Self-Referral to the University Hospital Resulting in Unnecessary Patient Expenses: A Prospective Descriptive Study in a Super-Tertiary Hospital

CONTEXT: Thailand subsidizes health-care costs, allowing citizens access to health care without out-of-pocket expenses. However, some citizens still spend large amounts of money on treatment provided at tertiary care hospitals. AIM: To identify the proportion of patients whose visits are not covered by national health insurance at the tertiary hospital and their reasons for visiting. SETTINGS AND DESIGN: Prospective, descriptive study in patients visiting Srinagarind hospital outpatient department from July to September 2019. SUBJECTS AND METHODS: We gathered and analyzed the data regarding demographics, hospital visits, and illness severity using a questionnaire. STATISTICAL ANALYSIS USED: Descriptive analyses and logistic regression were performed as appropriate. RESULTS: Of the 700 participants, 40% (95% confidence interval 36.3–43.7) was not covered for their visits. The three common reasons visiting this hospital were desire of treatment from a specialist (42.9%), the reputation of the hospital (31.4%), and service satisfaction (26.6%). CONCLUSIONS: Although the national health-care system provides a gratis service pathway, some people still pay out-of-pocket unnecessarily. Officials should work to better raise the level of public confidence in the primary and secondary care units.