1. Naresuan University, Thailand
Harmonization of three public health
insurance schemes on
Emergency medical service policy
By
Wannapha Bamrungkhet*; Sutherada Chimnoi**;
Samrit Srithamrongsawat**; Supasit Pannarunothai*
*Naresuan University
**Health Insurance System Research Office
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2. Outline
 Introduction
 Methodology
 Result
 Conclusion
 Recommendation
Naresuan University, Thailand
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3. Thai Health System
Health
scheme
Universal Coverage Scheme
(UCS)
Social Security Scheme
(SSS)
Civil Servant Medical
Benefit scheme (CSMBS)
Nature Citizen entitlement Mandatory Fringe benefit
Benefit
package
Small number of limited
condition
Prevention & promotion
Small number of
limited condition e.g.
plastic surgery
No preventive care
No explicit exclusion
special bed
Provider Public and private
contracting unit for primary
care
Public and private
hospitals > 100 beds
(50% is private)
Public provider only
Payment OP: Capitation
IP: DRGs with global budget
Capitation OP and IP
(DRG for IP DRG RW>2)
OP: fee for service
IP: DRG
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4. Harmonization of public health
insurance schemes on EMS policy
• Implemented on 1st April 2012
– Aimed to harmonized management of EMS
– Including non-contracted hospital of public health insurance
schemes into the management system
– Covered only urgent and emergent patients
– National Health Security Office (NHSO) is a clearing house
• Objective of the study
– The study aimed to study the effects of harmonization of
three public health insurance schemes on emergency
patients
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5. Methodology
• Telephone interview survey with semi-structured
questionnaire
– The questionnaire had been tested by 30 persons form three public
health insurance schemes
• Population sample
– Sample was emergency patient who accessed to health services
under the policy between August-October 2012
– Sample existed in Emergency Claim online (EMCO)
– Sampling sample by using simple random sampling with personal
identity number
Scheme UCS SSS CSMBS Total
Sample 105 95 92 292
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6. Result
EMS patient age (%) UCS SSS CSMBS Average
1-15 15 0 21 12
16-59 48 91 22 53
60 + 37 9 58 35
Average age of patient 45.6 40.4 53.0 46.2
Standard deviation 26.0 13.4 30.5 24.8
In-patient care (%) 85 80 96 87
Emergent patient (red case) (%) 50 25 25 34
Main reason of accessing to health services
Accidence and trauma 14 14 5 11
General emergency illness 81 79 93 84
Obstetric emergencies. 5 7 1 4
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7. Policy perception
0
5
10
15
20
25
30
35
40
45
News paper Television Promotion
of hospital
Family &
friend
Other
Source of policy information perceive (%)
UCS SSS CSMBS
Yes
50%
No
50%
Persons who know
the policy
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8. Expectation on the policy
0
10
20
30
40
50
60
70
80
90
UCS SSS CSMBS
Did not expect to be asking for health
insurance before service (%)
Was asked for health insurance before
service (%)
0
10
20
30
40
50
60
70
UCS SSS CSMBS
Knew that the policy covers only emergency
condition (%)
Knew that they must be refer back to the
registered hospital after the emergency (%)
Acceptable if they were sent to the registered
hospital after emergency (%)
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9. Accessing care channel
0
10
20
30
40
50
60
UCS SSS CSMBS
Know EMS hotline 1669 (%)
Need of EMS 1669 (%)
91%
3% 2% 4%
Health accessing channel
Their own
NGOs
EMS 1669
Calling to hospital
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10. HealthInsuranceSystemResearchOffice
Selecting health service
0
10
20
30
40
50
60
70
80
90
Nearest Standard and
quality
Without
waiting time
Other
Reason selecting health service
UCS SSS CSMBS
90%
10%
UCS
88%
12%
SSS
99%
1%CSMBS
Selected hospital by themselves
Selected hospital by other
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11. Service payment & Financial burden
UCS SSS CSMBS Average
Patient who had to pay at the point of service then
reimburse the clearing house
94% 91% 88% 91%
financial burden of household 77% 85% 76% 79%
0
10
20
30
40
50
60
UCS SSS CSMBS Total
94% 91% 88% 91%
Receiving financial reimbursement (% of patient)
Yes
No
Do not sure
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12. Satisfaction & Complaint
84%
86%
88%
90%
92%
94%
96%
UCS SSS CSMBS
Satify Recommended
11%
89%
UCS
10%
90%
SSS
17%
83%
CSMBS
Hotline
No. 1330
Know 1330
Do not know 1330
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13. Conclusion
Most of emergency patients were working ages and
half of them were aware of the policy
Asking for health insurance before treating still existed
Most of patients accessed hospital by themselves,
which related that EMS system was limited and
needed to be improved
Although the policy promoted that emergency
patients could access to health services for free, most
of them had to pay at the service point then
reimburse.
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14. Recommendation
Improving and promoting emergency medical
service hotline 1669 is important
Setting the process or guideline to prevent
payment at the point of service before
reimbursement
More focusing on the NHSO 1330
 Promoting NHSO hotline 1330 to increase awareness of
beneficiary’s rights
 Continuous study on the cause of non-perception of
people about hotline 1330, and their rights and benefits
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15. Thank you for attention
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