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Achieving Universal Health Coverage: The Roles of Evidence, Social Movements and Policy Commitment

Achieving Universal Health Coverage: The Roles of Evidence, Social Movements and Policy Commitment. Dr. Suwit Wibulpolprasert Senior Adviser on Disease Control, MoPH, Thailand, PHA3, July 9 th , 2012 University of Western Cape, South Africa. Thailand at a glance (2011).

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Achieving Universal Health Coverage: The Roles of Evidence, Social Movements and Policy Commitment

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  1. Achieving Universal Health Coverage: The Roles of Evidence, Social Movements and Policy Commitment Dr. Suwit Wibulpolprasert Senior Adviser on Disease Control, MoPH, Thailand, PHA3, July 9th, 2012 University of Western Cape, South Africa

  2. Thailand at a glance (2011) • Lower middle income with good health status - Gross National Income: US$ 3,760 per capita • Poverty –2% of population • Gini index 42.5 - MMR 30/100,000 LB and IMR 20 per 1,000 LB • UHC achieved in 2001 under three schemes –the CSMBS, the Social Security and the UC • Health expenditure (THE): • US$ 300 per capita – 6% GDP • Half from public – 13% of National Budget • Less than 50% out of pocket health expense

  3. Five important points • UHC is for poverty reduction not only health benefits • UHC can be started at low level of income • The need to ensure availability of satisfactory services. • Mobilizing more resources for UHC • Getting more health for the existing resources

  4. 1. UHC for Poverty reduction (MDG 1) Prediction without UC Actual situation Households with catastrophic illnesses 1996 1998 2000 2002 2004 2006 2007 2008

  5. GDP/capita 2. We can start UHC when we are still low income year

  6. Long march towards Thai UHC: You don’t have to wait until you are rich to start and achieve UHC National Health Security Act was proposed by 50,000 Thai citizens and it has 5 influential board members from civil society organizations

  7. Suwit Wibulpolprasert, MD., Ministry of Public Health, Thailand The Three Schemes of UHC - 2010 Civil servants Employees Gold card TAX 2001 1963 1991 NHSO CSMBS SSO Contribution 48 mil. 6.0 mil. 9.0 mil. NHSO Comptroller SSO Capitation 80 $US/y “Fee for service” 350 $US/y Capitation 75/y Services Insurees, Right holders “Public / Private Providers Private room non- ED

  8. Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand Extensive expansion of rural health services in early 80s, as part of PHC/HFA and rural development policies – inspite of economic crisis How? - Freeze new capital investment in urban health facilities for 5 years and reallocate the budget to build rural health centers and district hospitals, with extensive production of Community Health Workers Extensively increased use of rural facilities 3. Ensuring universal availability of satisfactory health services

  9. Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand Health Systems Strengthening as essential components of the UHC • Useless to have financial protection when the quality essential health services are not universally available • Adequate facilities, manned by dedicated well-trained HRH • Retention of Health Professionals in the rural areas – multiple ‘supply’ and ‘demand’ side measures. • Diabetic Conditions in some countries

  10. Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand Reallocation of budget during Economic Crisis in early 1980s, to build rural facilities and HRH Fast tracking rural health No investment in urban areas for 5 yrs.

  11. Suwit Wibulpolprasert, MD., Ministry of Public Health, Thailand Adequate and appropriately manned rural health facilitieis 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

  12. Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand Provincial hospitals 46.2% (5.5) 1977 Community hospitals 24.4% (2.9) Rural health centers 29.4% (3.5) Provincial hospitals 27.7% (10.9) Community hospitals 1989 32.8% (12.9) Rural health centers 39.4% (15.5) 18.2% (20.4) Provincial hospitals 35.7% (40.2) 2000 Community hospitals 46.1% (51.8) Rural health centers From reverse to upright triangle: PHC utilization (OP visits) Budget shift Peace, econ gwt, democracy Source: Rural Health Division, MoPH ( ) : Number of OPD visits (millions) 12

  13. Satisfaction of UC people & provider Percent Expand financial incentives

  14. Medical service Utilization OP visit 2003 2004 2005 2006 2007 2008 2009 2010 2011 Source : Report 5, 0110 , Yr2003 – 2011

  15. Medical service Utilization IP visit 2003 2004 2005 2006 2007 2008 2009 2010 Source :NHSO IP data in Yr. 2003-2011 15

  16. UHC achieved Source of finance 1994-2010Increased public financing sources with less OOPs

  17. 4. Mobilize more resources • Peace and Economic growth – less proportion of budget to security and serving public debt • National public health expense increased from 5% of national budget in 1980s to 13% in 2010 • ‘Community Health Development Fund’ – co-pay by local governments - $US 150 m in 2010 • Dedicated Health Promotion Fund – 2% additional levy on tobacco and alcohol excise tax – $US 100 m in 2010 – ‘support HiTAP’

  18. Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand From security and debt service budget to health Percentage Year Source: Bureau of Budget 18

  19. Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand More Budget to Health 77,720.7 mil. ฿(78x) (8.1%) 986.6 mil. ฿ (3.4%) 16,225.1 mil. ฿ (4.8%) 2010 PH budget rose to 14% of National buget 29,000 mil. ฿ 1972 335,000 mil ฿ 1,028,000 mil ฿ (35x)) 1990 National budget 2004 PH budget 19

  20. 5. 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 • Base on National Essential Drug List and use of TRIPs flexibilities - article 31(b) and Doha declar, and strict control of high price EDs • Base on intensive study on cost-effectiveness of health technologies – IHPP, HITAP, etc. • Central bargaining and purchasing with VMI • Drug price of all hospitals on web site

  21. Health Insurance coverage of three population groups in selected Asian countries in 2009 Source:Tangcharoensathien V et al, Health Financing Reform in South-East Asia (2009)

  22. Comparing % of Out of Pocket Health Expense and % of Public Expenditure on Health % in 2010

  23. Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand ASEAN plus three HMM Joint Statement July 6th, 2012 …….We commit to collectively accelerate the progress towards UHC in all countries by ……….the formation of an ASEAN Plus Three network on UHC. We concur and will collectively move the issue of UHC to be discussed and committed at the highest regional and global development forum, including the ASEAN Plus Three Summit, and the United Nations General Assembly.

  24. Dr. SuwitWibulpolprasert, Ministry of Public Health, Thailand 10 ASEAN Plus China Health Minister Meeting – July 6th 2012 • Most of them agreed with removal of Tobacco from the Free Trade Agreements • All agreed to support ‘specifically dedicated fund from tobacco and alcohol tax to be used for tobacco and alcohol control and other health promotion activities’ • Thai Health Promotion Foundation – 2% additional levy on top of the excise tax to tobacco and alcohol – 100 million per year

  25. Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand What we must reiterate to politicians and society “Because we are poor, we can not afford not to have primary health care based Universal Health Coverage”

  26. Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand “Triangle that move the mountain” “Tipping point” Knowledge generation & management Conductive Environment Three groups of people Socialmovement Stickiness of the issue Political/Policylinkages

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