Financial Protection from the Universal Health Care Coverage in Thailand: The Evidence
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
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
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. Source : MOPH BPS Health Resource Surveys The birth of district hospitals (Rural health development -1977) Trends in expansion of hospitals
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
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.