review of current situation in health inequity in thailand after achieving universal coverage n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Review of current situation in health inequity in Thailand after achieving universal coverage PowerPoint Presentation
Download Presentation
Review of current situation in health inequity in Thailand after achieving universal coverage

Loading in 2 Seconds...

play fullscreen
1 / 32

Review of current situation in health inequity in Thailand after achieving universal coverage - PowerPoint PPT Presentation


  • 124 Views
  • Uploaded on

Review of current situation in health inequity in Thailand after achieving universal coverage. Phusit Prakongsai, MD. Ph.D. Vuthiphan Vongmongkol, Warisa Panichkriangkrai International Health Policy Program (IHPP) Ministry of Public Health, Thailand 1 August 2010.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Review of current situation in health inequity in Thailand after achieving universal coverage' - temple


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
review of current situation in health inequity in thailand after achieving universal coverage

Review of current situation in health inequity in Thailand after achieving universal coverage

Phusit Prakongsai, MD. Ph.D.

Vuthiphan Vongmongkol,

Warisa Panichkriangkrai

International Health Policy Program (IHPP)

Ministry of Public Health, Thailand

1 August 2010

definition of health inequity
Definition of health inequity

The International Society for Equity in Health (ISEqH) defined equity in health as

“the absence of systematic and potentially remediable differences in one or more aspects of health across populations or population subgroups defined socially, economically, demographically, or geographically”

Inequity in health or ‘health inequity’ is differences in health that are avoidable, unjust, and unfair (Whitehead 1992).

objectives
Objectives
  • To review current situation in health inequity in Thailand after achieving universal coverage for one decade using documentary review and secondary data analysis,
  • To develop inputs for consultation among key stakeholders involving in SDH reduction in Thailand
    • Health System Research Institute (HSRI),
    • Thai Health Promotion Foundation (THPF),
    • Social Research Institute, Chulalongkorn University,
    • Mahidol University,
    • National Health Commission Office,
    • SIR-NET,
    • Ministry of Public Health.
slide5

Scheme beneficiaries by income quintiles, 2004

CSMBS, SHI covers the rich, 52% and 49% belong to Q5

UC scheme covers mostly the poor, 50% belong to Q1+Q2

Source: Analysis of Health and Welfare Survey 2004 (NSO 2004).

household oop for health income 1992 2008
Household OOP for health, % income 1992-2008

Source: Analysis from household socio-economic surveys (SES) in various years 1992-2008, NSO

slide8
Kakwani indexes of health care finance and share of health care finance in Thailand from 2000 to 2006
equity in utilization concentration index op service by levels 2001 to 2007
Equity in utilization: Concentration Index OP service by levels: 2001 to 2007

Note: CI range from -1 to + 1. Minus 1 (plus 1 ) means in favour of the poor (rich), or the poor (rich) disproportionately use more services than the rich (poor).

9

9

health service delivery better coverage of essential vaccines arv and condom use
Health service delivery:Better coverage of essential vaccines, ARV and condom use

Percentage of female sex worker consistently use condom when having sex with general client in the past 1 month, 1995 – 2007

Compulsory licensing

Include ART in UC package

Generic production of triple ART

slide14
More geographical access to open-heart surgery between 2004 – 2007but don’t know whether they were the rich or the poor

14

slide15

Inequity in quality and patterns of health service provision:Percentage of caesarian section to total deliveriesby health insurance schemes

Source: Electronic claim database of inpatients from National Health Security Office, 2004-2006

(N=13,232,393 hospital admissions)

slide16
Inequity in quality and patterns of health service provision:Propensity of receiving single source antiplatelets

clopidogrel, cilostazol: 6 regional hospitals

inefficiency of the thai health care system csbms expenditure from 1989 to 2008 current year price
Inefficiency of the Thai health care system:CSBMS expenditure from 1989 to 2008, current year price

Note: Expenditure for 2008 is extrapolated from 6 months actual spending

Source: Ministry of Finance, Comptroller Generals Department, various years

current situation and challenges of human resources for health in thailand
Current situation and challenges of human resources for health in Thailand

