the utilisation rate of IP care in Greater Bangkok far lower than in other areas. Sukmanee et al discovered that the number of monthly OP visits in Bangkok was approximately four-fold lower than that of other health regions over four years (2017–2020) [ 17 ]. Another plausible explanation for the low admission rate in Greater Bangkok is the fragmentation of the primary care system.…”

Universal Health Coverage – Exploring the What, How, and Why Using Realistic Review

“…In some context (e.g., Asia and pacific region), UHC is also explained as a process of delivering quality, equitable, and comprehensive care and services, including promotive, preventive, curative, rehabilitative, and palliative care with affordable cost or without financial barriers (37,38). Here, it is important to note that the term 'affordability' of care has various understanding, including free of costs (e.g., avoiding direct payments), prepaid through government-funded health service scheme, having large risk pools to ensure sustainable cross-subsidy between the healthy and wealthy and the sick and the poor, and covering the informal sector and households living on or below the poverty line financially (37)(38)(39). Under UHC, people can access services regardless of their ability to pay, and no citizen is denied service due to inability to pay (10).…”