Search

Introduction In 2017 the Thai Ministry of Public Health proposed a new financing mechanism to promote day surgery under the Universal Coverage Scheme - the main public insurance arrangement for Thais. The key feature of the policy is health facilities performing day surgery can claim the treatment expense based on relative weight (RW) instead of adjusted RW (adjRW). Procedures for 12 diseases (so-called "candidate procedures") are eligible for the new reimbursement. The objective of this study was to assess the current day surgery situation in Thailand and analyze potential budget impact from the new policy. Methods A quantitative cross-section design was employed. Individual inpatient records of the Universal Coverage Scheme during 2014-2016 were analyzed. Descriptive statistics and simulation analyses were applied. The analyses were divided into three subtopics: 1) case volume and expense claim, 2) utilization across facilities, and 3) case mix index and budget impact. Results Overall, day surgery accounted for 4.8% of admissions with candidate procedures. Inguinal hernias, hemorrhoids, and common bile duct stones caused the largest sum of admission numbers and admission days. Currently, the annual reimbursement for candidate procedures treated as inpatient cases is around 290.8 million Baht (US$ 8.8 million), with about 12.4 million Baht (US$ 0.38 million) for day surgery cases. If all candidate procedures were performed as day surgery and diagnostic-related groups (DRG) version 6 was applied, the incremental budget would amount to 1.9 million Baht (US$ 58,903). Conclusions The new reimbursement policy will likely lead to minimal budget burden. Even in the case of maximal uptake of the policy, the needed budget would increase by just 15%. The marginal budget increment was explained by the infinitesimal RW-adjRW difference. Apart from the financial measure, other qualitative aspects of the policy, such as infrastructure and health staff readiness, should be explored.

Background Thailand, an upper-middle income country, has demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country achieved full population coverage and a high level of financial risk protection since 2002, through implementing three public health insurance schemes. UHC has two explicit goals of improved access to health services and financial protection where use of these services does not create financial hardship. Prior studies in Thailand do not provide evidence of long-term UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002. Methods We used data from a 15-year series of annual national household socioeconomic surveys (SES) between 1996 and 2015, which were conducted by the National Statistic Office (NSO). The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payment (OOP) for health by households exceeding 10 and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by the additional number of non-poor households falling below the national and international poverty lines after making health payments. Results Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when the 25% threshold was applied from 1.8 to 0.4% during the same period. The incidence of impoverishment against the national poverty line reduced considerably from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was applied, the incidence of impoverishment was 1.4 and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low. Conclusion The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design of Thailand’s UHC, which provides a comprehensive benefits package and zero co-payment at point of services. The well-founded healthcare delivery system and favourable benefits package concertedly support the achievement of UHC goals of access and financial risk protection.

Melioidosis is among the most common causes of septicemia in Thailand, but data on economic burden are limited. We describe the economic impact of bacteremic melioidosis hospitalizations in two Thailand provinces during 2006-2008. Costs are presented in US dollars ($1 = 30.49 Thai Baht). The average annual incidence of bacteremic melioidosis cases per 100,000 persons in Sa Kaeo and Nakhon Phanom was 4.6 and 14.4, respectively. The annual cost of bacteremic melioidosis hospitalizations from the societal perspective, including direct and indirect costs, was $152,159 in Sa Kaeo and $465,303 in Nakhon Phanom. The average cost per fatal case was $14,182 and $14,858 in Sa Kaeo and Nakhon Phanom, respectively. In addition to the high morbidity and mortality, the substantial economic burden of melioidosis further supports the need for investments to identify improved prevention and control strategies for melioidosis.

In the light of increased burden from noncommunicable diseases (NCDs) worldwide, the availability of guidelines on effective and cost-effective prevention and control interventions for NCD, and the political commitment to address NCD epidemics, there is a need for mobilizing adequate funding for health promotion which addresses primary and secondary prevention of these NCD. This article reviews the progress in financing health care in general and health promotion in particular and provides a global review of innovative financing for health promotion in selected countries having such a specific dedicated tax and/or innovative governance mechanisms to manage health promotion expenditure. The article also draws on lessons from an in-depth case study of Thai Health Promotion Foundation which contributes to sustainable financing in supporting multisectoral and multidisciplinary actions on health promotion. Assessment of financing health care indicates that countries in Africa and Southeast Asia Regions, facing fiscal constraints and lack of political will to spend on health of their people, spent merely US$109 and US$71 per capita, respectively, in 2013. This level is well below the indicative benchmark of US$86 (in 2012 term) to achieve health of the population. Only one-third of total 194 WHO Member States countries produce complete data on health promotion expenditure. In 2012, the current financing level of health promotion was low, the global average of 3.9% of Total Health Expenditure or at US$61 per capita spending on health promotion in 2012. There is no increasing trend in health promotion expenditure between 1995 and 2012. In 2012, expenditure on health promotion was merely US$10.3 and US$7.2 per capita in Africa and Southeast Asia Region. This level cannot make significant contribution to health promotion in the context of increased diseases burden from NCD. Innovative funding sources from dedicated tax such as from products, which are harmful to health, such as tobacco, alcohol, energy-dense processed foods, or earmarks from other sources such as insurance fund, though provide additional new resources for health promotion, require effective governance mechanisms for resource allocation with participation by other non-health sector and civil society organizations. Even there is limited political will to support innovative financing health promotion from dedicated tax such as sin tax, countries may apply innovate governance mechanisms to manage effectively the annual budget allocation to health promotion often by the Ministries of Health. Lessons can be drawn from several countries introducing innovative financing for health promotion and innovative governance mechanisms in maximizing health gains from limited resources.

We estimate the distributional incidence of health care financing in 13 Asian territories that account for 55% of the Asian population. In all territories, higher-income households contribute more to the financing of health care. The better-off contribute more as a proportion of ability to pay in most low- and lower-middle-income territories. Health care financing is slightly regressive in three high-income economies with universal social insurance. Direct taxation is the most progressive source of finance and is most so in poorer economies. In universal systems, social insurance is proportional to regressive. In high-income economies, the out-of-pocket (OOP) payments are proportional or regressive while in low-income economies the better-off spend relatively more OOP. But in most low-/middle-income countries, the better-off not only pay more, they also get more health care.

The article compares the incidence of public healthcare across 11 Asian countries and provinces, testing the dominance of healthcare concentration curves against an equal distribution and Lorenz curves and across countries. The analysis reveals that the distribution of public healthcare is prorich in most developing countries. That distribution is avoidable, but a propoor incidence is easier to realize at higher national incomes. The experiences of Malaysia, Sri Lanka, and Thailand suggest that increasing the incidence of propoor healthcare requires limiting the use of user fees, or protecting the poor effectively from them, and building a wide network of health facilities. Economic growth may not only relax the government budget constraint on propoor policies but also increase propoor incidence indirectly by raising richer individuals' demand for private sector alternatives.

Objectives: There is an increasing policy concern over the growing trend of burden of diseases from non-communicable diseases (NCD) around the globe. In response to a call for increase investment in and explore potential role of innovative financing mechanism for health promotion and disease prevention, this multi-country study in South-East Asia Region reviews trend of burden of disease (BOD), expenditure on health promotion, innovative financing experiences, and views of policy stakeholders on innovative financing through a self-administrative questionnaire survey. Methods: Literature review on burden of disease (BOD), financing health care in general and financing health promotion in particular, and expereinces in innovative health care finance, in five selected countreis (India, Indonesia, Nepal, Sri Lanka, and Thailand). A self administered questionnaire survey on policy maker's and key stakeholder's views on health care financing, innovative financing for health promotion were conducted in five selected countries. In-depth interviews with key stakeholders were carried out in some countries. Results: The profile of burden of disease (BOD) indicates advanced stage of epidemiological transition in Sri Lanka, Thailand, and Indonesia towards NCD, whereas Nepal and India are facing dual burden from infectious disease and NCD. National Health Account (NHA) is not well established and maintained in South East Asia Region to reflect level and profile of health expenditure. Limited data indicate very small amount spent on health promotion, mostly on conventional clinical based preventive and health promotion services, rather than social mobilization and reduction of primary risk factors, notably tobacco and alcohol consumption, fatty diets, and sedentary life styles. It is questionable whether the current level and effectiveness of public spending on health promotion can effectively halt the trend of BOD from NCD. Among five selected countries, only Nepal and Thailand have innovative financing from sin tax and from tobacco and alcohol earmarked tax to health. Nepal Health Tax Fund is orientated toward treatment of cancers, while Thai Health Promotion Foundation focuses more on social mobilization and strong campaign against tobacco and alcohol consumption, and healthy lifestyles. Results from the questionnaire survey of policy makers and key stakeholders indicate serious under-funding for health and especially health promotion. In view of current burden from chronic NCD, the government should spend more than double or triple of the current spending level on health promotion. A consensus view emerged in favour of the potential role of earmarked tax from alcohol and tobacco, as most desirable and most feasible sources, across four countries lay a foundation for innovative financing health promotion in these countries. Conclusions: Current level and effectiveness of spending on health promotion in these countries are far from the reality to halt the trend of chronic NCD. Innovative financing for health promotion is one of several policy choices to mobilize additional resources. Policy maker's views consistently confirm the under funding of health and health promotion which requires a significant increase in the current level of spending. A consensus view from policy makers and key stakeholders emerges that earmark tax from alcohol and tobacco is highly desirable and feasible source for health promotion. Policy recommendations: In view of resource constraints, it is recommended to increase value for money of the current health promotion program by addressing primary reduction of risk factors. Mobilize more resources from hazardous products such as tobacco and alcohol is recommended. This movement towards additional resource and efficient spending requires strong political leadership and commitments by countries in this region.

