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

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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

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