Transcript ไม่มีชื่อเรื่องภาพนิ่ง

 Passive VS. Proactive
( health repairing VS. Health building )
25 % of population - not covered by any
health benefit schemes.
 Health - related inequalities
(discrepancy index, Kakwani index, concentration index)
 High health care cost
Table :Health benefit coverage (% of total population) from 1991 to 1997
Schemes
CSMB & state
enterprise
Social Security
Low income &
public welfare
Health card
scheme
Private
Employee
benefits
Private
Insurance and
others
Not covered
TOTAL
TOTAL
10
1991
Urban
23
Rural
7
1993
TOTAL
11
1995
TOTAL
11
TOTAL
10
1996
Urban
18
*
17
1997
Rural TOTAL
8
11
*
2
*
20
7
27
7
44
6
30
13
19
4
32
7
41
2
0
2
5
8
15
2
19
**9
2
7
1
na
na
-
-
-
na
1
0
1
1
2
2
3
2
na
68
100
68
100
68
100
49
100
28
100
37
100
45
100
35
100
32
100
Table : Distribution of hospital beds from 1981 to 1993 (beds/1,000 population)
1981
1986
1993
Public
Private
3.3
2.9
4.1
2.4
1.7
2.1
2.2
2.1
1.6
0.4
North
1.2
1.3
1.5
1.3
0.2
Northeast
0.8
0.9
1.0
0.9
0.1
South
1.4
1.7
1.7
1.5
0.2
TOTAL
1.5
1.6
1.9
1.5
0.4
Bangkok
Central
Sources: 1981-1986 - The Thai Government(1988); 1993-Pannarunothai (1994)
Table : Inpatient workload of doctors and nurses in 1992
Bed/Dr
IP/Dr/day
Bed/RN
IP/RN/day
Provinces
11.48
9.99
2.32
2.02
Bangkok
6.53
5.17
2.26
1.79
Other
Provinces
5.83
3.13
2.37
1.27
Ministries
Bangkok
2.85
1.19
1.40
0.59
Private
Provinces
Bangkok
8.08
3.13
4.50
1.74
3.65
1.86
2.12
1.08
MOPH
Source : Health Policy and Plan Bureau (1994) in Pannarunothai (1996)
RN = registered nurse
Scheme
characteristics
Low income
And public
welfare
CSMBS
SSS
Private
insurance
Health
Card
WCS
Benefit package
-Ambulatory
Services
- Inpatient
services
Only public
designated
Public only
Public &
private
Public &
private
Public
(MOPH)
Public &
private
Public only
Public &
private
Public &
private
Public &
private
Public
(MOPH)
Public &
private
Free
-Choice of
provider
Contractual basis
Free
Free
Referral line
Referral line
- cash benefit
No
No
Yes
Yes
No
Usually no
-Inclusive
conditions
All
All
Non-work
Related illness, injuries, except 15
conditions
Work-related illness and
injuries
All
As stated in the contracts
-Maternity benefit
Yes
Yes
Yes
No
Yes
Varies
- Annual physical checkup
No
Yes
No
No
Possible
Varies
- Promotion & preventive
Very limited
Yes
Health education and immunisation
No
Possible
Varies
- Services not covered
Private bed, special nurse,
eye glasses
Special nurse
Private bed, special nurse
No
Private bed
Varies
Financing
- Source of fund
General tax
General tax
Tripartite
contributions, 1.5%
of payroll
Employer, 0.2-2%
of payroll with
experience rating
Household
purchase 500 bath
+ tax subsidy 500
Premium
- Financing body
MOPH
Ministry o Finance
Ministry of Labour
Ministry of Labour
MOPH
Competitive
companies
- Payment
mechanism
Global budget
Fee-for-service
reimburse
Prospective
capitation
Fee-for-service
reimburse
Limited fee-forservice
Fee-for-service
reimburse
- Copayment
No
Yes,for IP at
private hospital
Maternityand
emergency
services
Yes, if beyon the
ceiling of 30,000
bath
No
Almost none
Table Total expenditure per capita of selected health benefit schemes
Schemes
1. Public welfare
+ Low income,elderl
(1995)
+ Primary school(1995)
2. Fringe benefit
+ CSMBS(1994)
3. Compulsory insurance
+ SSS (1993)
+ WCS (1993)
4. Voluntary insurance
+ Health card (1994)
Private
Government
Expenditure
Discrepancy
contributions
budget
Per capita
Index*
(million bath)
(million bath)
(bath)
0
0
4,143.1
>22
1
>3
0
161.1
0
9,954.0
5,553.5
3,803.7
711
3
921.4
0
96
0
807.4
400
Source:Supachutikul (1996)
* ratio between expenditure per capita of each scheme and the low income scheme
> 1,780
8
> 19
0
National Health Security Fund
Oversee
National Commission on Health
Security
SSS / WCS
Contract
Contracted providers
CSMBS
Consumer
Govt. budget / LICS
VHC
SSS = Social Security Scheme
WCS = Workmen Compensation Scheme
CSMBS = Civil Servant Medical Benefit Scheme VHC = Voluntary Health Card Programe
Figure 1.
Basic package
Private
Public
Choose
SSS / WCS
Contract
CSMBS
Contract
National Commission on Health
Security
coordinate
Common health benefit
Contracted providers
Govt. budget / LICS
Contract
Consumer
Private
VHC
Contract
SSS = Social Security Scheme
WCS = Workmen Compensation Scheme
CSMBS = Civil Servant Medical Benefit Scheme VHC = Voluntary Health Card Programe
Figure 2.
