Health Systems and Financing: Experiences from Thailand
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Transcript of Health Systems and Financing: Experiences from Thailand
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Health Systems and Financing: Experiences from Thailand
Alia Luz
HITAP International Unit (HIU)
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Disclaimer: The views expressed in this paper/presentation are the views of the author and do
not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board
of Governors, or the governments they represent. ADB does not guarantee the accuracy of the
data included in this paper and accepts no responsibility for any consequence of their use.
Terminology used may not necessarily be consistent with ADB official terms.
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Global Trend of Universal Health Coverage (UHC)
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More than 80 countries since 2010 have asked the WHO for technical assistance in moving toward UHC
UN December 2012 Resolution for UHC made it a top priority for the WHO and other IGOs and multilateral institutions
WHO Brief: Global Push For UHC.
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Priority setting is indispensable!
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Research should inform health policy in countries to focus on their current health challenges and make concrete recommendations - More Health for Money
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DEVELOPING EVIDENCE-BASED POLICY MAKING AND CAPACITY BUILDING
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Summary of health insurance schemes CSMBS SHI UCS
Population 5 Million (8%) 9.84 Million (15.8%) 47 Million (75%) Beneficiaries Civil servant +
spouse + vertical
relatives
Employees in private
sector
Those who are
not covered by
CSMBS and SHI
Source of
finance
General tax (~11,000 Baht/Cap*)
Tripartite from
employer, employee,
government rate 1.5%
of salary
General tax
(2,100 Baht/Cap)
Purchaser Comptroller
General's
Department,
Ministry of
Finance
Social Security Office,
Ministry of Labour
National Health
Security Office
Providers Public provider only,
Private in emergency
3,000 Baht/episode
Public and private hospital more
than 100 beds (>60%
contractors are private)
Public and private
contracting unit for
primary care
Benefit package No preventive care
No explicit exclusion
Special bed
Small number of limited
condition e.g. Non medical
plastic surgery
Small number of limited
condition
Prevention & promotion
Payment OP: Fee-for-service
IP: DRG since 2009
Capitation OP: Capitation
IP: global budget + DRG
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Managing the benefit package: gradual expansion of coverage
Negative list approach: comprehensive with few in the exclusion list
No maximum ceiling of financial coverage, free at point of service,
High level financial risk protection
Extend coverage to high cost RRT
Initially excluded from UCS due to high cost (Kasemsup et al 2006).
RRT not cost-effective, long-term fiscal burden (Tangcharoensathien et al 2005), But catastrophic for UCS members (Prakongsai et al 2007).
Despite being cost ineffective, RRT was included by 2006
To prevent catastrophic spending and ensure equity across 3 Schemes (Tangcharoensathien et al 2013). PD first was adopted (Tantivess 2013).
Processes of inclusion of new interventions
Rigorous economic evaluation: cost effectiveness + budget impact
Home-grown HTA capacities,
HITAP established in 2007 contribute significantly
Benchmark of one GNI per capita for one QALY gain (Tantivess et al 2009)
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Institutionalized research capacity
Establishment of associated institutes such as HSRI, HISRO, HITAP, IHPP
Contributed to evidence generation
Independent research institutes
Institutionalization of capacity
Health Intervention and Technology Assessment Program (HITAP)
Established in 2007 to assess health interventions and technologies efficiently and transparently
Develop systems and mechanisms to promote the management of health technology and appropriate health policy determination
Distribute research findings and educate the public
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Topic SelectionConsultation
HITAP, policy makers, healthcare providers, consumer groups, professional associations, etc.
Conducting HTA researchConsultation and technical collaboration
HITAP, experts and relevant stakeholders
Appraisal of resultsPeer review, submission of comments and discussion
HITAP, experts, private business/industry, policy makers, consumers/beneficiaries
Dissemination of results and recommendationsPublication, presentation and dialogues
HITAP, funding agencies, the media, consumer groups and other NGOs
HTA process at HITAP
Development of the National List of Essential Medicine (NLEM) (5
topics/year) Development of UC Benefit Package (5 topics/year)
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RECOMMENDED ACTIVITIES AND AREAS OF WORK
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1) Work with local researchers and institutes to build capacity and help them establish their own mechanisms
Technical Assistance for the Myanmar Maternal and Child Health Voucher Scheme feasibility
study and implementation assessment
Introducing HTA concepts and
principles for Free Drugs List
development in Nepal
Capacity
Building and Technical
support in the Philippines for
economic evaluations
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2) Implement long-term capacity building programs, e.g. HITAP
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3) Develop the countrys research institutes through the INNE model
Develop the INNE model:
Individual, Node, Network and Environment
Key factors A critical mass of qualified researchers (good at head, hand,
heart)
Institutional umbrella for them to work in a sustainable way
Knowledge brokers and a platform where evidence interacts with policy makers
Produce policy relevant research with political impartiality
Long term fellowship program
Linkages and supports from international partners and civic groups
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Included: Imiglucerase is an enzyme for
Gaucher disease treatment Budget impact of using imiglucerase
in GD1 patients: 5.3 M USD in 5 years
Increase: 24 M USD in 20 years
Imiglucerase is NOT COST-EFFECTIVE for treating GD1 patients, although it can help patients to live longer and increase quality of life
The Subcommittee for the development of the NLEM decided to INCLUDE imiglucerase in the NLEM since it can prevent impoverishment 15
4) Conduct policy-relevant research that is selected through a transparent and participatory process
Not Included: Absorbent products for urinary
and fecal incontinence among disabled and elderly people in Thailand topic was proposed by lay people group
ICER: 4,300 USD per QALY gained Budget impact: 90 M USD per
year The SCBP decided to NOT
INCLUDE the absorbent products in the benefit package according to very high budget impact, administrative systems, and environmental issues
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Conclusion: Potential Areas of Work
1. Developing evidence-based decision making Doing policy relevant research that addresses the
countrys needs: health technology assessments, health policy and systems research, health financing research
Instituting key platforms for evidence informed decisions in order to link policy and research
2. Interactive learning through action Research must be done alongside local researchers
Long-term capacity building nationally and in the region
3. Developing INNE for countries - building strong institutional capacities nationally and internationally
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Kob Khun Kha Thank you for your attention
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