Transcript ภาพนิ่ง 1

Information System
for Health Insurance in Thailand
Dr. Somnuek Sirisuwan
Senior Expert,
National Heath Security Office, Thailand
Presentation topics
• Introduction to The National Health
Security Act in Thailand
• The development of information system
for health insurance
• Utilization of health information in the
National Health Security Office (NHSO)
• Health information system : Our Future
plan
Introduction to The National Health
Security Act in Thailand
• The universal health coverage system in Thailand
had been introduced since 2000.
• and the National Health Security Act was enacted
in 2002.
• Three main health financing schemes including,
– Civil servant medical benefit scheme (CSMBS),
– Social security scheme (SSS), and
– Universal coverage scheme (UC)
Health insurance Scheme
• Civil Servant Medical Benefit Scheme
(CSMBS) – 1963 : for government
employee, retires and dependants
• Social security scheme (SSS) – 1990 : for
private sector employee
• Universal Coverage Scheme (UC) – 2002 :
for the rest of population
Health insurance Scheme in Thailand
SSS
16%
CSMBS
8%
UC
76%
The development of information system
for health insurance
• Because a huge information is needed for
supporting the health security office.
• A managing information system has been
established by using the electronic data
which have been collected from health
care providers under the act.
The UC scheme is financed by
general tax revenue.
2401
Fiscal year 1 Oct – 30 Sep
Initial three main programs
• Enrollment and registration
• Reimbursement, and
• Health service activities
reports
UC coverage from
The enrollment program
(46.9 million)
Data source : NHSO 16 Jan 09 (Total population 64,071,087)
Health care provider registration
Health care provider registration
Health service provider
Hospital (with in MOPH)
2007
2008
number number
830
836
%
86.54
Gov. hospitals (not in MOPH)
73
75
7.76
Private hospitals
60
55
5.69
963
966
100.00
4
13
5.35
80
80
32.92
152
150
61.72
236
243
100.00
Total hospitals
PCU (MOPH)
PCU (Municipality)
Private PCU
Total PCU
Grand total
1,199
Note : Primary care unit with nurse practitioners about 10,000 units
1,209
Reimbursement
In-Patient ~ 4.5-5.0 million claims/years
(All Case)
Out-Patient ~ 170,000 claims/years
(Esp. High cost/Accident/Emergency)
Health service activities reports
Health service report
2003
2004
2005
2006
2007
2008
No. of visit
(million)
111.94
112.49
111.64
114.76
119.29
128.94
Utilization
rate/person/
year
2.45
2.41
2.37
2.42
2.55
2.75
No. of IP
(million
person)
4.30
4.16
4.33
4.72
4.88
4.95
Utilization
rate/person/
year
0.09
0.09
0.09
0.10
0.10
0.11
mean
Adj.RW
na
0.87
0.89
0.91
0.95
0.99
OP
IP
Health service activities reports
Health service activities reports
130,000,000 visits
5,000,000 admissions
enrollment
Health service information
8 Terabytes
•
•
•
•
Hospital Profile
Population enrollment
Medical Records (OP, PP, IP)
reimbursement records
•
•
•
•
Disease Management Information
Health service reports
Customer feedback information
Budgeting etc .
Customer feedback information , 2008
( 1 Oct 2007 – 30 Sep 2008)
(1) Service quality complain
ม.57,59
4,239 (0.48%)
Total calls
879,571
(2) General Complaint
19,419 (2.21%)
(3) Q&A
852,003 (96.87%)
(4) Need for Referral assistant
3,910 (0.44%)
2
www.nhso.go.th
Health service information for DMI
1
IP service
Population
OP service
Service
department
PP service
Individual record
Cancer
enrollment
Disease
Registration
Software
DMIS
AIDS/TB
2
Information technology infrastructures
and computer networks have been constantly supported
Utilization of health information
in the NHSO
• To monitor
– the distribution of specific diseases,
– health outcome indicators, and health
care service performances
– the Dispensing information of supplies
(such as medications, laboratories, facilities,
equipment) for acquired immune deficiency
syndrome, tuberculosis, and end-stage
kidney disease from the Vender Managed
Inventory (VMI) program.
