Health Insurance System Research Office

Health System Research Institute

Thailand’s Universal Health Coverage

Regional Seminar
“Rethinking Social Protection in a Changing Arab Region”
Amman, Jordan
13 -15 May 2014

Dr. Thaworn Sakunphanit

MD., FRCPT, BA (Econ), MSc. (Social Policy Financing)
Director, Health Insurance System Research Office (HISRO)
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 Country profiles: Thailand
Health Insurance System Research Office

• Constitutional monarchy in Southeast Asia

Health System Research Institute

• Population - 67 million
• Unemployment rate is 1.4%
• GDP per capita (PPP US $) 8,703(2011), Gini 40
• Total Health Expenditure (PPP US $) 330 (2010)
• Sources: Public 65%, SHI 8%, Private 25%,
OOP 14% of THE,
• GGHE 13.1% GGE
• Health status
• Total fertility rate 1.6 (2010)
• Life expectancy at birth 74.1 years
• U5MR 14/1000
• MMR 48/100,000
• Physicians per capita 4/10,000
• ANC & hospital delivery 99-100% (2009)
 What is the Universal Coverage Scheme?
Health Insurance System Research Office
Health System Research Institute

Thai citizen have enjoyed “Universal Health Coverage” since 2002

Major Civil Servant Medical Social Security Scheme Universal Coverage

Schemes Benefit Scheme (SSS) (UCS)
(CSMBS)
Introduced in 1960s 1990s 2002
Target Govt employees & Private sector To whom which not
beneficiaries dependents, retirees employees: covered by CSMBS
nor SHI,
Pop Coverage 7% 16% 75%
Funding Govt budget Payroll contribution, Govt budget
Tripartite
(Tax) (Social Health (Tax)
Insurance)
Payment to health Fee-for-service for OP, Capitation for OP & IP, Capitation for OP,
facilities DRG for IP DRG for Adjusted RW DRG for IP
3 >= 2
 What is the Universal Coverage Scheme?:
Comprehensive Benefit Package
Health Insurance System Research Office
Health System Research Institute

• Promotive and preventive services

• Diagnosis
• Ante-natal care
• Curative care
• Medicine, medical supplies, organ substitutes, and medical
equipment
• Delivery
• Boarding expenses within health care unit
• Newborn and child care
• Ambulance or transportation for patient
• Transportation for disabled person
• Physical and mental rehabilitation
• Other expenses necessary as prescribed by the Board.
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 What is the Universal Coverage Scheme?:
Purchaser Provider Split with Gate Keeper
Health Insurance System Research Office
Health System Research Institute

NHSO tertiary care

Purchase
services
Regional secondary care
purchaser

referral
Primary Care as Gate Keeper
Contracted
Unit for
Primary Care
(CUP)
Primary Care Primary Care
Unit 1 Unit 2
 Enabling Factors for the
Universal Coverage Scheme
Health Insurance System Research Office
Health System Research Institute

• State commitment to health

– Socioeconomic (growth & poverty reduction)
– Human rights -> Legitimacy -> constitution
• Centralized (Public) health care coverage plan
• Planning and utilization of human resources
• Improvement of institutional capacity on health systems:
– health systems research, health care financing, model
development
• Support and collaboration with health care professionals, civil
societies and politicians

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 State Commitment to health
Health Insurance System Research Office
Health System Research Institute

Social Health Out of

Protection Pocket
Scheme Payment

Health Care
Facilities and
Personals
 State Commitment to health:
(Public) health care facilities
Health Insurance System Research Office
Health System Research Institute

Low income Country Low income Country

Decade of hosp 1977- 1986
Decade of health centre 1992-2001

Low income Country Low income Country

8 Source: Patcharanarumol W et al (2011). Why and how did Thailand achieve good health at low cost?10
 State Commitment to health:
Enacted Social Health Protection Laws
Health Insurance System Research Office
Health System Research Institute

Source: HISRO (2012) Thailand’s Universal Coverage Scheme: Achievements and Challenges. An
independent assessment of the first 10 years (2001-2010).
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 State Commitment to health:
Increasing of Coverage
Health Insurance System Research Office
Health System Research Institute

UCS

Source: National Statistics Office, the Health and Welfare Surveys in 1991, 1996, 2001 and 2003.
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 Increased Access and Health Status
Health Insurance System Research Office

Out-patient utilization In-patient utilization

Health System Research Institute

Outcome of HT,by Treatment

Distribution of Patients DM Services
Outcome Outcome of CA Cervix
100%

80%

60%

40%

20%

0%
2003-4 2008-9 2003-4 2008-9 2003-4 2008-9

Hypertension
Hypertension Diabetic
Diabetic Hypercholesteral
Hypercholesterol

No diag No trearment Uncontrol Control

Source: National Health Examination Survey 2003-2004. 2008-2009, Administrative data of UCS various years
 Positive Economic Impact of
the UCS
Health Insurance System Research Office

? Impact to labour market

Health System Research Institute

Crowd in ? Impact from

1.2 times Improvement of
over its spending health status

Does not have effect on

the precautionary savings
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 UCS prevented medical
impoverishment
Health Insurance System Research Office
Health System Research Institute

Source: HISRO (2012) Thailand’s Universal Coverage Scheme: Achievements and Challenges. An
independent assessment of the first 10 years (2001-2010).
 Financial Sustainability
Health Insurance System Research Office

Projection of Total health expenditure as Percentage of GDP is not high

Health System Research Institute

UCS shared in GDP around 1.2%

14 Source: Hennicot JC, Scholz W and Sakunphanit T. Thailand health-care expenditure projection: 2006–2020. A research
report. Nonthaburi, National Health Security Office, 2012
 Social Sustainability
Health Insurance System Research Office
Health System Research Institute

100.00
90.00 95.50
92.75 90.79
88.37 89.32 89.76
80.00 83.42 83.91 83.16
83.01 82.35
78.75
70.00
66.86 68.48 67.60
60.00
60.75 60.27
50.00 56.57
50.99
40.00 45.66 47.72
39.34
30.00
20.00
10.00
-
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Providers UCS
UC beneficiaries
beneficiaries
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Source: Satisfaction survey of NHSO (Various Years)
 Challenges and The Way Forward
Health Insurance System Research Office

• Harmonized social protection schemes

Health System Research Institute

– Multiple schemes using the same payment

mechanisms
– Identify basic health care package and
harmonized them e.g. life saving and high
cost care among three schemes
• More efficient and improved quality
health care
– More “efficient” public providers & Public-
Private Partnerships

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• Mitigate and cope with Aging Society
 Health Insurance System Research Office
Health System Research Institute

17
Thank You