Kanjana Tisayaticom

Why has the Universal Coverage Scheme in Thailand achieved a pro-poor public subsidy for health care?

BackgroundThailand has achieved universal health coverage since 2002 through the implementation of the Universal Coverage Scheme (UCS) for 47 million of the population who were neither private sector employees nor government employees. A well performing UCS should achieve health equity goals in terms of health service use and distribution of government subsidy on health. With these goals in mind, this paper assesses the magnitude and trend of government health budget benefiting the poor as compared to the rich UCS members.MethodBenefit incidence analysis was conducted using the nationally representative household surveys, Health and Welfare Surveys, between 2003 and 2009. UCS members are grouped into five different socio-economic status using asset indexes and wealth quintiles.FindingsThe total government subsidy, net of direct household payment, for combined outpatient (OP) and inpatient (IP) services to public hospitals and health facilities provided to UCS members, had increased from 30 billion Baht (US

Prevalence and profiles of unmet healthcare need in Thailand

1 billion) in 2003 to 40-46 billion Baht in 2004-2009. In 2003 for 23% and 12% of the UCS members who belonged to the poorest and richest quintiles of the whole-country populations respectively, the share of public subsidies for OP service was 28% and 7% for the poorest and the richest quintiles, whereby for IP services the share was 27% and 6% for the poorest and richest quintiles respectively. This reflects a pro-poor outcome of public subsidies to healthcare. The OP and IP public subsidies remained consistently pro-poor in subsequent years.The pro-poor benefit incidence is determined by higher utilization by the poorest than the richest quintiles, especially at health centres and district hospitals. Thus the probability and the amount of household direct health payment for public facilities by the poorest UCS members were less than their richest counterparts.ConclusionsHigher utilization and better financial risk protection benefiting the poor UCS members are the results of extensive geographical coverage of health service infrastructure especially at district level, adequate finance and functioning primary healthcare, comprehensive benefit package and zero copayment at points of services.

Innovative Financing for Health Promotion: A Global Review and Thailand Case Study

BackgroundIn the light of the universal healthcare coverage that was achieved in Thailand in 2002, policy makers have raised concerns about whether there is still unmet need within the population. Our objectives were to assess the annual prevalence, characteristics and reasons for unmet healthcare need in the Thai population in 2010 and to compare our findings with relevant international literature.MethodsA standard set of OECD unmet need questionnaires was used in a nationally-representative household survey conducted in 2010 by the National Statistical Office. The prevalence of unmet need among respondents with various socio-economic characteristics was estimated to determine an inequity in the unmet need and the reasons behind it.ResultsThe annual prevalence of unmet need for outpatient and inpatient services in 2010 was 1.4% and 0.4%, respectively. Despite this low prevalence, there are inequities with relatively higher proportion of the unmet need among Universal Coverage Scheme members, and the poor and rural populations. There was less unmet need due to cost than there was due to geographical barriers. The prevalence of unmet need due to cost and geographical barriers among the richest and poorest quintiles were comparable to those of selected OECD countries. The geographical extension of healthcare infrastructure and of the distribution of health workers is a major contributing factor to the low prevalence of unmet need.ConclusionsThe low prevalence of unmet need for both outpatient and inpatient services is a result of the availability of well-functioning health services at the most peripheral level, and of the comprehensive benefit package offered free of charge by all health insurance schemes. This assessment prompts a need for regular monitoring of unmet need in nationally-representative household surveys.

Research Series of Thai Health Care Financing: Part 1 Financial Reform Options of Health Care Coverage in Thailand (ชุดวิจัยการเงินการคลังระบบสุขภาพไทย : ตอนที่ ๑ แนวทางการปฏิรูปการเงินการคลังหลักประกันสุขภาพถ้วนหน้า)

In the light of increased burden from noncommunicable diseases (NCDs) worldwide, the availability of guidelines on effective and cost-effective prevention and control interventions for NCD, and the political commitment to address NCD epidemics, there is a need for mobilizing adequate funding for health promotion which addresses primary and secondary prevention of these NCD. This article reviews the progress in financing health care in general and health promotion in particular and provides a global review of innovative financing for health promotion in selected countries having such a specific dedicated tax and/or innovative governance mechanisms to manage health promotion expenditure. The article also draws on lessons from an in-depth case study of Thai Health Promotion Foundation which contributes to sustainable financing in supporting multisectoral and multidisciplinary actions on health promotion. Assessment of financing health care indicates that countries in Africa and Southeast Asia Regions, facing fiscal constraints and lack of political will to spend on health of their people, spent merely US

Cost Analysis and Estimate of Capitation Rate for Universal Health Care Coverage Project for Fiscal Year 2004 (การวิเคระห์และกำหนดอัตราเหมาจ่ายในโครงการหลักประกันสุขภาพถ้วนหน้า สำหรับปีงบประมาณ 2547)

109 and US

Unit Cost Analysis: Standard and Quick Methods (วิธีวิเคราะห์ต้นทุนบริการของสถานพยาบาลแบบมาตรฐานและแบบลัด)

71 per capita, respectively, in 2013. This level is well below the indicative benchmark of US

ความแตกต่างของการใช้พลังงานจากกิจกรรมทางกายระหว่างคนเมือง/คนชนบทในประเทศไทย: ข้อมูลจากการสำรวจอนามัยและสวัสดิการ พ.ศ. 2558

86 (in 2012 term) to achieve health of the population. Only one-third of total 194 WHO Member States countries produce complete data on health promotion expenditure. In 2012, the current financing level of health promotion was low, the global average of 3.9% of Total Health Expenditure or at US

ความแตกต่างของพฤติกรรมการบริโภคอาหารของประชากรไทย: ลักษณะประชากร เศรษฐกิจและสังคม และสถานะสุขภาพส่งผลอย่างไร

61 per capita spending on health promotion in 2012. There is no increasing trend in health promotion expenditure between 1995 and 2012. In 2012, expenditure on health promotion was merely US

คนไทยใช้พลังงานในกิจกรรมทางกายและพฤติกรรมเนือยนิ่งเท่าไร: ข้อมูลจากการสำรวจอนามัยและสวัสดิการ พ.ศ. 2558

10.3 and US

ผู้ป่วยด้วย NCD มีพฤติกรรมเสี่ยงทางสุขภาพอยู่มากน้อยแค่ไหน: รายงานจากการสำรวจอนามัยและสวัสดิการ พ.ศ. 2558

7.2 per capita in Africa and Southeast Asia Region. This level cannot make significant contribution to health promotion in the context of increased diseases burden from NCD. Innovative funding sources from dedicated tax such as from products, which are harmful to health, such as tobacco, alcohol, energy-dense processed foods, or earmarks from other sources such as insurance fund, though provide additional new resources for health promotion, require effective governance mechanisms for resource allocation with participation by other non-health sector and civil society organizations. Even there is limited political will to support innovative financing health promotion from dedicated tax such as sin tax, countries may apply innovate governance mechanisms to manage effectively the annual budget allocation to health promotion often by the Ministries of Health. Lessons can be drawn from several countries introducing innovative financing for health promotion and innovative governance mechanisms in maximizing health gains from limited resources.