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

Jarawee Sukmanee; Rukmanee Butchon; Picharee Karunayawong; Thanayut Saeraneesopon; Chulathip Boonma; Yot Teerawattananon; Wanrudee Isaranuwatchai

doi:10.1186/s12913-023-09121-3

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

BMC Health Serv Res. 2023 Feb 3;23(1):116. doi: 10.1186/s12913-023-09121-3.

Authors

Jarawee Sukmanee¹, Rukmanee Butchon¹, Picharee Karunayawong¹, Thanayut Saeraneesopon¹, Chulathip Boonma¹, Yot Teerawattananon^{1

2

3}, Wanrudee Isaranuwatchai^{4

5}

Affiliations

¹ Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand.
² Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
³ Health Administration Division, Office of the Permanent Secretary of the Ministry of Public Health, Nonthaburi, Thailand.
⁴ Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand. wanrudee.i@hitap.net.
⁵ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. wanrudee.i@hitap.net.

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.

Keywords: COVID-19; Interrupted time-series; Lockdown; Outpatient department; Thailand; Universal coverage scheme.

MeSH terms

Aged
Ambulatory Care Facilities*
COVID-19* / epidemiology
Communicable Disease Control
Humans
Interrupted Time Series Analysis
Outpatients
Pandemics
Thailand / epidemiology
Universal Health Insurance