Health Systems and Financing: Experiences from Thailand

Alia Luz

HITAP International Unit (HIU)

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Disclaimer: The views expressed in this paper/presentation are the views of the author and do

not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board

of Governors, or the governments they represent. ADB does not guarantee the accuracy of the

data included in this paper and accepts no responsibility for any consequence of their use.

Terminology used may not necessarily be consistent with ADB official terms.

Global Trend of Universal Health Coverage (UHC)

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More than 80 countries since 2010 have asked the WHO for technical assistance in moving toward UHC

UN December 2012 Resolution for UHC made it a top priority for the WHO and other IGOs and multilateral institutions

WHO Brief: Global Push For UHC.

Priority setting is indispensable!

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Research should inform health policy in countries to focus on their current health challenges and make concrete recommendations - More Health for Money

DEVELOPING EVIDENCE-BASED POLICY MAKING AND CAPACITY BUILDING

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Summary of health insurance schemes CSMBS SHI UCS

Population 5 Million (8%) 9.84 Million (15.8%) 47 Million (75%) Beneficiaries Civil servant +

spouse + vertical

relatives

Employees in private

sector

Those who are

not covered by

CSMBS and SHI

Source of

finance

General tax (~11,000 Baht/Cap*)

Tripartite from

employer, employee,

government rate 1.5%

of salary

General tax

(2,100 Baht/Cap)

Purchaser Comptroller

General's

Department,

Ministry of

Finance

Social Security Office,

Ministry of Labour

National Health

Security Office

Providers Public provider only,

Private in emergency

3,000 Baht/episode

Public and private hospital more

than 100 beds (>60%

contractors are private)

Public and private

contracting unit for

primary care

Benefit package No preventive care

No explicit exclusion

Special bed

Small number of limited

condition e.g. Non medical

plastic surgery

Small number of limited

condition

Prevention & promotion

Payment OP: Fee-for-service

IP: DRG since 2009

Capitation OP: Capitation

IP: global budget + DRG

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Managing the benefit package: gradual expansion of coverage

Negative list approach: comprehensive with few in the exclusion list

No maximum ceiling of financial coverage, free at point of service,

High level financial risk protection

Extend coverage to high cost RRT

Initially excluded from UCS due to high cost (Kasemsup et al 2006).

RRT not cost-effective, long-term fiscal burden (Tangcharoensathien et al 2005), But catastrophic for UCS members (Prakongsai et al 2007).

Despite being cost ineffective, RRT was included by 2006

To prevent catastrophic spending and ensure equity across 3 Schemes (Tangcharoensathien et al 2013). PD first was adopted (Tantivess 2013).

Processes of inclusion of new interventions

Rigorous economic evaluation: cost effectiveness + budget impact

Home-grown HTA capacities,

HITAP established in 2007 contribute significantly

Benchmark of one GNI per capita for one QALY gain (Tantivess et al 2009)

Institutionalized research capacity

Establishment of associated institutes such as HSRI, HISRO, HITAP, IHPP

Contributed to evidence generation

Independent research institutes

Institutionalization of capacity

Health Intervention and Technology Assessment Program (HITAP)

Established in 2007 to assess health interventions and technologies efficiently and transparently

Develop systems and mechanisms to promote the management of health technology and appropriate health policy determination

Distribute research findings and educate the public

Topic SelectionConsultation

HITAP, policy makers, healthcare providers, consumer groups, professional associations, etc.

Conducting HTA researchConsultation and technical collaboration

HITAP, experts and relevant stakeholders

Appraisal of resultsPeer review, submission of comments and discussion

HITAP, experts, private business/industry, policy makers, consumers/beneficiaries

Dissemination of results and recommendationsPublication, presentation and dialogues

HITAP, funding agencies, the media, consumer groups and other NGOs

HTA process at HITAP

Development of the National List of Essential Medicine (NLEM) (5

topics/year) Development of UC Benefit Package (5 topics/year)

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RECOMMENDED ACTIVITIES AND AREAS OF WORK

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1) Work with local researchers and institutes to build capacity and help them establish their own mechanisms

Technical Assistance for the Myanmar Maternal and Child Health Voucher Scheme feasibility

study and implementation assessment

Introducing HTA concepts and

principles for Free Drugs List

development in Nepal

Capacity

Building and Technical

support in the Philippines for

economic evaluations

2) Implement long-term capacity building programs, e.g. HITAP

3) Develop the countrys research institutes through the INNE model

Develop the INNE model:

Individual, Node, Network and Environment

Key factors A critical mass of qualified researchers (good at head, hand,

heart)

Institutional umbrella for them to work in a sustainable way

Knowledge brokers and a platform where evidence interacts with policy makers

Produce policy relevant research with political impartiality

Long term fellowship program

Linkages and supports from international partners and civic groups

Included: Imiglucerase is an enzyme for

Gaucher disease treatment Budget impact of using imiglucerase

in GD1 patients: 5.3 M USD in 5 years

Increase: 24 M USD in 20 years

Imiglucerase is NOT COST-EFFECTIVE for treating GD1 patients, although it can help patients to live longer and increase quality of life

The Subcommittee for the development of the NLEM decided to INCLUDE imiglucerase in the NLEM since it can prevent impoverishment 15

4) Conduct policy-relevant research that is selected through a transparent and participatory process

Not Included: Absorbent products for urinary

and fecal incontinence among disabled and elderly people in Thailand topic was proposed by lay people group

ICER: 4,300 USD per QALY gained Budget impact: 90 M USD per

year The SCBP decided to NOT

INCLUDE the absorbent products in the benefit package according to very high budget impact, administrative systems, and environmental issues

Conclusion: Potential Areas of Work

1. Developing evidence-based decision making Doing policy relevant research that addresses the

countrys needs: health technology assessments, health policy and systems research, health financing research

Instituting key platforms for evidence informed decisions in order to link policy and research

2. Interactive learning through action Research must be done alongside local researchers

Long-term capacity building nationally and in the region

3. Developing INNE for countries - building strong institutional capacities nationally and internationally

Kob Khun Kha Thank you for your attention

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