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Payment methods of health insurance system in Thailand

Payment methods of health insurance system in Thailand. Samrit Srithamrongsawat Health Insurance System Research Office Samrit.strsw@yahoo.co.th. Outline of presentation. Overview of payment methods of the Thai health insurance schemes Universal Coverage Scheme

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Payment methods of health insurance system in Thailand

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  1. Payment methods of health insurance system in Thailand Samrit Srithamrongsawat Health Insurance System Research Office Samrit.strsw@yahoo.co.th

  2. Outline of presentation • Overview of payment methods of the Thai health insurance schemes • Universal Coverage Scheme • Civil Servant Medical Benefit Scheme • Social Security Scheme • Effects of payment methods: the Thai experiences

  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 CHF 1990 SSS 1980 SSS CSMBS LIC  MWS Universal Coverage 4th -5th NHP (1977-86) District hospitals Health centers 1990 1994 PVHI SSS 2000 2001 Universal Coverage CSMBS Health Infrastructure 2001

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

  5. Age distribution by insurance scheme

  6. Civil Servant Medical Benefit Scheme (CSMBS)

  7. Social Security Scheme (SSS)

  8. Universal Coverage Scheme (UCS)

  9. Historical development: payment methods

  10. Aim and objectives of purchasing Ensuring good quality and efficient services are provided to beneficiaries Aim • To ensure good health • To solve health problems • Response to social expectation • To control cost Objectives

  11. Payment methods and provider risk Per Discharged Per member IP and OP DRGs Retrospective Full cost Full Capitation Bundled Hospital -MD DRGs Discount per diem Hospital IP DRGs Minimum Maximum Provider Risk

  12. Payment & provider behavior WHR 2000

  13. Effects of payment methods: the Thai experiences

  14. DALYs 1999: 2004

  15. Use of ambulatory care Use of ill persons Use of ill persons covered by the scheme Source: 2005 HWS

  16. Use of appointed services of patients with chronic conditions Take-up of benefits Use services Source: 2005 HWS

  17. Hospitalization Days of stay Being admitted Take-up of benefits Number of admission Source: 2005 HWS

  18. Responsiveness Enabling access Equal treatment Financial protection Prompt treatment* ABAC (2006)

  19. Responsiveness Equal treatment* Financial difficulties* Good quality* Satisfaction ABAC (2006)

  20. FFS: CSMBS experiences Cabinet resolution, full pay for non ED, limit ceiling LOS of private R&B and stringent private admission

  21. SSS: Per capita expenditures 1998-2005

  22. UCS: approved capitation budget and estimated expenses 2002 - 2006

  23. Conclusions • There were both improving and worsening health problems among Thai populations . • Provider’s bias in service provision was evident by insurance scheme, particularly for chronic conditions and hospitalization. Remaining issues of concern • Quality of medical are • Outcomeof treatment

  24. Conclusions • Health insurance systems in Thailand provide fairly responsiveness to their beneficiaries and need further improvement. • Close-end payment methods are more effective in controlling costs than open-end payment method.

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