Thailand Health Financing Review 2010

Abstract:     
The 2010 health financing review describes the configuration, and assesses health financing arrangements in Thailand in order to respond the following six major questions: a) how much is spent on health of Thai population and on what services‘ b) who are covered and what are their benefits or entitlements‘ c) where does the health system’s money come from‘ d) how is money pooling, allocated and purchased‘ e) who spends the money‘ f) how different services and health personnel are paid for, based on various models of payment.‘

After UC was successfully achieved by 2002, the whole population of Thais have been covered by one of the three public insurance scheme, as well as voluntary private health insurance. The financing healthcare is dominated by general tax revenue, which is one of the most progressive sources of funding. The level of THE, as percent of GDP, is modest; this is within the fiscal capacity of the country to afford in long term, see long term projection of total health expenditure by 2020. One of the strengths of healthcare financing is strategic purchasing, with the application of capitation contracting model as major mode of provider payment for SHI and UC Schemes. Compared to fee for service reimbursement model, capitation contracting model has better prospect of long term cost containment.

Benefit package provided by the three public insurance schemes is generous and comprehensive, almost all health services including high cost care are included; though a few items of negative exclusion list are excluded such as cosmetic surgery. Comprehensive coverage where services are provided free of charge results in extremely low prevalence of catastrophic health spending and impoverishment; the poor resided in rural areas had better access and use of health services from the district health provider network which serves as a “close to client service” results in pro-poor public budget subsidies. The administrative costs of the UC and SHI schemes are very low as NHSO relies on annual budget approval through the Budget Act processes, and SSO collects revenue from mandatory monthly wire transfer from the employers. The purchasing functions when apply the capitation contract model, the administrative cost is much less where there is no need to review and approve claims as is the case of CSMBS fee for service reimbursement model. Benefit package was harmonized across three public insurance schemes facilitate movement of members from one to another scheme, provider payment is better harmonized between SHI and UC scheme, while CSMBS is still outstanding when it applies fee for service direct disbursement for OP services, although CSMBS applies DRG systems for hospitalization similar to that of the UC Scheme.

Number of Pages in PDF File: 43

Keywords: Universal Coverage, Health Financing, Health Insurance, Benefit Package

JEL Classification: I18

working papers series