Warisa Panichkriangkrai

Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening

In 1985, the Rockefeller Foundation published Good health at low cost to discuss why some countries or regions achieve better health and social outcomes than do others at a similar level of income and to show the role of political will and socially progressive policies. 25 years on, the Good Health at Low Cost project revisited these places but looked anew at Bangladesh, Ethiopia, Kyrgyzstan, Thailand, and the Indian state of Tamil Nadu, which have all either achieved substantial improvements in health or access to services or implemented innovative health policies relative to their neighbours. A series of comparative case studies (2009-11) looked at how and why each region accomplished these changes. Attributes of success included good governance and political commitment, effective bureaucracies that preserve institutional memory and can learn from experience, and the ability to innovate and adapt to resource limitations. Furthermore, the capacity to respond to population needs and build resilience into health systems in the face of political unrest, economic crises, and natural disasters was important. Transport infrastructure, female empowerment, and education also played a part. Health systems are complex and no simple recipe exists for success. Yet in the countries and regions studied, progress has been assisted by institutional stability, with continuity of reforms despite political and economic turmoil, learning lessons from experience, seizing windows of opportunity, and ensuring sensitivity to context. These experiences show that improvements in health can still be achieved in countries with relatively few resources, though strategic investment is necessary to address new challenges such as complex chronic diseases and growing population expectations.

Health systems development in Thailand: a solid platform for successful implementation of universal health coverage

Thailands health development since the 1970s has been focused on investment in the health delivery infrastructure at the district level and below and on training the health workforce. Deliberate policies increased domestic training capacities for all cadres of health personnel and distributed them to rural and underserved areas. Since 1975, targeted insurance schemes for different population groups have improved financial access to health care until universal health coverage was implemented in 2002. Despite its low gross national income per capita in Thailand, a bold decision was made to use general taxation to finance the Universal Health Coverage Scheme without relying on contributions from members. Empirical evidence shows substantial reduction in levels of out-of-pocket payments, the incidence of catastrophic health spending, and in medical impoverishment. The scheme has also greatly reduced provincial gaps in child mortality. Certain interventions such as antiretroviral therapy and renal replacement therapy have saved the lives of adults. Well designed strategic purchasing contributed to efficiency, cost containment, and equity. Remaining challenges include preparing for an ageing society, primary prevention of non-communicable diseases, law enforcement to prevent road traffic mortality, and effective coverage of diabetes and tuberculosis control.

Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand

Strategic purchasing is an essential health financing function. This paper compares the strategic purchasing practices of Thailand’s two tax-financed health insurance schemes, the Universal Coverage Scheme (UCS) and the Civil Servant Medical Benefit Scheme (CSMBS), and identifies factors contributing to successful universal health coverage outcomes by analysing the relationships between the purchaser and government, providers and members. The study uses a cross-sectional mixed-methods design, including document review and interviews with 56 key informants. The Comptroller General Department (CGD) of Ministry of Finance manages CSMBS as one among civil servant welfare programmes. Their purchasing is passive. Fee for service payment for outpatient care has resulted in rapid cost escalation and overspending of their annual budget. In contrast, National Health Security Office (NHSO) manages purchasing for UCS, which undertakes a range of strategic purchasing actions, including applying closed ended provider payment, promoting primary healthcare’s gate keeping functions, exercising collective purchasing power and engaging views of members in decision making process. This difference in purchasing arrangements resulted in expenditure per CSMBS member being 4 times higher than UCS in 2014. The governance of the purchaser organization, the design of the purchasing arrangements including incentives and use of information, and the institutional capacities to implement purchasing functions are essential for effective strategic purchasing which can improve health system efficiency as a whole.

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

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

Diabetes prevention and care in the universal health coverage context: The example of Thailand

109 and US

Policy Choices for Progressive Realization of Universal Health Coverage; Comment on “Ethical Perspective: Five Unacceptable Trade-offs on the Path to Universal Health Coverage”

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

Public Insurance and Financial Risk Protection: Lessons from Thailand

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

Why and how did Thailand achieve good health at low cost

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

Health financing lessons from Thailand for South Africa on the path towards universal health coverage

10.3 and US

การใช้บริการทันตกรรมของประชาชนไทย : ผลจากการสำรวจอนามัยและสวัสดิการ 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.