International Conference on Public Health Graduate Program Universitas Sebelas Maret Surakarta, Indonesia September 2016

Transcription

1 International Conference on Public Health Graduate Program Universitas Sebelas Maret Surakarta, Indonesia September 2016

2 Lesson learned from Thailand s experience on the driving forces for accelerating the expansion of its universal coverage to support the attainment of the sustainable development goals

3 Outline (1)Health sector reform (2)Financial risk protection (3)Universal Coverage (4) Thailand Universal Coverage (UC) (5) Thailand UC success factors (6) Insights from Thailand health reforms (7) Thailand UC challenges (8) Epilogue

4 ❶ Health sector reform Health sector reform is a necessary ongoing process for any health sector. Based on 1993 World Development Report, it was perceived that the health sector was failing due to structural deficiencies.

5 Significant attention has been paid to the content of such reforms with an emphasis on (1) alternative financing mechanism for financial risk protection; (2) new forms of organization & management; and (3) a redefinition of the public/private interface.

6 ❷ Financial risk protection Financial risk protection in health is considered a social right and a key objective of health systems worldwide. International development organizations are supporting countries to move towards achieving universal coverage and improve financial risk protection to avoid medical poverty trap.

7 ❸ Universal Coverage The World Health Organization defined universal coverage (UC) as a mechanism to guarantee equal access to essential promotive, preventive, curative, and rehabilitative health interventions for all citizens at an affordable cost, thereby achieving equity in access. UC goes hand in hand with social justice, health equity, and a nation s responsibility.

8 ❹ Thailand UC As for Thailand, the 1997 Constitution stated that health is a basic right of Thai citizens and that equal access to basic health services should be guaranteed. Thailand UC policy was implemented as a major political decision with social support, plus a strong knowledge base with international experiences.

9 UC policy in Thailand is one of the principal mechanisms to achieve the goal of improving the functions of the health care system through fairness of health care financing.

10 Thailand s baht treats all diseases projects is a new public health insurance scheme that provides services within a defined benefit package to registered members initially for a co-payment of 30 baht per chargeable episode, but this was eliminated in 2006.

11 All members register with a primary care contracting unit (CUP) and receive a gold card entitling them to health services in their home area.

12 Elderly people, children, and poor people receive a special version of the registration card and pay no fee. Drugs prescribed are limited to those on a national essential drug list, while some high-cost or chronic disease treatments are subject to cost ceilings.

13 Treatment outside the area of registration is limited only to accident and emergency care, beyond which the members are responsible for the charges occur. Finance for the scheme comes mainly from public revenues paid to CUPs on the basis of population.

14 The original policy design called for a single fund, however, the decision was made to delay merging the public insurance schemes that covered less than two-thirds of the entire population, and left most workers in the informal sector uninsured.

15 1975 Medical Welfare Scheme (MWS) for the poor and the vulnerable; 1978 CSMBS for government employees and their dependents; 1983 Voluntary Health Card scheme (VHC) for informal workers; 1990 SSI for private employees in the formal sector.

16 Thailand s UC scheme was aimed to fill this gap, by covering everyone not already insured by either the CSMBS or the SSI. The general tax-financed UC had led an overall progressive financial incidence, where the rich contributed to health financing in a higher proportion of their income than the poor.

17 Since early 2000s, all Millennium Development Goals have been achieved, reflecting Thailand health systems resilience and capacities, and with locally initiated and financed, thus ensures sustainability.

18 UC provides equitable access to health services, a low level of unmet health needs, and a high level of financial risk protection to the Thais. It is considered a major success of the big bang reform, is it so?

19 ❺ Thailand UC success factors This presentation would like to share with the audience that UC reform in Thailand is not a big bang phenomenon, but emerged out of a lengthy policy formation process that paid careful attention to international experiences, the patterns of economic incentives, and costs associated with different funding models.

20 The 30 baht UC scheme required a transformation of the resource allocation system that takes years to complete. Started with: (1)the creation of a purchaser-provider split the National Health Security Office (NHSO); (2) the contracted primary care units (CUPs);

21 (3) capitation-based funding; (4) strengthened primary care; (5) legislative changes for central and local government; (6) Health Systems Research Institute (HSRI).

22 NHSO design of benefit packages; managing contracts; managing geographical monopoly and quality issues; managing provider payment and annual budget; preventing the downside of closed-end payment; executing monopsonistic purchasing power.

