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IHPP : International Health Policy Program, Thailand12 March 2013

Thai National Health Accounts: sustainable updates of 2009-

2010 Chitpranee Vasavid

Somjit JanyapongTaweesri Greetong

Shaheda ViriyathornTanavij Pannoi

Phusit PrakongsaiViroj Tangcharoensathien, et al

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Acknowledgements

• Health Systems Research Institute (HSRI)• Thailand Research Fund (TRF)• Bureau of Policy and Strategy, Ministry of

Public Health• WHO, Thailand for financial supports• The Central of Health Information (CHI)• Partners for 1994-20 10 NHA for their hard work

and commitment– College of Public Health, Chulalongkorn University– National Statistical Office– National Economic and Social Development Board– Ministry of Public Health– Ministry of Finance– The National Health Security Office– The Social Security Office

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Outlines of presentation

• Introduction• Objectives• Methodology• Data sources• Results• Conclusions• Application of Thai NHA• Diversification of Thai NHA

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Introduction

• National Health Account (NHA) , What a re its potential uses?

- NHA is an important tracking tool depicting how a country’s health resources are spent, on what services, and who pays for them

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Evolution and institutionalization of NHA

in Thailand• Phase I - Incubation - the 1994 NHA

– Capacity building, the College of Public Health- CU• Phase II - Consolidation - 1996,1998 NHA,

– Fine tune methodology – Standardization for international comparison

• Phase III - Institutionalization - 2001 NHA onward– Fine tune methodology and matrix, adaptation of

OECD - Systems of Health Account (SHA), 3 dimensional matrix

– Major revision of the whole series of 1994-2001• The following phases - Continuation of NHA

development and diversifications - 2002-2010 NHAThe focal point - The International Health Policy

Program (IHPP), MOPHAll phases funded by local resources: Health System Research Institute (HSRI) and Ministry of Public Health (MOPH)

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Methodology

• The methodological approach in updating 2009-2010 NHA was based on – OECD Systems of Health Account (SHA)

version 1.0 • using a 3 dimensional matrix [Financing

Agent X Healthcare Function X Providers].

– the International Classification of Health Account (ICHA)

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Data sources

• Public registration records– CGD, MOPH, SSO, MOI, etc,.

• Secondary data from the national surveys– Household and Enterprise surveys, (NSO)

• Primary surveys– State Enterprises – Public Independent Organizations

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Results of NHA: 1994-2010

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Total health expenditure and selected indicators on health spending, 1994 to 2010

(current year prices), Million Baht

Indicator 1994 1995 1996 1997 1998 2001 2002 2003 2008 2009 2010THE, Total Health Expenditure (mln baht) 127,655 147,837 177,103 189,143 172,811 170,203 201,679 211,957 360,272 377,226 392,368

THE as % of GDP 3.5% 3.5% 3.8% 4.0% 3.7% 3.3% 3.7% 3.6% 4.0% 4.2% 3.9%

THE from Public Financing Agencies (mln

baht)56,885 69,407 83,522 101,937 94,656 95,779 127,534 134,670 273,372 280,373 293,378 THE from Private Financing Agencies (mln

baht) 70,771 78,430 93,581 87,206 78,155 74,424 74,146 77,288 86,901 96,854 98,990

THE from Public Financing Agencies (%) 45% 47% 47% 54% 55% 56% 63% 64% 76% 74% 75%

THE from Private Financing Agencies (%) 55% 53% 53% 46% 45% 44% 37% 36% 24% 26% 25%

THE per capita (baht per capita per year) 2,160 2,486 2,946 3,110 2,811 2,732 3,211 3,354 5,683 5,938 6,142

THE per capita (USD per capita per year) 86 100 116 99 68 61 75 81 171 173 194

Exchange Rate (baht per USD) 25 25 25 31 42 44 43 41 33 34 32

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Government and Non-government financing source, 1994-2010

UC inception

Economic crisis

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Total health expenditure by financing source, 1994-2010

UC inception

Economic crisis

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Health expenditure by function1994-2010 (current prices)

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Conclusions• From 1994 to 2010, THE as % of GDP ranged from

3.3% to 4.2% of GDP despite of achieving universal health coverage in 2002 “Good Health at Low Cost”

• Increasing trend of government spending on health,• Decrease in HH out-of-pocket payments for health

protection of HH catastrophic health spending,• Still high spending on curative care, rather than

health promotion and disease prevention, • The Asian Financial Crisis in 1997 and the UHC

implementation in 2002 had impacts on the Thai health expenditure structure,

• The main financing agents in 2010 are: 1) the UHC; 2) the Central government; 3) the household out-of-pocket payments and; 4) the CSMBS.

