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Sustainability and effectiveness of health care delivery : National experience of Thailand

Sustainability and effectiveness of health care delivery : National experience of Thailand . Piya Netrawichien,MD Chantana Boon-Arj. Structure of the presentation. 1)   Health care coverage in Thailand. 2)   Health care delivery under the Social Security Scheme (SSS).

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Sustainability and effectiveness of health care delivery : National experience of Thailand

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  1. Sustainability and effectiveness of health care delivery :National experience of Thailand Piya Netrawichien,MD Chantana Boon-Arj

  2. Structure of the presentation 1)   Health care coverage in Thailand 2)   Health care delivery under the Social Security Scheme (SSS) 3) Health care delivery under the Universal Health Care Scheme (UC)

  3. Health care coverage in Thailand 1) Fringe benefit schemes -  Civil Servant Medical Benefit Scheme -  State Enterprise Medical Benefit Scheme 2) Health Insurance under the Social Security Scheme 3) Universal Health Care Scheme

  4. Health care delivery under the Social Security Scheme (SSS) 1) Financing of the Scheme   - Contribution and compulsory system - Sickness include medical care and cash benefit

  5. 2) The Medical Benefit Package - General practitioner and specialist care; - Outpatient and inpatient care; - Medication and pharmaceutical products - Ambulance and transportation services; and - Ancillary services Some illnesses/treatments are not covered for example : Drug addiction, cosmetic surgery, researching treatment, infertility condition, etc.

  6. 3) Health care provider  Requirement on hospital standards, - a minimum of 100 beds - 11 standards - referral system

  7. 4)  Payment mechanism Capitation Payment - based on the number of registered insured persons - 1,250 bahts per person per year - Monthly payment - At the beginning of the month – 75% - At the end of the month – 25%

  8. Additional payment for special high cost services - reimbursement with fixed fee schedules such as open heart surgery, coronary bypass, brain surgery etc. Additional payment for utilization incentives - extra capitation payments to hospitals whose caseloads are within the specific percentile rank

  9.  Additional payment for risk adjusted capitation - payment for risk adjusted capitation due to the 25 chronic diseases that occurred to the insured persons (out patient)  Payment for care arising from emergencies and accidents

  10. 5)Quality Assurance System Hospital quality assurance project

  11. 6)Sustainability of Social Security Fund ILO preliminary actuarial review of the reserve fund for short-term benefits including sickness benefit is expected to exceed 10 times benefits expenditure in 2015. Therefore, the Social Security fund is still sustainable in long run.

  12. Health care delivery under the Universal Health Care Scheme (UC)

  13. 1) Financing of the scheme UC is financed by general tax revenue with other 7 sources of income Contributions from local governments Fines from violation of the act Co-payments by patients Donations Interest on assets Other cash income earned Contributions by beneficiaries

  14. 2) Benefit Package include: Curative and rehabilitation care Health promotion and disease prevention Benefit package do not cover: Groups of medical services beyond the basic needs Groups of medical service for which specific budgets have been allocated

  15. 3) Health care provider Service Units under UC Category 1 : Contracted units of primary care (CUP) Category 2 : Subcontractors of a CUP Category 3 : Contracted units of secondary care (CUS) or contracted units of tertiary care (CUT) Category 4 : Units of super tertiary care

  16. Process of registration (for private health care provider) branch offices negotiate with local health facilities who wish to participate certification of the qualification and registration of health facilities will be announced to the public health facilities and NHSO signed the contract Management of Services System

  17. 4) Payment Mechanism Per capita budget Baht 1,659 (2006) Management of capitation budget Age differential capitation for curative care Flat rate capitation for prevention and promotion services

  18. Management of accident, emergency and high cost care fund Reimbursement of outpatient and inpatients Reimbursement of high cost care Reimbursement of medical prostheses and instruments

  19. Management of capital replacement fund Capital replacement plan

  20. Management of no fault liability fund Financial assistance to UC beneficiaries

  21. 5)Quality Assurance System Upgrading health centres to meet standards of PCU Promoting hospital accreditation Promoting quality and standard of excellent centres

  22. 6)Sustainability of the Scheme Feasibility studies on alternative sources of funding, e.g., sin tax, value added tax, in addition to improving efficiency of the current insurance schemes, are being undertaken in order to improve financial sustainability of the UC Scheme and controlling health care costs

  23. SAWASDEE

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