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Wolfgang Scholz ILO - Social Security Department

Modeling Sustainable Health Financing in Thailand. WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H). Wolfgang Scholz ILO - Social Security Department. Holiday Inn Silom Hotel Bangkok, 11 & 12 June 2007.

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Wolfgang Scholz ILO - Social Security Department

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  1. Modeling Sustainable Health Financingin Thailand WB-IHPP Workshop on the Development of Models for Sustainable Health Care FinancingWB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz ILO - Social Security Department Holiday Inn Silom Hotel Bangkok, 11 & 12 June 2007

  2. The Model: overview Labour supply (sex and single ages) Economy (wages, prices, employment, etc.) Population (sex and single ages) Health expenditure (revenue) outputs NHSO SSO CSMBS IHPP Capitation Capitation Base Rate NHA

  3. e0 Sch e1 Sch e2 Sch ... ... ... e100 Sch p0 Sch p1 Sch p2 Sch ... ... ... p100 Sch f0 Sch f1 Sch f2 Sch ... ... ... f100 Sch c0 Sch c1 Sch c2 Sch ... ... ... c100 Sch Health Expenditure Model ExpScheme = PopScheme * Frequency of contactsScheme * Costs per contactScheme SUMe SUMp Capitation = SUMe / SUMp ? Costs per contactScheme = Costs per contactHospitals

  4. Health Expenditure Model:designing the population model PopUC = PopTOT– PopSSO– PopCSMBS– PopOTH with PopTOT =: PopUC + PopSSO + PopCSMBS + PopOTH PopUC =: UC covered population (age: 0 to 100) PopSSO =: SSO covered population (age: 15 to [69]) PopCSMBS =: CSMBS covered population (age: 15 to [100]) PopOTH =: Residual (non-CSMBS public (age: 15 to [100]) schemes; residency abroad; others)

  5. How do population models work? PopulationStock (t+1) = PopulationStock (t) + ImmigrationFlow (t+1) – EmigrationFlow (t+1) alternative: [EntriesFlow (t+1) – ExitsFlow (t+1)] + NewbornsFlow (t+1) – DeathsFlow (t+1)

  6. How do population models work?

  7. How do population models work?

  8. Health Expenditure Model:designing the population model Problems / solutions: PopTOT =: Data base MoI Weakness: fertility and mortality data Solution: standard UN parameters (?) PopOTH = k * PopTOTk =: PopOTH / PopTOT => exog; constant (?) PopSSO =: Data base SSO Problem: labour market entries & exits; mortality Solution: construction of theoretical rates (?) PopCSMBS =: Data base CSMBS Problem: dependents(children; spouses; parents)=f (actives) Solution: ??? [under investigation]

  9. How do population models work? PopulationStock (t+1) = PopulationStock (t) + ImmigrationFlow (t+1) – EmigrationFlow (t+1) alternative: [EntriesFlow (t+1) – ExitsFlow (t+1)] + NewbornsFlow (t+1) – DeathsFlow (t+1)

  10. Health Expenditure Model:designing the population model Frequencies of contacts: Scheme specific • UC • SSO • CSMBS

  11. Health Expenditure Model:designing the population model Costs per contact: Scheme specific • UC [« hospital costs / shadow fees »] • SSO [« hospital costs / shadow fees »] • CSMBS [« hospital fees for service »]

  12. Health Expenditure Model:Hospital Expenditure Structure

  13. Hospital Expenditure Structure:Cost and Volume Indicators Hospital labour costs: Per capita wages (by profession (?)) =: Cost index Number of staff (by profession (?)) =: Volume index Hospital non-labour costs: For Sundries, Pharmaceutical drugs, Medical material (goods), Equipment, Other supplies, Electricity / energy Price Indexes to be developed => Volume indexes follow

  14. Open questions Permanently many.

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