Objective: To study clinical outcome and cost of treatment of patients presented with acute ST-segment elevation myocardial
infarction (STEMI) amongst different medical coverage, civil servant reimbursement (CSR) and National universal coverage system (UCS), in Thammasat University Hospital.

Design: Retrospective cohort study.

Materials and Methods: Medical records of patients presented with acute ST elevation myocardial infarction (STEMI) in Thammasat University Hospital between January 2010 and December 2012 were reviewed. 89 patients were analyzed. Baseline characteristics, underlying disease, type of medical coverage, complications, treatment options and cost of treatment during hospitalization was collected and reported. The primary endpoint was the in-hospital mortality rate and the secondary endpoint was the cost of treatment and difference in management among these two medical coverages.

Results: A total of 89 patients were included in the present study. Types of medical coverage were civil servant reimbursement (CSR) (n = 34), National universal coverage system (UCS) (n = 43), Social Security insurance (n = 9) and other (n = 3). Compared to the patients with UCS, Patient with CSR had more hypertension (78.8% vs. 52.8%; p = 0.02) and dyslipidemia (69.7% vs. 44.4%; p = 0.03). Mortality rate during hospitalization were not different between groups (11.8% in CSR group and 11.6% in UCS group, p = 1.00). However, the cost of treatment were significantly higher in CSR group compared to UCS group in the total cost of treatment (349,974 baht in CSR group vs. 171,251 baht in UCS group; p<0.001), cost of procedures (247,605 baht in CSR group vs. 106,772 baht in UCS group; p<0.001) and non-formulary drug (8,089 baht in CSR group vs. 2,036 baht in UCS group; p<0.001) but not different in terms of national formulary drugs (38,249 baht in CSR group vs. 19,046 baht in UCS group; p = 0.74), Laboratory investigations (14,737 baht in CSR group vs. 13,266 baht in UCS group; p = 0.63), and the cost of medical equipment (13,887 baht in CSR group vs. 13,232 baht in UCS group; p = 0.17).

Conclusion: The in-hospital mortality rates were not different between STEMI patients with CSR and UCS. However, the overall cost of treatment of STEMI in patients with CSR medical coverage was higher than those with UPS medical coverage.

Keywords: Right to medical care, Acute ST-segment elevation myocardial infarction, STEMI, Universal coverage system, Civil
servant reimbursement, Cost of treatment