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Contributions of health system research to health system performance assessment in Thailand

Contributions of health system research to health system performance assessment in Thailand.

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Contributions of health system research to health system performance assessment in Thailand

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  1. Contributions of health system research to health system performance assessment in Thailand Phusit Prakongsai, MD. PhD.International Health Policy Program (IHPP)Ministry of Public Health, ThailandPresentation to the 1st Global Symposiumon Health Systems ResearchMontreux, Switzerland17 November 2010

  2. Inputs & processes Outputs Outcomes Impact Intervention access & services readiness Intervention quality, safety and efficiency Coverage of interventions Prevalence risk behaviours & factors Improved health outcomes & equity Social and financial risk protection Responsiveness Infrastructure / ICT Health workforce Supply chain Information Financing Governance Population-based surveys Coverage, health status, equity, risk protection, responsiveness Administrative sources Financial tracking system; NHA Databases and records: HR, infrastructure, medicines etc. Policy data Facility assessments Clinical reporting systems Service readiness, quality, coverage, health status Vital registration Monitoring & Evaluation of health systems reform /strengthening A general framework Indicator domains Data sources Analysis & synthesis Data quality assessment; Estimates and projections; In-depth studies; Use of research results; Assessment of progress and performance of health systems Communication & use Targeted and comprehensive reporting; Regular country review processes; Global reporting

  3. Historical evolution: Infrastructure development + financial protection extension Establishment of prepayment schemes User fees Informal user fee exemption 1945 Expansion consolidation of prepayment schemes 1970 1975 LIC 1980 CSMBS 1-3rd NHP 1962-76 Provincial hospitals 1990 SSS 1980 1983 CBHI SSS CSMBS LIC  MWS Universal Coverage 1990 4th -5th NHP (1977-86) District hospitals Health centers 1994 Pub VHI SSS 2000 2002 full achieve Universal Coverage CSMBS Health Infrastructure extension--wide geographical coverage 2002

  4. Improving production capacity, but still shortage of human resources for health in Thailand Thailand Source: World Development Indicator 2002 and World Health Report 2006

  5. Geographical mal-distribution of health workforce in 2007 Physicians Dentists 800-3,305 3,306-6,274 6,245-9,272 9,243-12,300 5,500-15,143 15,144-25,767 25,768-36,390 36,391-47,011 Nurses Pharmacists 280 - 652 653 - 904 905 - 1,156 1,157 – 1,408 4,600-8,432 8,433-12,274 12,275-16,115 16,116-19,956

  6. Real term growth GDP versus THE, 1994-2005

  7. Total health expenditure 1994-2005 Achieving UC 36 36 37 37 46 53 45 45 44 44 53 55 64 64 63 63 47 54 56 47 55 55 56 45 Total health expenditure during 2003-2005 ranged from 3.49 to 3.55% of GDP, THE per capita approx 100 USD

  8. Health service delivery:Better coverage of essential vaccines, ARV and condom use Percentage of female sex worker consistently use condom when having sex with general client in the past 1 month, 1995 – 2007 Compulsory licensing Include ART in UC package Generic production of triple ART

  9. Increase access to particular services 9

  10. More equitable health care use and better distribution of public subsidies on health after achieving universal health coverage (20% poorest) (20% richest) 2007 2006 Before UC After UC 2003 2001 Hospital admission 2001-2005 OP visits 2001-2005

  11. More equitable health financing and better financial risk protection 1. Out-of-pocket health payment 2. Catastrophic health payment 3. Health impoverishment

  12. Child mortality in Thailand from various sources of surveys Source: Hill et al. Int J Epidemiol 2007 (with updates)

  13. Child mortality by quintile: 1990 and 2000 censusSource: Vapattanawong et al. (2007)

  14. Efficiency in health resource use compared to health outcome Reduction in under 5 mortality rate (U5MR) The highest level of annual reduction in child mortality during 1996-2006 Note: only countries with GNI US$ ≤5,000 per capita; Births ≥ 100,000/year Source: Rohde et al in Lancet 2008 14

  15. Health outcome on maternal mortality Maternal mortality rate (MMR per 100,000 live births) Analysis from various sources • Various MMR show steep reduction trend; though problematic MMR: 65% of all deaths occurred outside health facilities, high (40%) ill defined cause of deaths • Recent update in Lancet May 2010 by Hogan et al • 1980: 115 (101-131) 2000: 43 (38-48) • 1990: 44 (39-50) 2008: 47 (42-53) 15

  16. Inequitable health service provision: Percentage of caesarian section to total deliveries by health insurance schemes Source: Electronic claim database of inpatients from National Health Security Office, 2004-2006 (N=13,232,393 hospital admissions)

  17. Inequity in quality and patterns of health service provision:Propensity of receiving single source antiplatelets clopidogrel, cilostazol: 6 regional hospitals

  18. Inefficiency of the Thai health care system:CSBMS expenditure from 1989 to 2008, current year price Note: Expenditure for 2008 is extrapolated from 6 months actual spending Source: Ministry of Finance, Comptroller Generals Department, various years

  19. Data availability for M&E system in Thailand Note: SES = household socio-economic survey, HWS= Health and Welfare survey, NHES = National Health Examination survey, MICS = Multiple Indicator Cluster survey, NHA = National Health Accounts, HA = Hospital accreditation, SPC= Survey of Population Changes

  20. Health Information System for supporting HSPR in Thailand Network and Coordination of HIS Data analysis and synthesis for report production and publication Reviews for health information systems Reviews for HIS Demands and indicators Data quality assessment Utilization mechanism Research and development for improving HIS, health system and policy research

  21. Key challenges in future health system development in Thailand (1) • BOD - Increasing disease burden from chronic NCD and rapid demographic changes  aging society, - The pandemic of new emerging infectious disease and unsuccessful control of TB and HIV/AIDS, - Inequitable health risk distribution among different SE groups. • Inequity and inefficiency - Mal-distribution and internal brain drain of HRH  external brain drain of nurses in the future, - Inefficiency and inequitable access to good quality of health services among different health insurance schemes, - Require more efficient use of new medical products and health technology. 21

  22. Key challenges in future health system development in Thailand (2) • Governance - Poor governance of the Thai health systems, • Contexts - The impact of globalization and international trade agreement on health  import of harmful products e.g. alcohol, tobacco, - Economic recover and growth of the private sector, • Financing - Sustainability of health care finance in Thailand. 22

  23. Lessons learnt from Thailand • Need good relationship and collaboration between Data producers Researchers Policy makers To bridge HSPR and HIS to health system performance assessment in Thailand • Good quality and timely health information system • Skills of researchers to analyze the data, and get research into policy and practice.

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