2013 harmonization of three public health insurance schemes on emergency medical services...

Naresuan University, Thailand

Harmonization of three public health insurance schemes on

Emergency medical service policy

By

Wannapha Bamrungkhet*; Sutherada Chimnoi**;

Samrit Srithamrongsawat**; Supasit Pannarunothai*

*Naresuan University

**Health Insurance System Research Office

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Outline

Introduction

Methodology

Result

Conclusion

Recommendation


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Thai Health System

Health scheme

Universal Coverage Scheme (UCS)

Social Security Scheme (SSS)

Civil Servant Medical Benefit scheme (CSMBS)

Nature Citizen entitlement Mandatory Fringe benefit

Benefit package

Small number of limited condition Prevention & promotion

Small number of limited condition e.g. plastic surgery

No preventive care No explicit exclusion special bed

Provider Public and private contracting unit for primary care

Public and private hospitals > 100 beds (50% is private)

Public provider only

Payment OP: Capitation IP: DRGs with global budget

Capitation OP and IP (DRG for IP DRG RW>2)

OP: fee for service IP: DRG


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Harmonization of public health insurance schemes on EMS policy • Implemented on 1st April 2012

– Aimed to harmonized management of EMS – Including non-contracted hospital of public health insurance

schemes into the management system – Covered only urgent and emergent patients – National Health Security Office (NHSO) is a clearing house

• Objective of the study – The study aimed to study the effects of harmonization of

three public health insurance schemes on emergency patients


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Methodology

• Telephone interview survey with semi-structured questionnaire – The questionnaire had been tested by 30 persons form three public

health insurance schemes

• Population sample – Sample was emergency patient who accessed to health services

under the policy between August-October 2012

– Sample existed in Emergency Claim online (EMCO)

– Sampling sample by using simple random sampling with personal identity number

Scheme UCS SSS CSMBS Total

Sample 105 95 92 292


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Result

EMS patient age (%) UCS SSS CSMBS Average

1-15 15 0 21 12

16-59 48 91 22 53

60 + 37 9 58 35

Average age of patient 45.6 40.4 53.0 46.2

Standard deviation 26.0 13.4 30.5 24.8

In-patient care (%) 85 80 96 87

Emergent patient (red case) (%) 50 25 25 34

Main reason of accessing to health services

Accidence and trauma 14 14 5 11

General emergency illness 81 79 93 84

Obstetric emergencies. 5 7 1 4


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Policy perception

0

5

10

15

20

25

30

35

40

45

News paper Television Promotionof hospital

Family &friend

Other

Source of policy information perceive (%)

UCS SSS CSMBS

Yes 50%

No 50%

Persons who know the policy


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Expectation on the policy

0

10

20

30

40

50

60

70

80

90

UCS SSS CSMBSDid not expect to be asking for healthinsurance before service (%)Was asked for health insurance beforeservice (%)

0

10

20

30

40

50

60

70

UCS SSS CSMBS

Knew that the policy covers only emergencycondition (%)

Knew that they must be refer back to theregistered hospital after the emergency (%)

Acceptable if they were sent to the registeredhospital after emergency (%)


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Accessing care channel

0

10

20

30

40

50

60

UCS SSS CSMBS

Know EMS hotline 1669 (%)

Need of EMS 1669 (%)

91%

3% 2% 4%

Health accessing channel

Their ownNGOsEMS 1669Calling to hospital


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e Selecting health service

0

10

20

30

40

50

60

70

80

90

Nearest Standard andquality

Withoutwaiting time

Other

Reason selecting health service

UCS SSS CSMBS

90%

10%

UCS

88%

12%

SSS

99%

1% CSMBS

Selected hospital by themselves

Selected hospital by other


Service payment & Financial burden UCS SSS CSMBS Average

Patient who had to pay at the point of service then reimburse the clearing house

94% 91% 88% 91%

financial burden of household 77% 85% 76% 79%

0

10

20

30

40

50

60

UCS SSS CSMBS Total

94% 91% 88% 91%

Receiving financial reimbursement (% of patient)

Yes

No

Do not sure


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Satisfaction & Complaint

84%

86%

88%

90%

92%

94%

96%

UCS SSS CSMBS

Satify Recommended

11%

89%

UCS

10%

90%

SSS

17%

83%

CSMBS

Hotline No. 1330

Know 1330

Do not know 1330


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Conclusion

Most of emergency patients were working ages and half of them were aware of the policy

Asking for health insurance before treating still existed

Most of patients accessed hospital by themselves, which related that EMS system was limited and needed to be improved

Although the policy promoted that emergency patients could access to health services for free, most of them had to pay at the service point then reimburse.


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Recommendation

Improving and promoting emergency medical service hotline 1669 is important

Setting the process or guideline to prevent payment at the point of service before reimbursement

More focusing on the NHSO 1330

Promoting NHSO hotline 1330 to increase awareness of beneficiary’s rights

Continuous study on the cause of non-perception of people about hotline 1330, and their rights and benefits


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Thank you for attention


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2013 harmonization of three public health insurance schemes on emergency medical services...

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