Background In the light of the universal healthcare coverage that was achieved in Thailand in 2002, policy makers have raised concerns about whether there is still unmet need within the population. Our objectives were to assess the annual prevalence, characteristics and reasons for unmet healthcare need in the Thai population in 2010 and to compare our findings with relevant international literature. Methods A standard set of OECD unmet need questionnaires was used in a nationally-representative household survey conducted in 2010 by the National Statistical Office. The prevalence of unmet need among respondents with various socio-economic characteristics was estimated to determine an inequity in the unmet need and the reasons behind it. Results The annual prevalence of unmet need for outpatient and inpatient services in 2010 was 1.4% and 0.4%, respectively. Despite this low prevalence, there are inequities with relatively higher proportion of the unmet need among Universal Coverage Scheme members, and the poor and rural populations. There was less unmet need due to cost than there was due to geographical barriers. The prevalence of unmet need due to cost and geographical barriers among the richest and poorest quintiles were comparable to those of selected OECD countries. The geographical extension of healthcare infrastructure and of the distribution of health workers is a major contributing factor to the low prevalence of unmet need. Conclusions The low prevalence of unmet need for both outpatient and inpatient services is a result of the availability of well-functioning health services at the most peripheral level, and of the comprehensive benefit package offered free of charge by all health insurance schemes. This assessment prompts a need for regular monitoring of unmet need in nationally-representative household surveys.

Background Thailand has achieved universal health coverage since 2002 through the implementation of the Universal Coverage Scheme (UCS) for 47 million of the population who were neither private sector employees nor government employees. A well performing UCS should achieve health equity goals in terms of health service use and distribution of government subsidy on health. With these goals in mind, this paper assesses the magnitude and trend of government health budget benefiting the poor as compared to the rich UCS members. Method Benefit incidence analysis was conducted using the nationally representative household surveys, Health and Welfare Surveys, between 2003 and 2009. UCS members are grouped into five different socio-economic status using asset indexes and wealth quintiles. Findings The total government subsidy, net of direct household payment, for combined outpatient (OP) and inpatient (IP) services to public hospitals and health facilities provided to UCS members, had increased from 30 billion Baht (US$ 1 billion) in 2003 to 40-46 billion Baht in 2004-2009. In 2003 for 23% and 12% of the UCS members who belonged to the poorest and richest quintiles of the whole-country populations respectively, the share of public subsidies for OP service was 28% and 7% for the poorest and the richest quintiles, whereby for IP services the share was 27% and 6% for the poorest and richest quintiles respectively. This reflects a pro-poor outcome of public subsidies to healthcare. The OP and IP public subsidies remained consistently pro-poor in subsequent years. The pro-poor benefit incidence is determined by higher utilization by the poorest than the richest quintiles, especially at health centres and district hospitals. Thus the probability and the amount of household direct health payment for public facilities by the poorest UCS members were less than their richest counterparts. Conclusions Higher utilization and better financial risk protection benefiting the poor UCS members are the results of extensive geographical coverage of health service infrastructure especially at district level, adequate finance and functioning primary healthcare, comprehensive benefit package and zero copayment at points of services.