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UHC in developing countries , Health system : Ethical dilemmas.

UHC in developing countries , Health system : Ethical dilemmas. Dr. Peerapol Sutiwisetsak Deputy Secretary General National Health Security Office Thailand. Thailand: country profiles. Population - 64 million GNI 2012 US$5,090 per capita, Gini 42.5 UHC achieved in 2001 under 3 scheme

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UHC in developing countries , Health system : Ethical dilemmas.

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  1. UHC in developing countries , Health system : Ethical dilemmas. Dr. PeerapolSutiwisetsak Deputy Secretary General National Health Security Office Thailand

  2. Thailand: country profiles • Population - 64 million • GNI 2012 US$5,090 per capita, Gini42.5 • UHC achieved in 2001 under 3 scheme • civil servants, social security and UC • Health status • Life expectancy at birth 74 years • IMR 20/1000 LB, MMR 30/100,000 LB • Physicians per capita 5/10,000 • ANC & hospital delivery 99-100 (2009) • Total Health Expenditure • US$300 per capita, 6% GDP • Half from public , 14% of National budget • Less than 40% out of pocket

  3. GDP/capita UHC can be started and achieved at low level of income The children n elderly 71% 29% 20% 100% 53% 42% year SuwitWibulpolprasert, MoPH, Thailand

  4. Health Insurance Schemes

  5. Ethical point 1.Ensure Healthcare for all and poverty reduction 2.The Development of benefit package 3.The Transparency and participatory mechanism. 4.The Strategic purchasing under fiscal constraint 5.The Preliminary assistance for damage or injury caused by any services 6.The 24 hr services of the call center

  6. 1. Ensure availability of quality health care for all Fast tracking rural health No investment in urban areas for 5 yrs. Dr. SuwitWibulpolprasert, Ministry of Public Health, Thailand

  7. Adequate and appropriately manned rural health facilities Rural health centers with 3-6 nurses n CHWs cover 2,000-5,000 population Extensive production of appropriate cadres and motivated health personnel with mandatory public works and adequate support are essential. Rural community hospital with 2-8 doctors cover 30-80,000 population

  8. Seamless Health Service Networks For more complex service, secondary and tertiary hospitals with specialized personnel , highly diagnostic and treatment technology are available . Referral system was set up . Medical school hospital General hospital in every province Regional hospital in every region

  9. 46% (5.5) Regional H./General H. District Hospital 1977 24% (2.9) Rural Health Centres 29% (3.5) 27% (11.0) Regional H./General H. 1987 35% (14.6) District Hospital Rural Health Centres 38% (15.7) 18.2% (20.4) Regional H./General H. 35.7% (40.2) 2000 District Hospital 46.1% (51.8) Rural Health Centres 12.6% (18.1) Regional H./General H. 33.4% (33.4) 2010 District Hospital 54.0% (78.0) Rural Health Centres 1. Healthcare for all : Changes in out-patientutilization: ( ) : Number of OPD visits (millions) Source: Rural Health Division, MoPH

  10. UHC achieved UHC is effective for poverty reduction Source: Viroj Tangcharoensathien SuwitWibulpolprasert, MoPH, Thailand

  11. 2. The Ethic in the benefit packages development • Evidence base transparent n participatory processes • Life saving non cost-effective treatments but high impoverishment tendency w low budget impact • Increase access at affordable budget by using mix payment methods to control cost and also stimulate demand and services • The use of quality generic medicines, TRIPs flexibilities, and the promotion of rational drug use

  12. Use of Lopinavir/Ritonavir (200/50mg) CL bottles CL UC Scheme Suwit Wibulpolprasert, MoPH, Thailand

  13. 3.The Transparency and participatory mechanism • By law National Health Security board consists of • Minister of Health chair the Board, • 8 Government Ex-officio • 4 Local Government Representatives, • 5 representatives selected from 9 NGO constituencies • 4 representatives from four Professional Councils, • 1 representative from Private Hospital Association, • 7 experts appointed by Cabinet [insurance, medical and public health, traditional medicines, alternative medicines, financing, lawyer and social science], • Secretary General serves as secretary of the Board • Public hearing from provider, people every year • Annual accounting audit • Satisfaction survey every year

  14. Satisfaction: UC members and providers Percent Expand financial incentives Source: Satisfaction survey NHSO & ABAC University in various years

  15. 4.Strategic purchasing : Better Value for Money • Close end capitation based budget with mixed payment mechanisms mainly on capitation (OP) and Case Mix (IP) and some FFS and PC as gate keeper • Involvement of the private providers, e.g, providing primary care in the urban areas, emergency medical services, and some specific tertiary care, e.g., cardiac surgery • Central bargaining and purchasing with VMI (Vendor Managed Inventory)

  16. 5.The Preliminary assistance for damage or injury caused by any service From: NHSO data 2011

  17. 6.The 24 hrs services of the call center 1330 (1) Complaint – quality care 4,386 (0.51%) 96.18% Complete cases in 30 days 96,45% Complete cases in 30 day (2) Complaint - general 5,758(0.75%) Total call 743,744 (3) Information 729,320 (98.35%) (4) Inpatient bed finding 4,280 (0.39%) From : NHSO data 2011

  18. Three key take home messages • UHC is the accesses to health services without financial barrier, not merely financial protection. It is can be achieved at low level of income and it is effective for poverty reduction • Fiscal spaces and innovative financing are possible with political leadership - resources must be used cost-effectively thru Health Technology Assessment and strategic purchasing • Mechanisms to assure sustainable financing and meeting the emerging challenges are needed and should be developed thru evidence based health systems researches SuwitWibulpolprasert, MoPH, Thailand

  19. Thank you

  20. TRIPS flexibilities • TRIPS stands forTrade-Related Aspects of Intellectual Property Rights agreed inDOHA ,2001 • Flexibilities : special mechanism is allowed for developing countries to gain access to essential drugs and or to protect health system • Such as to import some generic drugs aiming to lower ARV cost for HIV patients • The example of flexibilities is CL in ARV drug Thailand,

  21. MDG 1 • The Millennium Development Goals (MDGs) are eight international development goals that were officially established following the Millennium Summit of the United Nations in 2000, following the adoption of the United Nations Millennium Declaration. All 193 United Nations member states and at least 23 international organizations have agreed to achieve these goals by the year 2015. • The first goal is : Eradicating extreme poverty and hunger

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