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The Thai Experience on Achieving Universal Healthcare Coverage

CHF best practice workshop Dar les Salaam 31 Jan – 2 Feb 2007. The Thai Experience on Achieving Universal Healthcare Coverage. Samrit Srithamrongsawat Health Insurance System Research Office. Thailand: Country Background. Thailand: historical development.

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The Thai Experience on Achieving Universal Healthcare Coverage

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  1. CHF best practice workshop Dar les Salaam 31 Jan – 2 Feb 2007 The Thai Experience on Achieving Universal Healthcare Coverage Samrit Srithamrongsawat Health Insurance System Research Office

  2. Thailand: Country Background

  3. Thailand: historical development Establishment of prepayment schemes User fees Informal exemption 1945 Expansion of prepayment schemes 1970 1975 LIC 1980 CSMBS 1-3rd NHP 1962-76 Provincial hospitals 1983 HC(CHF) 1990 SSS 1980 SSS CSMBS LIC  MWS Universal Coverage 4th -5th NHP (1977-86) District hospitals Health centers 1990 1994 HC(PVHI) SSS 2000 2001 Universal Coverage CSMBS Health Infrastructure 2001

  4. Coverage of health insurance: 1991-2003 Source: HWS 1991, 1996, 2001, 2003

  5. System design: ensuring sustainability • Close-end budgets – Capitation • Purchaser-Provider split • Financial management reform • Capitation for OP • DRG weighted global budget for IP • Capitation and performance for prevention and promotion services • Reinsurance for accident and emergency services and high cost services • Strengthening primary care: establishment of primary care unit (PCU) • Prevention and promotion services • Quality improvement: HA, service practice guideline • Consumer protection: no-fault liability, call center

  6. Characteristic of the UCS

  7. Some policy achievements • 80% of UC members are those residing in rural areas and 60% are those in the two bottom quintiles • Shifting utilization of service toward primary care • Increase in access to high cost services i.e. open-heart surgery, malignancy, cataract • Reduce catastrophic expenditure cases by 25% and prevent impoverishment according to paying medical care ~300,000 people in 2003 • Decrease in the gap of burden of health expenditure between the poor and the rich

  8. Utilization: increase access and use of PCU and district hospitals source: NSO HWS2001, 2003 and 2004

  9. Improved fairness of financial contributions Declining of gap Source: Socio-Economic Survey 1992 - 2002 conducted by NSO.

  10. Declining of financial catastrophic illnesses in Thailand 1996-2002 Source: National Statistic Office, Household Socio-economic Survey, 1996, 1998, 2000, 2002

  11. Major constraints and further development • Competing with other social objectives as depending totally government budgets • Inequitable distribution of health infrastructure • Fragmentation of health insurance schemes harmonization • Long term financial sustainability of the scheme need further exploration

  12. Comparison of Tanzania & Thai CHF_1

  13. Comparison of Tanzania & Thai CHF_2

  14. Comparison of Tanzania & Thai CHF_3

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