The Effect of Additional Payment for Health Workers on Case Mix Index in Thailand: Panel Data Analysis


Sila Tonboot Kanchit Sooknak Kwanpracha Chiangchaisakulthai Supasit Pannarunothai


     The maldistribution of health resources is a challenging problem for Thailand’s health system. Thus, the application of financial incentives is a choice to get through the situation. This article presents efficiency measuring of financial incentives for health workforce efficiency through the Case Mix Index as a proxy for hospital efficiency. The panel data used in this article included the Case Mix Index and financial incentives paid to health workers at a hospitals during 2009-2014. A fixed effect analysis was adopted in order to control the different hospital service plans’ effects and time variation. Moreover, we separated the study results into two parts. The first focused on allowance paid in fixed monthly amounts by workload criteria. The second part explored the individual effect of each financial incentive program on the Case Mix Index. The result found that the Top-up program, with a fixed monthly amount, could increase the Case Mix Index significantly. The individual program analysis found the non-private practice allowance program and P4P program conducted a critical improvement of the Case Mix Index of the hospital.

Keywords: Fixed-Effect Analysis, Additional Health Payment, Health Workforce, Case Mix Index (CMI)


Eijkenaar, F. (2012). Pay for Performance in Health Care: An International Overview of Initiatives. Medical Care Research and Review, 69(3), 251-276.

Eijkenaar, F., Emmert, M., Scheppach, M., & Schöffski, O. (2013). Effects of Pay for Performance in Health Care: A systematic review of Systematic Reviews. Health Policy, 110(2), 115-130.

Fetter, R. B., Shin, Y., Freeman, J. L., Averill, R. F., & Thompson, J. D. (1980). Case Mix Definition by Diagnosis-Related Groups. Medical Care, 18(2), 1-53.

France, F. H. R., Mertens, I., Closon, M. C., & Hofdijk, J. (Eds.). (2001). Case Mix: Global Views, Local Actions: Evolution in Twenty Countries. Amsterdam, The Netherlands: IOS Press.

Gaynor, M., & Pauly, M. V. (1990). Compensation and Productive Efficiency in Partnerships: Evidence from Medical Groups Practice. Journal of Political Economy, 98(3), 544-573.

Ginsburg, P. B., & Carter, G. M. (1986). Medicare Case-Mix Index Increase. Health Care Financing Review, 7(4), 51-65.

Glickman, S. W., & Peterson, E. D. (2009). Innovative Health reform Models: Pay-for-Performance Initiatives. American Journal of Managed Care, 15(12), S300.

Grosskopf, S., & Valdmanis, V. (1987). Measuring Hospital Performance: A Non-Parametric Approach. Journal of health Economics, 6(2), 89-107.

Grosskopf, S., & Valdmanis, V. (1993). Evaluating Hospital Performance with Case-Mix-Adjusted Outputs. Medical Care, 31(6), 525-532.

Henderson, L. N., & Tulloch, J. (2008). Incentives for Retaining and Motivating Health Workers in Pacific and Asian Countries. Human Resources for Health, 6(1), 18.

Hornbrook, M. C. (1982). Hospital Case Mix: Its Definition, Measurement and Use: Part I. The Conceptual Framework. Medical Care Review, 39(1), 1-43.

Jongudomsuk, P., Srithamrongsawat, S., Patcharanarumol, W., Limwattananon, S., Pannarunothai, S., Vapatanavong, P., Sawaengdee, K., & Fahamnuaypol, P. (2015). The Kingdom of Thailand Health System Review (Health Systems in Transition, Vol.5 No.5). In WHO Library Cataloguing in Publication Data. Geneva, Switzerland: World Health Organization.

Meessen, B., Kashala, J. P. I., & Musango, L. (2007). Output-Based Payment to Boost Staff Productivity in Public Health Centres: Contracting in Kabutare District, Rwanda. Bulletin of the World Health Organization, 85(2), 108-115.

Mendez, C. M., Harrington, D. W., Christenson, P., & Spellberg, B. (2014). Impact of Hospital Variables on Case Mix Index as a Marker of Disease Severity. Population Health Management, 17(1), 28-34.

Ozcan, Y. A. (2008). Health care benchmarking and performance evaluation: an assessment using data envelopment analysis (DEA), International Series in Operations Research and Management Science. New York, NY: Springer Science and Business Media, LLC.

Pettengill, J., & Vertrees, J. (1982). Reliability and Validity in Hospital Case-Mix Measurement. Health Care Financing Review, 4(2), 101-128.

Puenpatom, R. A., & Rosenman, R. (2008). Efficiency of Thai Provincial Public Hospitals during the Introduction of Universal Health Coverage using Capitation. Health Care Management Science, 11(4), 319-338.

Robinson, J. C., Williams, T., & Yanagihara, D. (2009). Measurement of and Reward for Efficiency in California’s Pay-for-Performance Program. Health affairs, 28(5), 1438-1447.

Studenmund, A. H. (2000). Using Econometrics: A Practical Guide. USA: Addison Wesley.

Suraratdecha, C., & Okunade, A. A. (2006). Measuring Operational Efficiency in a Health Care System: A Case Study from Thailand. Health Policy, 77(1), 2-23.

Wibulpolprasert, S., & Pengpaibon, P. (2003). Integrated Strategies to Tackle the Inequitable Distribution of Doctors in Thailand: Four Decades of Experience. Human Resources for Health, 1(1), 1-17.

Fixed-Effect Analysis, additional health payment, health workforce
Research Articles


How to Cite
TONBOOT, Sila et al. The Effect of Additional Payment for Health Workers on Case Mix Index in Thailand: Panel Data Analysis. Journal of Community Development Research (Humanities and Social Sciences), [S.l.], v. 11, n. 2, p. 70-80, june 2018. ISSN 2539-5521. Available at: <>. Date accessed: 09 apr. 2020.