Morbidity monitoring
Top Twenty 1677 Diseases' 2008
44,713
Septi caemi a due to Staphyl ococcus aur eus
47,185
47,199
47,906
Status asthmati cus
50,089
Febr i l e convul si ons
50,512
55,214
Congesti ve hear t fai l ur e
55,990
57,527
Acute tubul o-i nter sti ti al nephr i ti s
63,353
64,886
Dengue haemor r hagi c fever
67,563
74,036
Seni l e i nci pi ent catar act
75,201
78,119
Acute appendi ci ti s wi th gener al i zed per i toni ti s
83,342
85,769
Chr oni c obstr ucti ve pul monar y di sease wi th acute l ower r espi r ator y
i nfecti on
91,513
118,985
Di ar r hoea and gastr oenter i ti s of pr esumed i nfecti ous or i gi n
286,450
0
Top Twenty 1677 Di seases' 2008
50,000
100,000
150,000
200,000
250,000
300,000
350,000
The distribution
of tracer diseases
(high cost and high burden)
Ischaemic heart diseases (I20-I25)
morbidity rate , 2004 -2008
(/100,000 population)
160.00
140.00
120.00
100.00
80.00
60.00
40.00
20.00
0.00
2004
2005
Data source : NHSO 16 Jan 09
2006
2007
2008
year
Ischaemic heart diseases morbidity rate
by region , 2004 -2008
250
(/100,000 population)
Saraburi
Ratchaburi
200
150
100
Sakonakorn
50
0
1
2
3
4
Data source : NHSO 16 Jan 09
5
6
7
8
9
10
11
12
13
region
Health outcome and Health care service
performances indicators
Admission rate of some chronic conditions
DM
HT
Stroke
AM I
Asthma
COPD
TB
Hospitalization Rate per 100,000 Pop Uc
200
180
175.1
163.3
160
140
143.9
117.4
111.9
163.2
148.7
140.7
130.7
129.2
120
180.5
122.2
116.5
123.9
112.5
107.9
100
80
60
62.1
48.3
40
65.7
67.9
71.5
68.1
49.8
46.4
56.5
49.5
49.6
36.4
20
0
2005
2006
2007
2008
Case Fatality Rate of some chronic/acute diseases
DM
HT
Stroke
AM I
Asthma
COPD
TB
25
22
20.9
Case Fatality Rate ( %)
20
19.3
18.1
17.3
16.8
16
15.7
15
10
5
6
5.2
2
0
0.8
0.7
2005
6.8
6.2
6.3
4.8
4.8
4.6
1.6
0.7
0.6
1.5
0.8
0.5
1.4
0.9
0.5
2006
2007
2008
In patients Case Fatality Rate ,
2005 - 2008
R ate
x 100
3.0
2.59
2.59
2.58
2.56
2.5
2.0
1.5
1.0
0.5
0.0
2005
2006
2007
2008
Acute condition : Rupture appendicitis
25.00
%
19.58
20.00
18.45
18.76
18.61
18.04
18.06
17.70
15.00
10.00
08
20
07
20
06
20
05
20
04
20
03
20
02
-
20
ร้อยละ
5.00
Pay for Quality Performance
• Service coverage , and some Quality
Performance indicators are used for on top
payment (1.7 %).
– Primary care indicators
– Hospital care indicators
The Dispensing information
the Vender Managed Inventory
(VMI) program.
GPO
reimburse
ARV / TB drugs
peritoneal dialysis solution
NHSO
GPO : Gov. Pharmaceutical Organization
Report/billing
Other source of Information : Survey
Health information system :
Our Future plan
• Three main health financing schemes should be
able to exchange together for optimal use of the
national health information.
• The health service reports will be replaced with
individual records.
• Maximize the utilization of health information
provide by NHSO.
• http://www.nhso.go.th/eng/#