Thailand

Source: World Development Indicator 2002 and World Health Report 2006

inequity in geographical distribution of health workforce in 2007
Inequity in geographical distribution of Health workforce in 2007

Physicians

Dentists

800-3,305

3,306-6,274

6,245-9,272

9,243-12,300

5,500-15,143

15,144-25,767

25,768-36,390

36,391-47,011

Nurses

Pharmacists

280 - 652

653 - 904

905 - 1,156

1,157 – 1,408

4,600-8,432

8,433-12,274

12,275-16,115

16,116-19,956

2542 25471
จำนวนปีสุขภาวะที่สูญเสียจากภาระโรค พ.ศ. 2542 และ 2547จำแนกตามกลุ่มอายุ

เพศชาย

เพศหญิง

2542 25472
ปัจจัยเสี่ยงและจำนวนปีสุขภาวะที่สูญเสียจากภาระโรคของประชากรไทย พ.ศ. 2542 และ 2547

ที่มา โครงการศึกษาภาระโรคและปัจจัยเสี่ยงของประเทศไทย พ.ศ. 2547

15 2544 2546 2549
ความชุกของการดื่มสุราในประชากรอายุ 15 ปีขึ้นไปแหล่งข้อมูลสอส. 2544, 2546 และ 2549
slide25
Household consumption: tobacco, alcohol and healthMedian household expenditure per month Sources: Analyses from 2006 SES
child mortality in thailand from various sources of surveys
Child mortality in Thailand from various sources of surveys

Source: Hill et al. Int J Epidemiol 2007 (with updates)

slide28

RR = 2.8 (95% CI 2.5-3.0)

55% (39%-68%) reduction

RR = 1.8 (95% CI 1.6-2.0)

Child mortality by quintile of household economic status from 1990 and 2000 census

Error bars are 95% CIs

Source: Vapattanawong P, Hogan MC, Hanvoravongchai P, Gakidou E, Vos T, Lopez AD, Lim SS. Reductions in child mortality levels and inequalities in Thailand: analysis of two censuses. Lancet 2007; 369:850-855

how equity and efficiency were achieved
How equity and efficiency were achieved?

Breadth and depth coverage, comprehensive benefit package, free at point of services

In-feasible for informal sector (equally 25% belong to Q1 and Q2) to adopt contributory scheme

2. Minimum catastrophic health expenditure

3. Minimum level of impoverishment

EQUITY GOALS

4. Equity in use of services

5. Equity in government subsidies

1. Equity in financial contribution

Tax financed scheme, adequate financing of primary healthcare

Provider payment method: capitation contract model and global budget + DRG

Functioning primary health care at district level, wide geographical coverage of services, referral back up to tertiary care where needed, close-to-client services with minimum traveling cost

1. Long term financial sustainability

2. Technical efficiency, rational use of services at primary health care

EFFICIENCY GOALS

key challenges and unfinished agenda
Key challenges and unfinished agenda

BOD challenges

Increased diseases burden from chronic NCD

Demographic changes in Thailand

Little success in controlling traffic injuries

Revitalizing HIV prevention in the light of universal ART

Health systems capacity to cope with

Increased workload with very strained health workforces

Decentralization context –threats and opportunities, don’t’ move fast

Public private dialogues, better trust and collaboration

Medical tourism and internal brain drains

Long term financial sustainability

Universal access to renal replacement therapy-heavy fiscal pressure, cost ineffective, >4X GNI per QALY, but adopted due to catastrophic and inequity across 3 schemes

Second and third lines ARV

Medical technology advancement-main drivers in OECD

30

diseases risk factor priorities in thailand
Diseases/risk factor priorities in Thailand

Significant high disease burden and economic loss

  • HIV/AIDS
  • การป้องกันและควบคุมอุบัติเหตุจราจรในประเทศไทย
    • For traffic injuries
  • การควบคุมการบริโภคแอลกอฮอล์และยาสูบ
    • For prevention of HIV/AIDS, traffic injuries and COPD
  • การลดภาวะน้ำหนักเกินและโรคอ้วน
    • For DM, CVD and other chronic non-communicable diseases