Assessing the impact of a policy on universal coverage on financial risk protection, health care finance, and benefit incidence of the Thai health care system Phusit Prakongsai, MD Supon Limwattananon, PhD Walaiporn Patcharanarumol, BSc MPH Kanjana Tisayatikom, MPH Viroj Tangcharoensathien, PhD International Health Policy Program (IHPP) - Thailand Presentation to the 6 th IHEA World Congress 9 July 2007, Copenhagen
Transcript
Slide 1
Assessing the impact of a policy on universal coverage on
financial risk protection, health care finance, and benefit
incidence of the Thai health care system Phusit Prakongsai, MD
Supon Limwattananon, PhD Walaiporn Patcharanarumol, BSc MPH Kanjana
Tisayatikom, MPH Viroj Tangcharoensathien, PhD International Health
Policy Program (IHPP) - Thailand Presentation to the 6 th IHEA
World Congress 9 July 2007, Copenhagen
Slide 2
Outline of presentation Background Health insurance coverage
after UC implementation in 2003 Changes in health service use and
benefit incidence Changes in the incidence of catastrophic health
payments Discussion and conclusions
Slide 3
Health care finance and service provisions of the Thai health
care system after implementation of the universal coverage policy
General tax General tax Standard Benefit package Tripartite
contributions Payroll taxes Risk related contributions Capitation
Capitation & global Co-payment budget with DRG for IP Services
Fee for services Fee for services - OP Population Patients Ministry
of Finance - CSMBS (6 million beneficiaries) National Health
Insurance Office The UC scheme (47 millions of pop.) Social
Security Office - SSS (7 millions of formal employees) Voluntary
private insurance Public & Private Contractor networks
Slide 4
Methods and data sources Benefit incidence (BIA) and financial
incidence analyses (FIA) were employed, Two different approaches of
BIA: Using household income per capita and asset indexes; Using
aggregated and regional unit government subsidies. Data sources
Nationally representative household surveys on health insurance
coverage and health service use in the 2001 and 2003 HWS, National
household surveys on household income and consumption expenditure,
Unit government subsidies for public and private health care
providers in 2001 & 2003.
Slide 5
Health insurance coverage in 2003 Source: The 2003 Health and
Welfare Survey conducted by the National Statistical Office of
Thailand (NSO) Note: PHI = private health insurance, UC = the UC
scheme11 Source: The 2003 Health and Welfare survey Note: Q1 = the
poorest quintile, Q5 = the richest quintile
Slide 6
The distribution of ambulatory service use among different
income quintiles in 2001 and 2003, by types of health facilities
2001 2003 Concentration indices of ambulatory service use among
different types of health facilities in 2001 & 2003 Type of
health facilities20012003 Health centers - 0.2944- 0.3650 Community
hospitals- 0.2698- 0.3200 Provincial and regional hospitals-
0.0366- 0.0802 Private hospitals0.43130.3484
Slide 7
The distribution of hospitalization among different income
quintiles of Thais in 2001 and 2003, by types of health facilities
Types of health facilities20012003 Community hospitals - 0.3157-
0.2934 Provincial and regional hospitals- 0.0691- 0.1375 Private
hospitals0.31990.3094 Overall hospitalization- 0.0794- 0.1208
Concentration indices of hospitalization among different types of
health facilities in 2001 & 2003 2003 2001
Slide 8
Percent distribution of net government health subsidies among
different income quintiles in 2001 and 2003 Note: -Overall net
government health subsidies in 2001 were approximately 58,733
million Baht, and in 2003 were 80,678 million Baht (in 2001-value)
- The concentration index of government health subsidies in 2001
was -0.044 and in 2003 was -0.123
Slide 9
Benefit incidence in 2003 between using aggregate and regional
unit subsidies Benefit incidence in 2003 between using household
income per capita and an asset index to rank individuals
Slide 10
The incidence of catastrophic health payments in 2000, 2002,
and 2004 200020022004 Q1 (poorest) 4.0 %1.7 %1.6 % Q26.6 %2.1 %2.4
% Q35.4 %3.6 %2.7 % Q45.6 %4.0 %2.9 % Q5 (richest) 5.6 %5.0 %4.3 %
All quintiles5.4 %3.3 %2.8 % Note: Catastrophic health expenditure
refers to household out-of-pocket payments for health over 10% of
total household consumption
Slide 11
Conclusions (1) The UC policy has improved equity in access to
and utilization of health services in Thailand through four
strategies: The expansion of public health insurance to nearly
universal coverage The removal of financial barriers to essential
health services The comprehensive benefit package of the scheme The
promotion of primary care use as the main contracting unit The
distribution of government health subsidies in Thailand was
pro-poor before UC, and the re-distributive effect is getting
better after implementation of the UC policy. Health services at
primary and secondary care levels were more pro-poor than health
services at tertiary care and private facilities.
Slide 12
Conclusions (2) Using different figures of government unit
subsidies (aggregated vs regional unit subsidies) and different
measures to categorize individual socio-economic status (income and
asset index) does not provide different pictures of improvements in
health care use and the distribution of government health subsidies
in Thailand. The incidence of catastrophic health expenditure after
UC is better than the situation before UC, particularly in poorer
quintiles, but some expensive health services such as RRT for
end-stage renal disease patients is still excluded from the UC
benefit package and causes households to be financially
catastrophic. Changes in the allocation method of government health
resource and health financing mechanisms appear to be a key factor
in the success of UC in improving equity in the Thai health care
system.
Slide 13
Limitations of the study Differences in questions and answer
choices between the 2001 and 2003 HWS questionnaires, Lack of
rigorous welfare indicators to categorize individuals into
different socio-economic status, Variations of unit government
subsidies among different regions and health care levels, The
estimates of unit subsidies for CSMBS and SSS beneficiaries,
Limitations in identifying UC members before implementation of the
UC policy.
Slide 14
Acknowledgements National Statistical Office of Thailand (NSO)
Ministry of Public Health (MOPH) Thailand Research Fund (TRF)
Health Systems Research Institute (HSRI) World Health Organization
(WHO)