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Limitations and lesson learned

• Data and information needed for compiling NHA are belong to various organizations, both in public and private sector,– Incomplete, not fit with the NHA matrix, – Not available every year time lag for two

years,

• Methodology to breakdown data into the NHA tables,

• Structure of organization in the Thai context– New established organizations based on the Thai

Constitution,– Public Independent organizations,

• Variations in collaboration and commitment of key partners.

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THE projection: 2006-2026

Application of Thai NHA

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THE projection: 2006-2026 based on 1994-2005 NHA

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Expenditure Share in GDP of Financing Agencies - Long-term Trends

0.0

1.0

2.0

3.0

4.0

5.0

6.0

1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 2024 2026

Per

cent

MoPH OthMin LocGovt StateEnterprise CSMBS SocSec UC WCF PrivIns TrafficIns ERBenefits PrivHH NonProfit RoW

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National AIDS Spending Assessment (NASA), 2010-2011

Diversification of Thai NHA

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What is NASA?

• NASA is a tool that produces strategic information in the framework of national HIV responses,

• It measures and tracks the use of financial resources for HIV,

• NASA methodology focuses on expenditure and consumption,

• NASA analyses the activities implemented by governments, bilateral aid, multilateral programs, private households and NGOs as part of the HIV response. 18

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AIDS Spending Categories

• Prevention • Care and Treatment • Orphans and Vulnerable Children (OVC)• Program Management Administration

Strengthening • Incentive Human Resources• Social protection and social services

excluding Orphans and vulnerable Children• Enabling Environment and community

Development • Research excluding operational research

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National AIDS spending 2008-2011

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  2008 2009 2010 2011

Total AIDS expenditure, million Baht 6928, 7208, 7733 9922,Total Health Expenditure, million Baht 3602,

72

3772,26

3923,68

4087,18

Total AIDS expenditure, as        ·        per capita population, Baht 110 114 121 154

·        per capita PLWHA, Baht 1427,

5

1447,1

1548,7

2059,4

·        per capita population, US$ 33 33 38. 51.·        per capita PLWHA, US$ 431 415 489 675

·        % GDP 008. 008. 008. 009.·        % THE 19. 19. 20. 24.

Source        Domestic, % of total AIDs exp. 85 93 85 86

International, % of total AIDs exp. 15 7 15 14

Expenditure profiles        Prevention, % of total AIDs exp. 21.

7 13.

7 13.

1 134.Care and treatment, % of total AIDs exp. 65.

8 76.

1 73.

4 732.

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Total AIDS expenditure by beneficiary populations

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2010 2011

Adult and young people

(15 years and over) living with HIV not

disaggregated by genderOthers: for example; Children (under 15 years) living with HIV not disaggregated by

gender, Injecting drug users (IDU) and their sexual partners, Female sex workers and their clients, Men who have sex with men (MSM), Orphans and vulnerable children (OVC),

Migrants/mobile populations

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Limitations and lesson learned• HIV/AIDS expenditure in Thailand has increased for 4

consecutive years care and treatment, in particular Antiretroviral Therapy (ART) was a majority of HIV/AIDS spending in Thailand,

• From the analysis of NASA 2008 to 2011, HIV/AIDS spending is financially affordable in long-term, as it relies mostly on domestic resources,

• During 2008 to 2011, domestic resources was dominant in supporting curative care, while international source was dominant in supporting prevention programs,

• Adult and young people (15 years and over) living with HIV are the major share of expenditure spent to Beneficiary populations (BP). Furthermore, they were spent more care and treatment than prevention program,

• HIV/AIDS prevention activities should be highly promoted from domestic financing sources enabling to ensure the sustainability of HIV/AIDS prevention activities.

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Sawasdee Thank you for your attention