Reaching the Poor: The Case of Universal Coverage in Thailand

1
Reaching the Poor The Case of Universal Coverage
in Thailand

• Chutima Suraratdecha
• Somying Saithanu
• Viroj Tangcharoensathien
• International Health Policy Program, Thailand
• Reaching the Poor Conference, 18-20 Feb 2004,
  Washington DC

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Program characteristics

• Universal Coverage Policy
• UC, Gold card, 30 Baht Policy, 30 Baht treat all
• April 2001, pilot project in 6 provinces
• April 2002, national coverage

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Characteristics MWS CSMBS SSS WCF Health Card Scheme
Nature of the scheme Social welfare Fringe benefit Compulsory Compulsory Voluntary
Model Public integrated model Public reimbursement model Public contracted model Public reimbursement model Public integrated model
Population covered The poor, elderly, children under 12 years old, secondary school student, the disabled, monks and veterans Government employees, pensioners and their dependents (parents, spouse, children) Private formal sector employees, gt10 worker establishments Private formal sector employee, gt10 worker establishments Non-poor households not eligible for medical welfare scheme, community leader and health volunteers families
Source of funds General tax General tax Tripartite 1.5 of payroll each (reduce to 1 since 1999) Employer, 0.2-2 of payroll with experience rating Household 500 Baht tax 1000 Baht
Financing body Ministry of Public Health Ministry of Finance SSO SSO Ministry of Public Health
Payment mechanism Capitation plus global budget Fee for service Capitation Fee for service Proportional reimbursement among primary, secondary, tertiary care
Types of benefits Comprehensive package Comprehensive package Non-work related illnesses, injuries Work related illness, injuries Comprehensive package
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Characteristics UC SSS WCF CSMBS
Nature of the scheme Social welfare
Model Public contracted model
Population covered People not covered by SSS and CSMBS (45.7 million)
Ambulatory services Registered public private
Inpatient services Registered public private
Choice of provider Registration required
Cash benefit No
Types of benefits Comprehensive package
Conditions excluded 12 conditions
Maternity benefit Yes
Annual physicals Yes
Prevention and promotion Yes
Services not covered Private bed, special nurses
Source of funds General tax
Financing body Ministry of Public Health
Payment mechanism Inclusive capitation or capitation for OP and DRG for IP
Co-payment 30 Baht per visit
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Research questions

• How effective is the UC implementation?
• Coverage?
• Indicators across insurance schemes?
• Impact on providers?

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Methodology

• Six-month sample of households
• interviewed by the 2002 SES
• Random sample of 515 households
• (1834 individuals) in Tak,
• Sakolnakorn and Narathiwat
• representing 3 regions, low income
• and high HIV prevalence provinces

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Respondents profile (1834 individuals)
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Performance coverage
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Performance coverage

• 164 respondents (8.9) had no health insurance

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Performance coverage
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Performance across insurance schemes
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Performance across insurance schemes
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Performance Illness and health care seeking
behavior

• ML probit estimation with selection

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Performance Illness and health care seeking
behavior

• ML probit estimation with selection

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Performance impact on providers

• 857 health staff from 216 UC facilities
• Inadequate supply
• Inadequate financial resources
• Lack of understanding on benefits and coverage

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Policy implications

• Universal coverage
• Targeting issue - UCE vs. UCP
• Quality of care, long waiting time, poor attitude
  of health provider
• Out-of-pocket expenditure
• Inequality across health insurance schemes and
  economic classes