Transcript Slide 1
Health System Research Institute Health Insurance System Research Office From principle to practice: Experience from Thailand in Amending the social security law: Training Seminar on Social Security Standards, Policy and Implementation Luang Prabang, Lao PDR 28 August 2013 Dr. Thaworn Sakunphanit Boonyawee Aueasiriwon สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย 1 Health Insurance System Research Office Health System Research Institute 2 • • • • Thai Social Security Act (SSA) Situation in 1990 (Enact of the SSA) Expansion to Universal Health Coverage Forecast of Financial Status of the Social Security Scheme สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย Health Insurance System Research Office Health System Research Institute 3 Development of Thai Social Security Act Did not implement SSA 40 Years 1954 Amend SSA 1994 SSA 1990 Amend Workmen’s Compensation Announcement 1972 SSA 1999 Merge? Workmen’s Compensation Announcement Act 1994 สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย Health Insurance System Research Office Health System Research Institute Summary of SSS implementation coverage mandatory 2010 - voluntary benefit Informal sector Sickness (cash benefit only), invalidity, death, OAP 2004 - - Unemployment 2002 1 employee - - 1996 - - OAP, child allowance 1994 - Self employed Maternity, invalidity, death 1993 10 employees 1991 20 employees (had been revoked in 2010) - Sickness, maternity, invalidity, death สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย Health System Research Institute Health Insurance System Research Office Situation in 1990 สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย 5 Health Insurance System Research Office Health System Research Institute Centralized (Public) health care coverage Low-income Country Low-income Country Decade of hosp 1977- 1986 Decade of health centre Low-income Country 1992-2001 Low-income Country Source: Patcharanarumol W et al (2011). Why and how did Thailand achieve good health at low cost?10 6 สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย Health Insurance System Research Office Health System Research Institute Step by Step Approach Health Care Facilities - No computers - Simple report, no coders Health Card - A few trained health policy analysts - Short course training on Health Economics for director of community hospitals Exiting Schemes -Two Cost accounting Studies สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย Health Insurance System Research Office Health System Research Institute 8 Challenge of Implementation • Social Security Act was enacted in 1990 • Implementation of 4 short term benefits (Sickness, Maternity, Invalidity and Death benefits) had to started in 1991 • Regarding Social Health Insurance – Established responsible unit in the Social Security Office (SSO) – Registration/ Contribution collection – Benefit package / Service provision – Payment mechanism – Information system สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย Health Insurance System Research Office Health System Research Institute Overcome Challenges: Registration/ Contribution collection • Lack of trained staff, equipment, office building and operating procedures • tremendous increasing of workload • SSO decided to implement centralized registration system using its own ID number. Since the Citizen ID was not completed at that time สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย Health Insurance System Research Office Health System Research Institute Overcome Challenges: 10 Benefit package / Service provision • Using “Exclusive” List approach for Benefit package • Working with the ILO and Ministry of Public Health on actuarial issue • Using existed public and private health care facilities • Cabinet Order – Force every public health care facilities providing services for member of SHI – Lead to amendment for more flexible financial procedure in public health facilities include compensation to staffs • Competition among Public and Private Providers สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย Health Insurance System Research Office Health System Research Institute 11 Overcome Challenges: Payment mechanism • Debate between payment mechanisms – Fee for services, which is used under Civil Servant Medical Benefits Scheme and Workmen Compensation Fund • Moral hazard: High risk to SSO->workload to adjudication and utilization review – Capitation • High risk to provider-> decrease quality – Case Based (DRG) • Data was in paper-based discharge summary สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย Health Insurance System Research Office Health System Research Institute 12 Overcome Challenges: Information System • Ministry of Public Health (MOPH) officially announced to use ICD10 (2nd country in the world) • SSO decided to asking computerized report from contracted health care providers – Every contracted providers got a PC computer – A stand alone computer application for contracted providers was developed – Nation wide training for using the application with the new standard coding system by SSO and MOPH สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย Health System Research Institute Health Insurance System Research Office Expansion to Universal Health Coverage สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย 13 Health Insurance System Research Office Health System Research Institute 14 Hurdles • Social Security Act has potential to expand for UHC • Hurdles – Mission for UHC is not clear – Vision and leadership of Secretary General – Flexibility of orgnisation to new demand of member and new initiative e.g. new payment mechanism – Composition of Triparty Committee, Ownership of the funds • Specific scheme for specific population VS Universal • Representative of new member (self-employed, government officers) • Result: Expansion to other group of population is very slow – Sickness benefit for spouse in the law was suspend – Voluntary insurance for informal employee was delay สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย Health Insurance System Research Office Health System Research Institute 15 Result • New Law is enacted – National Health Security Act – Only member of SSS has to pay contribution for sickness benefits, the rest enjoy health care benefit using tax • Impact to the Social Security Act – Argument from members why do they have to pay contribution and tax? สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย Health System Research Institute Health Insurance System Research Office There Should be The New Amendment of The Social Security Act. สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย 16 Health System Research Institute Health Insurance System Research Office Forecast of Financial Status of the Social Security Scheme สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย 17 Health Insurance System Research Office Health System Research Institute Projection Health Care Expenditure: From Actuarial Model Current health expenditure by agency, 1994 - 2020, NHA, % of GDP MoPH WCF Other Min Local govt Employer Private ins OOP SOE CSMBS Non profit UC Traffic ins SSO Rest of world 5.0% 4.5% 4.0% SS 3.5% CSMBS 3.0% 2.5% UC 2.0% 1.5% Out of pocket 1.0% 0.5% MoPH 0.0% 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 Source: Health Care Reform Project (2008) สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย 2020 25.00% 20.00% 15.00% 10.00% PAYG cost ratio min res ratio = 3 5.00% min res ratio = 10 2098 2092 2086 2080 2074 2068 2062 2056 2050 2044 2038 2032 2026 2020 2014 2008 0.00% 2002 Health Insurance System Research Office Health System Research Institute 19 Contribution for Pension From Actuarial Models สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย