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Estimating uncompensated medical care cost as a result of adverse events in a university hospital in Thailand

Abstract Background The impact of adverse events on costs of medical care in developing countries is more limited than in developed countries. Objective To estimate uncompensated medical care costs as a result of adverse events in hospitalized patients. Method Retrospective study based on a panel reviews of the medical records and hospital charges relating to 574 inpatients in the electronic database of a tertiary-care university hospital in Bangkok, Thailand, of which 138 were identified to have adverse events in 2009. The main outcome measure was hospital charges for medical care standardized by Thai diagnosis-related groups (Thai-DRGs). Result After controlling for personal and clinical factors, the average medical cost of an adverse event was estimated at US $128.98 per adjusted relative weight of Thai-DRGs, equivalent to 52% of the standard payment rate paid to the hospital set by a Universal Coverage Scheme. Conclusion Adverse events in the hospital increased the cost of medical care despite adjustment for the case-mix based on DRG. Under the close-ended DRG-based payments for hospitals in Thailand, this meant that adverse events resulted in significant amounts of uncompensated care.