Public
 Universal Coverage
 Core Package
 Health Care Service System
 Monetary and Fiscal System
Primary care gate keeper
 Main contractor neighborhood primary care
 Provider network public private mix
 Health care accreditation system
 Cost Containment Systems
 Capitation
 Operating areas
- adjusted rate
- minimum guarantee
 Closed ends
a. Inclusive capitation
- ambulatory care
- promotive and preventive care
- in-patient care
 Closed ends
B. Combined method
Capitation
- ambulatory care
- promotive and preventive care
Global budget
- inpatient care (DRG’s)
 Closed ends
C. Both (a) and (b)
 Performance related payment
Table :The health care insurance system reformation trends
2002
1. Social
Security
Project
2003
Expend its coverage from the
Expand the coverage
business with over 10 employees
to the business with 1 or more
employees, coverage of the
to the insured families,
Number of the incurred shall rise
raising the coverage
of 10 million to 14-15
million
from 6 million to 9 million
2. Civil
servants
welfare
project
in term of
medical
care
Change payment method to per
Management by new
person for out-patient service
and DRG for in-patient create
system and the
incurrence of new
information technology for DRG
information
and other systems development
technology of the
in connection with the management
future system
or pre-management by social
security fund or the national health
care security fund
2004
Integration to form
single fund or
multiple funds to be
managed by standard
beneficial right and
single format payment
mechanism
Table 1: The health care insurance system reformation trends
2002
3. Public Health
Ministry
Integrate lower income
cards, health care security
cards and other operating
budgets to be managed,
administered under
Performance Based
Budgeting System(PBBS)
2003
Continuing operation
encouraging areas
committees to take,
charge of service
buyers units
guidelines and made the
allocation to the provinces
or areas committees in
the from of block grant.
4. Commerce
Ministry
Amend the Act covering
faced cars accident so
medical care budget be
integrated in the national
health care security fund
Starts transferring
money to the national
health care security
fund
2004
Civil Servants
Welfare Fund
Public Health
Care Security
Board
Unity
Public - private medical care
provider network
Core
Benefits
Tertiary
Social Security
Fund
Area
Purchaser
Secondary
Choice of
Population
Primary
Low income and
public welfare cards,
and other health cards
Payments
Format
Satisfaction
Standard Regulation
and Certification
Public Health Ministry and
Accreditation bodies
 Budget
- For service
- For management
 Operating area
- all in October 2001
 Public health care organization reform
- Regulation reform
- Autonomous Organization
- Both
 Private participation
 Registry
 Accreditation
W
o
r
k
i
n
g
 Core Package
 Service Standard
 Information Technology
G
r
o
u
p
s
 Public relation and Petition
 Referral Service System
 Organization Development
 Management System
 Human resource development
 Research and Development
 Monitoring and Evaluation
Conceptual Framework of Health Systems Refrom
NEED FOR
CURRENT SITUATION
NATIONAL
* Undesired deterioration
HEALTH ACT
of the health of the Thai.
(As a health constitution for the Thai
* High health expenditure,
people)
emphasizing on treatment
with low returns.
* Much thought but little
on health promotion work.
* Limited rights, opportunity,
system and support for good
health building..
* Many problems with the
health service system.
* Many Thai people lack
health security.
REFROM THE WAY
OF THINKING OF
THE THAI PEOPLE
ON HEALTH
*
*
*
*
*
*
*
*
NEED FOR
REFORMOR THE
WHOLE HEALTH
SYSTEM AS:
Policy system
Health promotion system
Disease prevention
system
Health service system
Quality control system
Technology system
Human resources
system
research system etc.
Desirable
Health
Systems
Goals And Strategies Of National Health System Reform
Desired Health Systems
• Focus on health building
• Access health service system that is efficient, of
good quality and justice to all.
National Health Act
• A health constitution
• Legeslative framework
• National Health Council
1.
2.
3.
4.
(3 years)
National Health System
Reform Commitee
(NHSRC)
HSRO
(Secretariat)
Strategies
Knowledge generation
Partnership building
Public communication
Management
(5 years)
Evidence - based social movement
- Ministy of Public Health (all departments, Policy and Planning Office. Office of The
Health Care Systems Reform) Health Systems Research institute.
- National Health Foundation. - National Economic and Social Development Board. - Non
Government Organizations. - Private business organizations. Public sector. - political
sector. - Political organizations.
- Professional organization. - Mass media, etc.
Machanism of National Health System Reform
National Health System
Reform Committee
(NHSRC)
Technical
Advice
Partnership
building
Knowledge
generation
HSRI Board
Health Systems
Research
Institute
(HSRI)
HSRO *
Drafting
NH act
Media
movement
* HSRO is set up under HSRI
Capitation = 1,200 Baht/Person/yr.
1. Curative Care (934 Baht/Person/yr.)
1.1 General curative care
- OPD 574 Baht/Person/yr.
- IPD 303 Baht/Person/yr.
1.2 High cost 32 Baht/Person/yr.
1.3 Emergency 25 Baht/Person/yr.
2. Promotive and Preventive Care 175 Baht/Person/yr.
3. Investment 91 Baht/Person/yr.
 Management 110 Baht/Person/yr.
 Contingency Fund 110 Baht/Person/yr.
Budget Management
High cost 32 Baht/Person/yr.
Emergency care 25 Baht/Person/yr.
Investment 91 Baht/Person/yr.
Management 110 Baht/Person/yr.
Contingency fund 110 Baht/Person/yr.
Medical care with promotive and preventive care(887+175=1,052 Baht/Person/yr.)
Managed by Central
Committee
Budget
Refer
Area Purchaser
Tax
Citizens
Budget for
OPD, Promotive,
Preventive care
(574+175=749 Baht/Person/yr.)
Primary
Health care
Registry and
choice of health care
Working Committee
for monitoring and
control
Refer
Budget for IPD
(303 Baht/Person/yr.)
Secondary
Tertiary care