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Information System for Health Insurance in Thailand

Information System for Health Insurance in Thailand. Dr. Somnuek Sirisuwan Senior Expert, National Heath Security Office, Thailand. Presentation topics. Introduction to The National Health Security Act in Thailand The development of information system for health insurance

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Information System for Health Insurance in Thailand

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  1. Information System for Health Insurance in Thailand Dr. Somnuek Sirisuwan Senior Expert, National Heath Security Office, Thailand

  2. Presentation topics • Introduction to The National Health Security Act in Thailand • The development of information system for health insurance • Utilization of health information in the National Health Security Office (NHSO) • Health information system : Our Future plan

  3. Introduction to The National Health Security Act in Thailand • The universal health coverage system in Thailand had been introduced since 2000. • and the National Health Security Act was enacted in 2002. • Three main health financing schemes including, • Civil servant medical benefit scheme (CSMBS), • Social security scheme (SSS), and • Universal coverage scheme (UC)

  4. Health insurance Scheme • Civil Servant Medical Benefit Scheme (CSMBS) – 1963 : for government employee, retires and dependants • Social security scheme (SSS) –1990 : for private sector employee • Universal Coverage Scheme (UC) – 2002: for the rest of population

  5. Health insurance Scheme in Thailand

  6. The development of information system for health insurance • Because a huge information is needed for supporting the health security office. • A managing information system has been established by using the electronic data which have been collected from health care providers under the act.

  7. The UC scheme is financed by general tax revenue. 2401 Fiscal year 1 Oct – 30 Sep

  8. Initial three main programs • Enrollment and registration • Reimbursement, and • Health service activitiesreports

  9. UC coverage from The enrollment program (46.9 million) Data source : NHSO 16 Jan 09(Total population 64,071,087)

  10. Health care provider registration

  11. Health care provider registration Note : Primary care unit with nurse practitioners about 10,000 units

  12. Reimbursement In-Patient ~ 4.5-5.0 million claims/years (All Case) Out-Patient ~ 170,000 claims/years (Esp. High cost/Accident/Emergency)

  13. Health service activitiesreports

  14. Health service activitiesreports

  15. Health service activitiesreports 130,000,000 visits 5,000,000 admissions

  16. enrollment

  17. Health service information8 Terabytes • Hospital Profile • Population enrollment • Medical Records (OP, PP, IP) • reimbursementrecords • Disease Management Information • Health service reports • Customer feedback information • Budgeting etc .

  18. Customer feedback information , 2008( 1 Oct 2007 – 30 Sep 2008) • Service quality complainม.57,59 • 4,239 (0.48%) (2) General Complaint 19,419 (2.21%) Total calls 879,571 (3) Q&A 852,003 (96.87%) (4) Need for Referral assistant 3,910 (0.44%) 2 www.nhso.go.th

  19. Health service information for DMI 1 IP service Population OP service Service department PP service Individual record Cancer Disease Registration enrollment DMIS 2 AIDS/TB Software

  20. Information technology infrastructures and computer networks have been constantly supported

  21. Utilization of health information in the NHSO • To monitor • the distribution of specific diseases, • health outcome indicators, and health care service performances • the Dispensing information of supplies(such as medications, laboratories, facilities, equipment) for acquired immune deficiency syndrome, tuberculosis, and end-stage kidney disease from the Vender Managed Inventory (VMI) program.

  22. Morbidity monitoring

  23. The distribution of tracer diseases(high cost and high burden)

  24. Ischaemic heart diseases (I20-I25) morbidity rate , 2004 -2008 (/100,000 population) year Data source : NHSO 16 Jan 09

  25. Ischaemic heart diseases morbidity rate by region , 2004 -2008 (/100,000 population) Saraburi Ratchaburi Sakonakorn region Data source : NHSO 16 Jan 09

  26. Health outcome and Health care service performances indicators

  27. Admission rate of some chronic conditions

  28. Case Fatality Rate of some chronic/acute diseases

  29. In patients Case Fatality Rate, 2005 - 2008 2005 2006 2007 2008

  30. Acute condition : Rupture appendicitis %

  31. Pay for Quality Performance • Service coverage , and some Quality Performance indicators are used for on top payment(1.7 %). • Primary care indicators • Hospital care indicators

  32. The Dispensing information

  33. the Vender Managed Inventory (VMI) program. GPO VMI reimburse ARV / TB drugsperitoneal dialysis solution Report/billing NHSO GPO : Gov. Pharmaceutical Organization

  34. Other source of Information : Survey

  35. Health information system : Our Future plan • Three main health financing schemes should be able to exchange together for optimal use of the national health information. • The health service reports will be replaced with individual records. • Maximize the utilization of health information provide by NHSO. • http://www.nhso.go.th/eng/#

  36. The end

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