Policy brief on the Thai UHC systems National Health Security Office (NHSO)

Transcription

1 Policy brief on the Thai UHC systems National Health Security Office (NHSO)

2 2 Thailand: at a glance (2017) Population 69 million GNI (2017) $US 6,000 (UMIC) ANC & hospital delivery 99% Life Expectancy 75 Doctor+nurse/midwife: 3.5/1,000 pop <30% H resources in private sector UHC in 2002 Gov. Health Budget 17% Total Budget Total Health Expenditure (2014) % GDP [< $US 300/cap] Out of pocket 12% of THE 2

3 3 4,000 3,000 2,700 2,000 1, , GNI/capita A 27 long march to achieve full population coverage, when the GDP/cap was $US 1,900 lowest after 1997 economic crisis US $ 1997: Asian financial crisis Financial protection 100% The children n elderly 71% 2001: 29% of population are uninsured 53% 42% 29% 1980 CSMBS introduced 2002 Universal Coverage for entire population achieved 1975 Low Income scheme introduced 1990 SHI introduced 1983 CBHI introduced year Source: Suwit Wibulpolprasert 3

4 THREE DIMENSIONS OF THAI UHC Under three public health insurance schemes (CSMBS (5%), SSS (20%), UCS (75%) Y axis: Financial protection - High Free at the point of service (Out of pocket 12% of THE) Z axis: Depth of services Comprehensive package with small exclusion list. P&P, All essential drugs, Renal Replacement Therapies, organ transplant, CABG, cataract, dental services and dentures, etc. X axis: Population coverage universal population coverage (99.95% of population) 4

5 OUTCOME OF UHC IN THAILAND 4.0% 3.5% 3.0% 2.9% Reduction of Catastrophic Health Expenditure 3.6% 3.4% 3.2% 3.2% All Quintile 1 Quintile 5 2.9% 2.5% 2.0% 2.8% 2.6% 2.6% 2.6% 2.4% 2.6% 2.5% 2.3% 2.4% 2.2% 2.2% 1.9% 2.0% 1.8% 1.8% 1.7% 1.7% 1.6% 1.5% 1.6% 1.5% 1.0% 0.5% 0.0% UHC 1.4% 1.5% 1.3% 1.0% 1.1% 1.0% 1.1% 1.0% 1.2% 1.0% 1.0% 0.9% Data from: National Statistic Office 5

6 Preventing Health Impoverishment UHC 6

7 OUTCOME OF UHC IN THAILAND OP use rate IP use rate INCREASED UTILISATION AND REDUCED UNMET NEEDS OP use rate IP use rate Unmet healthcare need was on par with OECD countries Outpatient 1.4%, Inpatient 0.4% Source: National Health Security Office and National Statistical Office 7

8 OUTCOME OF UHC IN THAILAND Satisfaction of UC beneficiaries and Health care providers Source 1.FY : Satisfaction survey report, Academic Network for Community Happiness Observation and Research (ANCHOR), Assumption University of Thailand 2. FY2014 : NIDA Poll Center, National Institute of development Administration 3. FY : Institute for Social and Economic studies : ISES, Dhurakij Pundit University 8

9 LIFE EXPECTANCY AT BIRTH IN THAILAND ( ) Pre-UHC Post-UHC Full Population Coverage 2002 Source: World Bank 9

10 Millions of Baht 180, , , , ,281 16, times 153,450 39,840 20% return from investment on UHC 100,000 80,000 60,000 40,000 20, , ,610 UCS Final investment Consumption Intermediate Major return comes from Chemical, Trade, Electricity and Water, Mining and Quarrying, and Transportation and Communication sector National Health Security Domestic Office Import : 10

11 11 Income redistribution: Increased share of consumption of the lowest quintile Source: World Bank, GMO 11

12 Key success factors 1. Adequate, equitable and resilent health systems 2. Committed spirit of Champions and health professionals 3. The strategy of Triangle That Moves the Mountain 4. Best Value for Money 12

13 3 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. 1,000,000 health volunteers 13 Rural community hospital with 2-8 doctors cover 30-80,000 population

14 3 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 14 Regional hospital in every region

15 3 EFFECT OF RESOURCES REALLOCATION 15

16 A R M Y o f T H A I U H C C H A M P I O N S

17 1 Champions. 16 years as the Director of Tha Songyang Hospital 11 years as the Director of Phop Phra Hospital 34 years as the Director of Mae Ramat Hospital 27 years as the Director of Umphang Hospital 17

18 1 Spirit of health personnel Put self interest as second, public interest as first priority, and you will have a better life True success is not in the learning, but in its application to the benefit of mankind HRH Prince Mahidol Father of Thai modern medicine 18

19 1 Spirit of health personnel and champion. fight with equanimity Champion in UHC (Dr. Sanguan Nittayarumpong) 19

20 Triangle that moves the mountain Tipping point Knowledge generation & management Three groups of people Conductive Environment Social movement Political/ Policy linkages Stickiness of the issue Wasi P. Gladwell M.

21 5 Best Value for Money under the UHC Health Promotion and Disease Prevention as priority with secured budget (>15% of UHC budget), established sin tax health promotion foundation Extensive use of Economic Evaluation in the formulation of benefit packages with serious price negotiation Central and regional bargaining and procurement Capitation, bundle payment, and fixed fee schedule, with close end budget 21

22 5 COST SAVING FROM CENTRAL PROCUREMENT ($US) Year ARV-NonCL ARV_CL ED Cat E(2) EPO/CAPD Total Saving ,907,677 24,750,922 3,037,543 15,258,756 51,954, ,871,763 49,509,529 49,670,753 23,111, ,163, ,500,819 66,257,010 33,501,682 28,237, ,497, ,745,449 67,915,751 40,828,581 42,295, ,785, ,219,778 82,000,880 64,246,998 55,159, ,627, ,649, ,097,868 20,091,332 48,943, ,782, ,006,380 75,873,013 78,358,114 55,544, ,782,004 Total 244,901, ,404, ,735, ,551,493 1,276,593,137 Saving based on Purchasing price in 2009 Source: National Health Security Office 22

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