Dr. Winai Sawasdivorn. National Health Security Office. Thailand

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Judith Norman
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1 Universal Coverage experience of Thailand Dr. Winai Sawasdivorn Secretary General National Health Security Office 1 Thailand Provinces 76 Districts 876 Tambons (communes) 7,255 Villages 68,839 Source: Thai Health Profile

2 Background dinformation Population 63.2 million (2007) GNI per capita 2,840 US (2008) 5,990 International dollar IMR 11.3/1,000 (2006) MMR 9.8/100,000 (2006) Life expectancy female 77.6 (2006) male 69.9 (2006) Population with health care coverage 97.7%** From: Thailand Health Profile 2007 World Bank Atlas Health service providers Facilities units beds Regional hospital 25 17,233 Provincial hospital 69 22,585 District i t hospital ,366 Health Center 10,848 University hospital 15 8,792 Private hospital ,678 Private clinics 346 Drug stores 17,017 Others 1,175 31,560 Source: Thailand Health Profile

3 Health workers Pop./ctors 3,569 3,476 3,305 3,182 Pop./Dentist 17,606 17,182 15,143 14,901 Pop./Pharmacist 9,948 8,807 8,432 7,847 Pop./Profes.Nurse Pop./Technical Nurse 2,233 2,625 3,085 3,910 Source: Thailand Health Profile Public private expenditure in South East Asia region Perce ent % 5.9% 2.5% Public Private % GDP 4.3% 4.0% 3.8% 2.2% 3.3% 6.6% 7.0% 6.0% 5.0% 35% 3.5% 4.0% 3.0% 2.0% re as % of GDP Total expenditur T % 0 0.0% Source: World Health Statistics Report

4 Health expenditure as % of GDP Mil. Bah ht 350, , , , , ,000 50, % 3.5% 4.5% 3.8% 4.0% 3.7% 3.7% 3.7% 3.7% 40% 4.0% 3.5% 3.5% 3.4% 3.5% 3.5% 3.3% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% %GDP public private %GDP 0.0% Source: Thai Working Group on National Health Account Per capita total t expenditure on health (PPP int $) Country 2006 Thai 264 Malaysia 544 Republic of Korea 1467 Singapore 1536 United Kingdom 2815 Australia 3119 US 6719 Capitation for UC (2009): US$, or 2,202 Thai Baht Source: World Health Statistics Report

5 UC SCHEME IN THAILAND 9 Scheme characteristics CSMBS SSS UC scheme Population 5 Million (8%) 9.84 Million (15.8%) 47 Million (75%) Source of finance General tax (~11,000 Baht/Cap*) Tripartite from employer, employee, government General tax (2,100 Baht/Cap) rate 1.5% of salary (maximum salary: 15,000) (health care 1,250 Baht/Cap, total 2,134 Baht/Cap) h/ Benefit package No preventive care No explicit exclusion Special bed Small number of limited condition eg. Non medical plastic surgery Small number of limited condition Prevention & promotion Providers Public provider only, Private in emergency 3,000 Baht/episode Public and private hospital more than 100 beds (50% private) Public and private contracting unit for primary care(cup) Payment OP: Fee for service IP: DRGs (2year) Capitation OP: Capitation IP: DRGs Year 2008, CSMBS = Civil Servant Medical Benefit scheme, SSS = Social Security Scheme, UC scheme = Universal Coverage Scheme Adapted from: Mills et al. 2005; Srithamrongsawat S. Thammatacharee J

6 Principles System efficiencies cost containment Close end provider payment methods Rationalize use of health services: promote PHC Encourage private sector involvement, but limited by geographical monopoly of MOPH district health providers Equity Standardized core package across the two schemes Convergence magnitude of financing per beneficiary Separate the role of purchaser and provider Move away from integrated model towards contracting model Quality and accreditation Source: Manual of Universal Coverage research Use local researcher Preparation Stage Design according to Local context Capacity strengthening of national health systems researchers Conduct pilot projects To test the systems Get more evidence from different contexts Evidence for implementation X Copy other countries X Implement by intuition, without evidence support 12

7 Collecting Financing (1) Compulsory SHI for X Voluntary insurance can formal private sector never achieve UC employee X Out of pocket General tax for public X Contributory scheme servant and rest of for informal sector: high h population cost to collect premium, +/ Earmarked tax difficult to enforce enrolment 13 Pooling Financing (2) Regional or National Thailand choose national pool through h general tax X Too small population no enough risk sharing pool 14

8 Financing (3) Benefit package Comprehensive package: covers OP, IP, A&E, P&P, high cost, rehabilitation, dialysis, ART etc. A small number of negative list e.g. cosmetic surgery Based on evidence of cost effectiveness X Allow additional charges by providers for which hresults in two tiers services 15 Purchasing Financing (4) Close ended payment: For SHI: inclusive capitation for OP and IP, For UC scheme: Capitation for OP and prevention, health promotion; global budget + DRG for IP, X Open ended payment: e.g. fee for service, per day of admission, X Stimulate supplier induced demand d X Fee for service with high copay results in household catastrophic health expenditure 16

9 CSMBS Expenditure , Fee for service payment Expenditur re (M Baht) Total IP OP Source: Dr.Samrit Srithamrongsawas s presentation 17 Information Technology Harmonization of three public insurance schemes, as beneficiaries cross schemes Beneficiary registration Provider registration Electronic transfer of funds Strong ground DRG development E patient records Maximize use of information and evidence for decisions X Implement UC using paper work transaction 18

10 Health lhservices Delivery Purchase services from a contractor network in particular district health systems (DH, HC) Strengthen primary care as gate keeper [budget holding for OP] Develop comprehensive referral system Private partnership through contractual agreement X Direct contact to tertiary care or specialist 19 Governance System Enact a Law on National Health Security Purchaser provider split Multi partner governance board, Evidence based culture Hotline for and transparent mechanism to handle complaints No fault liability payment to compensate medical adverseevents events Balance interests between members and healthcare providers X UC scheme should not governed by bureaucratic Department 20

11 Enabling factors for Thai UC 1. Political commitment policy agenda setting 2. Evidence based policy formulation 3. Existing functioning primary healthcare, close to client services, easy access by rural populations Result in equitable utilization and benefit incidence 4. Government effectiveness in scaling up and sustaining UC scheme 5. High capacity on information systems: enabling monitor, evaluate and continued systems fine tuning 6. Champion of Thai UC 21 Dr. Sanguan Nittayarumpong The first Secretary General of National Health Security Office 22

Thailand s UHC development. National Health Security Office 23 June 2014

Thailand s UHC development. National Health Security Office 23 June 2014 Welcome to NHSO Thailand s UHC development National Health Security Office 23 June 2014 Thailand: country profiles Population - 64 million GNI 2012 US$5,090 per capita UHC achieved in 2001 under 3 scheme