The First Aid Solatium Payment Regarding Section 41 of 2002 National Health Security Act (NHSA) in region 7 during 2012-2014 for quality improvement of the health system and guideline to minimize the problems in obstetric and gynecological cases

Objectives: To analyze the medical diagnosis that led to payments of the fist aid solatiums (FAS)  regarding Section 41 of 2002 National Health Security Act (S41NHSA) in the region 7 of NHS  Office (R7NHSO) and the magnitude in both number of cases and amount of money paid. To  focus FAS cases and payment in the obstetric specialty which had the greatest part of FAS  payment, and to fid out the quality improvement for reducing the problems in obstetric and  gynecological cases. The study was done for only during 2012-2014. Materials and Methods: All of the FAS medical cases records regarding S41NHSA in the R7NHSO  during 2012-2014 were collected. The medical diagnosis that led to the fial approval of FAS  payment by NHSO was reviewed. The working group of the Sub-Committee to Control the  Quality and Standard of the Public Health Service of the R7NHSO had created the guideline  to minimize the problems in obstetric and gynecological cases.  Results: The R7NHSO included 4 provinces in the Northeast which are Khon Kaen, Kalasin, Roi Et,  and Maha Sarakham. The numbers of FAS payment cases during 2012-2014 were 79, 106,  and 110 cases or 295 cases in 3 years. The ratio of S41NHSA complaint per total number of  in-patients was low but increasing yearly during this 3 years period. The province with more  number of in-patients had a more FAS cases and a more FAS payment. The fie most common  FAS payment cases in descending rate were from department of obstetrics (54.38%), surgery  (13.9%), medicine (10.5%) pediatric (7.4%) and orthopedics (3.73%). The obstetric department  shared the greatest part of FAS payment cases and money. The top fie number of cases  (percentage) FAS payment in obstetrics were neonatal death 59 (30.73%), shoulder dystocia  41 (21.35%), unintended pregnancy after tubal ligation 40 (20.83%), maternal death 20 (10.42%)  and cerebral palsy 6 (3.13%). The total amount of FAS money paid during the 2012-2014 was  54.68 million Baht for the whole R7NHSO, of which was from Khon Kaen 22.99 million Baht,  Kalasin 12.89 million Baht, Roi Et 12.30 million Baht, and Maha Sarakham 6.49 million Baht.  The average FAS payment was 185,361.36 Baht/case. The authors suggested 5 items of quality  improvement methods to reduce obstetric loss. Conclusion: The FAS cases and FAS payment in R7NHSO were rising. Most of the FAS cases and  payment were from the department of obstetrics. Many diagnoses that caused FAS cases and  payments were preventable. A good policy of man power arrangement of obstetricians, a  continuously in-service training, and a better incentive for the service providers, the consultation  and transferring system of the risky patients should be revised.