Development of reimbursement model forhome-based chemotherapy in Thailand
Bibliographic record
Abstract
The objectives of the study were (1) to review on HC reimbursement model in other countries (2) to conduct economic evaluation comparing HC with inpatient chemotherapy and hospital-based chemotherapy treatment (IP) from a societal perspective (3) to develop national models and financing and reimbursing of HC services in Thailand. Literature review and semi-structured interviews as the mixed methods had been applied for data collection. The characteristic of HC and reimbursement policies for public payer and service delivery were obtained from eight countries: Australia, Canada (Ontario), England, France, Japan, Korea, Singapore and the United States (US) (Medicare Part B). A cost-utility analysis was conducted for stage III colon cancer patients after resection with a 6-month time horizon. Parameter inputs for the analysis had gathered data from Ramathibodi hospital and literature review. The measuring of health outcomes was in the form of Quality-adjusted life years (QALYs). Result of international review, Thai context literature review and economic evaluation were used to develop the HC reimbursement model in Thailand. A stakeholder meeting was proceeded to summarize opinions to the models. The budget impact analysis was done after the reimbursement model was developed. Comparators of the analysis were hospital-based chemotherapy with the current reimbursement model and HC with proposed reimbursement models. The result found that the HC characteristics are various among countries. There are three types of HC: Ambulatory infusion pump (AIP), Hospital in the home program (HITH) and Home health provider (HHP) where the different service structures are provided under healthcare system organization and governance. Funding mechanisms reflect country-specific context and local variations in care provision, where this depends on the reimbursement mechanism and compliance on the healthcare system of each country. The result of the economic analysis showed that HC was a dominant option that provided 52,968 baht of cost-saving per patient for the episode of treatment. QALYs of HC and IP were 0.3598 and 0.3362, respectively. We recommend the reimbursement models that comply with the Thai context. The models supported hospital management, central venous (CV) port, AIP and mini spill kit that were the important compositions of HC service. The stakeholder meeting was conducted with 31 participants from payers, hospitals and cancer organizations in Thailand. The stakeholders considered AIP HC that would be suitable for the organization, governance, and management of the hospital and payers would support HC management and equipment for more accessibility of the service. The budget impact analysis found total cost saving comparing HC and IP treatment from a societal perspective was 27.84 million baht for 100% patient accessibility rate. The study concluded that HC is a cost-saving strategy comparing with IP. In Thailand, moving chemotherapy into HC could help with cost-saving and increasing patient health outcomes. For HC development, healthcare providers, patients, and relatives must be trained to handle the process of treatment at home. The HC AIP service is optional for a cancer patient in Thailand. The implementation of the service would be supported by the new reimbursement model that appropriate with the Thai healthcare system.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".