International Health Systems: The Asian

Transcription

1 International Health Systems: The Asian Asst. Prof. Borwornsom Leerapan, MD PhD MGMG 548: Health Service Systems and Health Systems CMMU, Mahidol University July 26, 2016 Pix source: ra.mahidol.ac.th Format F/U Presentation Discussion Q&A To-do list Minilecture Wrap up 1

2 Housekeeping Issues 1) Confirmed a guest lecturer on Sat Aug 6 th (week 12): Mahippathorn Chinnapa, MB BCh MRCPCH 2) No guest lecturer on Aug 9th (week 13) Instead, I ll share some of my work with you. 3) No final exam, but you will have a chance to present your course paper (oral presentation, with media such as PPT slides) in the class on Aug 16 th (week 14): 4) Course paper due at 11.59PM of Aug 22th How do the advanced Asian countries (e.g. Japan, Taiwan, Singapore) finance and organize health services? How such health systems have performed? What would be the lessons learned for healthcare managers currently working in Thai healthcare system? Discussions/Q&A Outline for Today 2

3 Reviewing Concepts of Health Systems: Organizing & Financing Healthcare What Level of Our Learning? Wisdom Why Knowledge How Information What, Who, When, Where Data Number, Text, Picture, Sound, etc. 3

4 Health System s Building Blocks Pix source: WHO (2007). Control Knobs Framework for Health Reform Source: Adapted from Roberts et al. (2003). 4

5 Comparative Health Systems: Organizing & Financing Healthcare 5

6 Major Mechanisms of Healthcare Financing 1) Outof-pocket Payments 2) Taxes Payers 3) Individual private health insurance Healthcare Regulator(s) Hospitals Ambulatory Facilities 4) Employerbased private health insurance Payment Mechanisms: Salary, Fee-for-Service, Global Budget, Capitation, etc. Medical Specialists Generalists & PCPs Feature Financing of Thai Healthcare System Targeted groups of beneficiaries Source of financing Method of payment to health facilities Major problems CSMBS SSS UCS Motor Vehicle Victim Protection Law State/Employer welfare Civil servants, state enterprise employees and dependents Govt. budget Fee-for-service Rapidly and constantly rising costs Compulsory heath insurance with state subsidies Employees in private sector and temporary employees in public sector Tri-party (Employee, employer and govt. budget) Capitation and Fee-for-service Covering while being employed only State welfare Thai citizens without the coverage of CSMBS & SSS Compulsory heath insurance for vehicle owners Victims of vehicle accidents Private Health Insurance Voluntary health insurance General public Govt. budget Vehicle owners Household Capitation and Fee-for-service Inadequate budget Fee-for-service Redundant eligibility and slow disbursement Source: Adapted from Wibulpolprasert et al. (2011). Thailand Health Profile Fee-for-service Redundant eligibility and slow disbursement 6

7 Thai Healthcare Systems Payment Mechanisms: Salary, Fee-for-Service, Global Budget, Capitation, DRGs, etc. Providers in Public & Private Sector Taxes Payers Employer-based private health insurance CGD (CSMBS), NHSO (UCS) Social Security Office (SSS) Hospitals Ambulatory Facilities Individual & Employer s private health insurance (Voluntary) Motor vehicle s owners (Mandatory by the Motor Vehicle Victim Protection Law) Commercial Insurance Companies Patients paying out-of-pocket Medical Specialists Generalists & PCPs Comparing Asian Healthcare Systems: Organizing & Financing Healthcare 7

8 Japanese Healthcare System Corporates Employers & Employees Central govt. Most providers are in the private sector, most small facilities are private, but large facilities are in the public sector. Taxes Payers Local govt. Retirees & (ex-employers) Self-employed, Farmers, Fishermen, etc. Negotiated standardized payment rates (e.g. FFS, per diem) Source: Bodenheimer TS, Grumbach K (2009). Understand health policy: a clinical approach Japanese Healthcare Systems Ø Social Health Insurance with standard comprehensive benefits, including payment for hospital and physician services, prescription drugs, maternity care, and dental care, disable adults with long term insurance and earmarked income tax. Healthcare financing mix Figure source: Wagstaff (2005). World Bank Policy Research Working Paper

9 Singaporean Healthcare Systems Compulsory Savings Scheme (Employees & Employers) Patients paying out-of-pocket Central Provident Fund(CPF) Medical Saving Accounts (Medisave) Providers in Public & Private Sector Individual Insurers Catastrophic insurance program (Medishield) Corporatized public hospitals & Private hospitals Ambulatory Facilities Taxes payers Public assistant program (Medifund) Severe disability insurance program (Eldershield) Medical Specialists Generalists & PCPs 3M, Means-testing Singaporean Healthcare Systems ØGovt. subsidies aim to provide all Singaporeans basic health care defined as good and affordable medical services, but not provide the latest and best of everything ØEmphasize on greater transparency about costs and prices, more regulation of insurance company s prices and policies. Source: Hsiao (1995); Singapore's Ministry of Health (2003) 9

10 Taiwanese Healthcare System Most Providers in the Public Sector Taxes Payers Govt-run, Single fund, National Health Insurance Taiwanese Healthcare Systems Ø Consolidated System : providing everyone equal access to health care, free choice of doctors, with no waiting time, and a system that encouraged a lot of competition among medical providers. ØEfficient administrative system: utilization of information technology, including smart cards, online medical information systems, and online billing systems. Figure source: Wagstaff (2005). World Bank Policy Research Working Paper

11 How have health systems performed? Health System Source: WHO (2000). The World Health Report

12 Health System s Building Blocks Pix source: WHO (2007). Source: WHO (2000). The World Health Report Pix source: buelahman.files.wordpress.com 12

13 Health System s Performance Pix source: WHO (2000). World Health Report What would be your lessons learned from these comparative health systems? 13

14 What Level of Our Learning? Wisdom Why Knowledge How Information What, Who, When, Where Data Number, Text, Picture, Sound, etc. Four Major Types of Healthcare Systems Entrepreneurial Health Systems Welfare-oriented Health Systems Comprehensive Health Systems Socialist Health Systems US Singapore Germany Japan Canada Tai wan UK Cuba The least market interventions -Private financing -Private providers The most market interventions -Public financing -Public providers Source: Adapted from Roemer (1993). 14

15 Control Knobs Framework for Health Reform Source: Adapted from Roberts et al. (2003). Food-for-Thought 15

16 The track of the previous cart is the teacher of the following cart. --A Chinese proverb Pix source: en.wikipedia.org/ Q& A Discussions 16