Delivering Effective Health Care for All Monday 29 th  March, 2010 Financial Protection from the Universal Health Care Cov...
Outline <ul><li>Trends in  population coverage  by health insurance </li></ul><ul><li>Poverty impact of health payment bef...
1. What do we mean by the universal coverage?
Population coverage by health insurance before and after the 2001 UC reform Source : Analysis of Health and Welfare Survey...
2. Impoverishment by health payment before and after UC
Household impoverishment from health 1996 (Pre-UC)   2008 (Post-UC) Health impoverishment  per 100 households 0 –  0.5 0.6...
3.  Progressive  tax-based health financing of UC
Source : National Health Accounts UC 2001
Source : CREHS year-2 Report
4.  Pro-poor  utilization and  pro-poor  public subsidy of district health services during UC
Utilization shares (%) by income quintile Ambulatory visits and hospital admissions, 2001-2007 Source : CREHS year-2 Report
Public subsidy shares (%) by income quintile Ambulatory visits and hospital admissions, 2001-2007 Source : CREHS year-2 Re...
Source : CREHS year-2 Report Pro-rich Pro-poor
5. The message to go! Health infrastructure and human resources are  the prerequisite of the demand-side financial risk pr...
Source : MOPH BPS Health Resource Surveys  The birth of district hospitals (Rural health development -1977) Trends in expa...
Source : MOPH BPS Health Resource Surveys  Mandated rural service of  new medical graduates -1972 Production of  technical...
2000 1970 1 st -3 rd  NHP (1962-76) Mandatory rural services for new MDs and nurses  100% provincial hospitals  1. Infrast...
Upcoming SlideShare
Loading in …5
×

Financial Protection from the Universal Health Care Coverage in Thailand: The Evidence

2,081 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
2,081
On SlideShare
0
From Embeds
0
Number of Embeds
7
Actions
Shares
0
Downloads
43
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • A recent history of health financing systems reveals a substantial drop in the number of population who had no health insurance after the Universal Health Coverage (UC) scheme was introduced in 2001. In 2007, the uninsured were down to less than 4% of the total population.
  • Over the same periods, spending in health increased at about the same rates as total economy, at a ratio of 3.5-4%. A major achievement is the health share by household payment has reduced over time, while the public share consistently increased to almost 75% in 2007. A decreasing trend in the rich-poor gap in health payment is largely due to a reducing OOP burden shouldered by the poor households.
  • Analysis of two household surveys, HWS and SES, shows impacts on equity in health service use and financing as well as the time trends. Here, the ambulatory visits and hospitalization at the district health facilities concentrated among the poor (a negative CI), whereas utilization of private hospitals was pro-rich (a positive CI). Health financing by direct tax was very progressive with respect to household wealth (a positive CI). However, OOP payment and indirect tax were relatively less progressive as compared to the income gap (as shown by a negative Kakwani index).
  • The last six decades observed two major policy development. By 1990, geographic coverage of health infrastructures was completed in the first five National Health Plans. Major development is Rural Health Programs which established district hospitals beginning in 1977. Innovative health payment mechanisms in terms of prospective payment systems (PPS) began in 1990 when social health insurance scheme was implemented.
  • Financial Protection from the Universal Health Care Coverage in Thailand: The Evidence

    1. 1. Delivering Effective Health Care for All Monday 29 th March, 2010 Financial Protection from the Universal Health Care Coverage in Thailand: The Evidence Supon Limwattananon International Health Policy Program (IHPP), THAILAND
    2. 2. Outline <ul><li>Trends in population coverage by health insurance </li></ul><ul><li>Poverty impact of health payment before and after UC </li></ul><ul><li>Who pay for health care during UC? </li></ul><ul><li>Who benefit from health care use during UC? </li></ul><ul><li>Why is that so? </li></ul><ul><li>The long (3-decade) march of health infrastructure development </li></ul><ul><li>and financing innovation </li></ul>
    3. 3. 1. What do we mean by the universal coverage?
    4. 4. Population coverage by health insurance before and after the 2001 UC reform Source : Analysis of Health and Welfare Surveys (HWS, various years) LIC : Low-Income Card Scheme  Tax-funded, public welfare program ( defunct ) VHC : Voluntary Health Card Scheme  Subsidized, voluntary, community-based health insurance ( defunct ) UC : Universal Coverage Scheme  Tax-funded, entitlement scheme for the rest of all Thai population SS : Social Security Scheme  Compulsory, contributory, social health insurance (SHI) for formal private employees CSMB: Civil Servant Medical Benefit Scheme  Tax-funded, fringe benefit for government employees/pensioners, dependants
    5. 5. 2. Impoverishment by health payment before and after UC
    6. 6. Household impoverishment from health 1996 (Pre-UC) 2008 (Post-UC) Health impoverishment per 100 households 0 – 0.5 0.6 – 1.0 1.1 – 2.0 2.1 – 3.0 3.1+ Source : Analysis of Socio-Economic Surveys (SES, various years)
    7. 7. 3. Progressive tax-based health financing of UC
    8. 8. Source : National Health Accounts UC 2001
    9. 9. Source : CREHS year-2 Report
    10. 10. 4. Pro-poor utilization and pro-poor public subsidy of district health services during UC
    11. 11. Utilization shares (%) by income quintile Ambulatory visits and hospital admissions, 2001-2007 Source : CREHS year-2 Report
    12. 12. Public subsidy shares (%) by income quintile Ambulatory visits and hospital admissions, 2001-2007 Source : CREHS year-2 Report
    13. 13. Source : CREHS year-2 Report Pro-rich Pro-poor
    14. 14. 5. The message to go! Health infrastructure and human resources are the prerequisite of the demand-side financial risk protection introduced by UC
    15. 15. Source : MOPH BPS Health Resource Surveys The birth of district hospitals (Rural health development -1977) Trends in expansion of hospitals
    16. 16. Source : MOPH BPS Health Resource Surveys Mandated rural service of new medical graduates -1972 Production of technical nurses -1982 Trends in expansion of health workers
    17. 17. 2000 1970 1 st -3 rd NHP (1962-76) Mandatory rural services for new MDs and nurses 100% provincial hospitals 1. Infrastructure development UC: the long march LIC 1975 1990 CSMB 1980 CHF 1983 SS 1991 4 th -5 th NHP (1977-86) Expansion of district hospitals and health centers UC 2001 VHC 1994 1980 MOPH established 1942 15 provincial hospitals 300+ health centers 2. Innovative financing Source : Adapted from Srithamrongsawat Prospective payment system (PPS) - Capitation for SS (OP-IP) - Diagnostic-related groups (DRG) for LIC/VHC (IP) <ul><li>PPS expansion </li></ul><ul><li>- Capitation for UC (OP) </li></ul><ul><li>DRG for UC (IP) </li></ul><ul><li>DRG for CSMB (IP) </li></ul><ul><li>Direct billing for CSMB (OP) </li></ul>LIC + 1996 SS + 1994 SS + 2002 Formal and informal user fee exemption

    ×