23 ❻ Insights from Thailand health reforms middle-income country context; state funding and a long-term commitment; unrealised insurance schemes harmonization; remarkably successful rollout from two strands of health systems development before UC implementation.

24 ❼ Thailand UC challenges (1)NCDs prevalence & cost pressure; (2)geographical monopoly & quality of care; (3) disparities on sub-national level; (4) human resources; (5) globalization;

25 (6) private sector & single regulatory system between public and private sectors; (7) inherent market failures; (8) inequity among CSMBS, SSI, and UC.

26 ❽ Epilogue Thailand s UC design called for: (1) radically different governance; (2) organizational & management arrangements that included new institution, new relationships, and new ways of working;

27 (3) The policy intention was to ensure transparency, responsiveness, and accountability, by involving a wider range of agencies and stakeholders in decisionmaking process; (4) 4 decades of health infrastructure development & 3 decades of designing and implementing a number of different financial risk protection schemes;

28 (5) While countries must find their own path to UC as no blueprint emerges - the Thai reform experience, however, provides some valuable lessons. All countries and stakeholders have much to learn from each other.

29 References Ghislandi, S., Manachotphong, W., & Perego, V.M.E. (2015). The impact of Universal Health Coverage on health care consumption and risky behaviors: Evidence from Thailand. Health Economics, Policy and Law, 10(03), Green, A. (2000). Reforming the health sector in Thailand: The role of policy actors on the policy stage. International Journal of Health Planning and Management, 15,

30 Hanvoravongchai, P. (2013). Health financing reform in Thailand: Toward Universal Coverage under fiscal constraints. Washington, D.C.: The World Bank. Hughes, D., & Leethongdee, S. (2007). Universal coverage in the Land of Smiles: Lessons from Thailand s 30 Baht Health Reforms. Health Affairs, 26(4),

31 Patcharanarumol, W., Tangcharoensathien, V., Wibulpolprasert, S., & Suthiwisesak, P. (2014). Universal Health Coverage for Inclusive and Sustainable Development. Country Summary Report for Thailand. Japan-World Bank Partnership Program for Universal Health Coverage. Rokx, C., Schieber, G., Harimurti, P., Tandon, A., & Somanathan, A. (2009). Health financing in Indonesia: A reform road map. Washington, D.C: The World Bank. Somkotra, T., & Lagrada, L.P. (2008). Payments for health care and its effect on catastrophe and impoverishment: Experience from the transition to Universal Coverage in Thailand. Social Science & Medicine, 67,

32 Taearak, P. (2002). Primary care reform. In P. Pramualratana and S. Wibulpolprasert (Eds.), Health Insurance Systems in Thailand (pp ). Nonthaburi: Health Systems Research Institute (HSRI). Tangcharoensathien, V., Limwattananon, S., Patcharanarumol, W., & Thammatacharee, J. (2014). Monitoring and evaluating progress towards Universal Health Coverage in Thailand. PLOS Medicine, 11(9), 1-3.

33 Tangcharoensathien, V., Limwattananon, S., Patcharanarumol, W., Thammatacharee, J., Jongudomsuk, P., & Sirilak, S. (2015). Achieving Universal Health Coverage goals in Thailand: The vital role of strategic purchasing. Health Policy and Planning, 30, Tangcharoensathien, V., Wibulpolprasert. S., & Nitayaramphong, S. (2004). Knowledge-based changes to health systems: The Thai experience in policy development. Bulletin of the World Health Organization, 82(10),

34 Thailand s Universal Coverage Scheme: Achievements and Challenges. An independent assessment of the first 10 years ( ). Nonthaburi, Thailand: Health Insurance System Research Office, Vongmongkol, V., Patcharanarumol, W., Panichkriangkrai, W., Pachanee, K., Prakongsai, P., Tangcharoensathien, V., Hanson, K., & Mills, A. (2011). Effectiveness of public health insurance schemes on financial risk protection in Thailand: The assessments of purchasers capacities, contractors responses and impact on patients. The Consortium for Research on Equitable Health Systems (CREHS).

35 Weraphong, J., Panarunothai, S., Luxananun, T., Junsri, N., & Deesawatsripetch, S. (2013). Catastrophic health expenditure in an urban city: Seven years after universal coverage policy in Thailand. Southeast Asian Journal of Tropical Medicine and Public Health, 44(1), World Health Organization. (2014). Country Cooperative Strategy at a glance Thailand. Retrieved August 14, 2016 from sbrief_tha_en.pdf

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