The Thai Experience on Achieving Universal Healthcare Coverage

1
The Thai Experience on Achieving Universal
Healthcare Coverage
CHF best practice workshop Dar les Salaam 31 Jan
2 Feb 2007

• Samrit Srithamrongsawat
• Health Insurance System Research Office

2
Thailand Country Background
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Thailand historical development
Establishment of prepayment schemes
Informal exemption
User fees
1945
Expansion of prepayment schemes
1970
1975 LIC
1980 CSMBS
1-3rd NHP 1962-76 Provincial hospitals
1983 HC(CHF)
1990 SSS
1980
SSS
CSMBS
LIC ? MWS
Universal Coverage
4th -5th NHP (1977-86) District
hospitals Health centers
1990
1994 HC(PVHI)
SSS
2000
2001 Universal Coverage
CSMBS
Health Infrastructure
2001
4
Coverage of health insurance 1991-2003
Source HWS 1991, 1996, 2001, 2003
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System design ensuring sustainability

• Close-end budgets Capitation
• Purchaser-Provider split
• Financial management reform
• Capitation for OP
• DRG weighted global budget for IP
• Capitation and performance for prevention and
  promotion services
• Reinsurance for accident and emergency services
  and high cost services
• Strengthening primary care establishment of
  primary care unit (PCU)
• Prevention and promotion services
• Quality improvement HA, service practice
  guideline
• Consumer protection no-fault liability, call
  center

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Characteristic of the UCS
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Some policy achievements

• 80 of UC members are those residing in rural
  areas and 60 are those in the two bottom
  quintiles
• Shifting utilization of service toward primary
  care
• Increase in access to high cost services i.e.
  open-heart surgery, malignancy, cataract
• Reduce catastrophic expenditure cases by 25 and
  prevent impoverishment according to paying
  medical care 300,000 people in 2003
• Decrease in the gap of burden of health
  expenditure between the poor and the rich

8
Utilization increase access and use of PCU and
district hospitals
source NSO HWS2001, 2003 and 2004
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Improved fairness of financial contributions
Declining of gap
Source Socio-Economic Survey 1992 - 2002
conducted by NSO.
10
Declining of financial catastrophic illnesses in
Thailand 1996-2002
Source National Statistic Office, Household
Socio-economic Survey, 1996, 1998, 2000, 2002
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Major constraints and further development

• Competing with other social objectives as
  depending totally government budgets
• Inequitable distribution of health infrastructure
• Fragmentation of health insurance schemes?
  harmonization
• Long term financial sustainability of the scheme
  need further exploration

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Approved vs estimated capitation 2002 - 2006
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Comparison of Tanzania Thai CHF_1
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Comparison of Tanzania Thai CHF_2
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Comparison of Tanzania Thai CHF_3