Assessment of magnetic resonance imaging : utilization and financial aspects

Abstract

This thesis aims to study the situation, utilization and financial aspects of Magnetic Resonance imaging (MRI) technology in Thailand in order to assess the two most important economics appraisal, efficiency and equity in use the MRI service. Thus it is important to understand the situation, diffusion and utilization of this technology. Because we have bought a high cost but it gave limited benefit on the clinical use of MRI. In 1998, there are 27 MRIs installed the whole country. (0.45 unit per million population), of which 18 (68%) are in Bangkok, 9 (32%) are in outside Bangkok. Of the total 27 MRIs, 9 MRIs (33%) were owned by public and 18(67%) by private sector. So, There is an inequity of diffusion of MRI and inequity in accessibility to health care service like MRI. The inappropriated diffusion of MRI causes immigration patients from outside Bangkok to use services in Bangkok. Two MRI units were purposely selected as a case study, classified by public and private. This study aims to collect (a) financial data from MRI's installed to estimate cost of production, cost recovery and break-even output, (b) utilization pattern eg. main application, (c) factors affecting utilization eg. age-sex, resident, payment status (insurance corporate), and monthly income. The study shows that the major application on clinical use of MRI in both hospitals is on the brain and spine. The financial data of both hospitals show that the cost are more than revenue or the other word, it still less efficiency. They are operating at the level lower than the break-even output. Moreover, most of cases, 45% paid from their own pocket 7% were civil servant who can be fully reimbursed from the Ministry of Finance, 25% were low income card holders, 18% were deducted using sliding scale up on the social insurance scheme. In conclusion the poor and the low income could not access as equal MRI service as the civil servant and the rich people. This clearly reflects unequal treatment for equal needs. Finally, an important implication is that there should be closer collaboration between the public and private sectors.