Financial Protection Trends in Thailand
Session 8: Expanding financial risk protection:
regional progress, challenges and opportunities
New Delhi, 30th March - 1st April 2016
By Chakrarat Pittayawonganon, MD, MPH
Bureau of Policy and Strategy, Ministry of Public Health, Thailand
These slides are prepared in March 2016 by Dr. Viroj Tangcharoensathien International Health Policy Program, MOPH, Thailand
The SEAR Universal Health Coverage (UHC) Meeting Health, the SDGs and the role of UHC: next steps in South East Asia
‘Reaching those who are left behind’
1
2
• Population 67.7 million
• GNI per capita US$ 5,410 (UMIC)
• Health status
• Life expectancy 77 (F)/ 71(M)
• U5MR 12.6/1,000 LB
• MMR 26/100,000 LB
• Skilled birth attendance 99.6% (2012)
• UHC achieved by 2002 with comprehensive
package, almost zero co-payment
• Health Expenditure
• THE 4.6 % GDP, US$ 264 per capita
• Public source
• 56% THE, 3.3% GDP (2001) prior UHC
• 80% THE, 4.6% GDP (2014) post UHC
• GGHE, 17 % of GGE
• Out of pocket 11.3% of THE
Thailand at a glance, 2014
Source: World Development Indicators, World Bank
Impact of National Health Insurance Scheme (30 Baht)
Protect families to bankrupt
Decrease Household
expenditure
0%
50%
100%
1 2Before 30 Baht scheme Present
35%
Proportion of average family expenditure costs for health, Thailand
65%
78% GOV
Self 22%
Cost for health ≈4.6% of GDP Public sector ≈ 78% (17% of government fiscal budget)
In 2014 (GDP per capita) 5,500 USD/person/year
Thai Health System Financial Protection
3
4 UC budget include all budget eg. Contingency fund, ARV, RRT, 2ry prevention DM, HT
TRT TRT TRT TRT TRTSurayu
dSurayu
dSamak
Democrat
Democrat
Yingluk Yingluk Yingluk
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Budget/Cap 1,269. 1,267. 1,308. 1,396. 1,717. 1,983. 2,194. 2,297. 2,497. 2,693. 2,909. 2,916. 3,157.
0
500
1,000
1,500
2,000
2,500
3,000
3,500
Continued political commitment to UCS: Budget, Baht per capita, by Regime 2002-2014
Baht per capita
5
Low income
Lower middle income
Upper middle income
High income: OECD
High income: nonOECD
Thailand
0
20
40
60
80
100
120
140
160
180
200
U5
MR
per
1,0
00 li
veb
irth
s
1990 1995 2000 2005 2010 2015
Under-five mortality, Thailand and other countries by income groups
U5MR trend 1990-2015
6
Low income
Lower middle income
Upper middle income
High income: OECD
High income: nonOECD
Thailand
0
10
20
30
40
50
60
OO
P-H
E a
s %
of T
HE
1995 2000 2005 2010
Out-of-pocket health expenditure, Thailand and other countries by income groups
OOP as %THE, trend 1995-2013
UCS
7
Incidence of medical impoverishment UCS versus counterfactual 2000 onwards
Source: analysis from Socio-Economic Survey conducted by National Statistical Office, Supon Limwattananon
280.6
290.4
277.4274.0
261.3
249.7243.8
226.0
213.3
191.6
172.7
204.8
190.8
182.3
170.3
158.7
150.2
134.1
120.6
101.7
83.8
If without UC policy
After UC policy
Before UC policy
0
50
100
150
200
250
300
350
Num
ber
of h
ealth
-impo
veris
hed
hous
ehol
ds (
x 1,
000)
1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
Note: Dot -Observed; Line -Predicted by Prais-Winsten interrupted time-series analysis of SES
Poverty impact to households due to health payments
8
Incidence of catastrophic health spending >10% of household expenditure, before and after UCS in 2002
Health Research Policy and Systems 2013;11:25
9
Increased utilization with low unmet healthcare needs
Annual prevalence of unmet healthcare need was very low, on par with OECD countries; Outpatient 1.4%, Inpatient 0.4%
Source: BMC Public Health 2012; 12: 923
Source: Health Research Policy and Systems 2013;11:25
Unmet need for outpatient services due to cost and geographical barrier
10 Source: Thammatacharee et al. BMC Public Health 2012, 12:923, http://www.biomedcentral.com/1471-2458/12/923
Conclusion and Challenges
• UCs can reduce the OOP expenditure and protect
local Thai families to impoverishment
• Comparing the unmet health need between the
poorest and richest of Thailand with OECD counties,
Thailand has less inequality than OECD counties
• The key challenge is to reduce disparities in access to
health services among different target groups to
achieve equity goal
11
References
• Thammatacharee et al. BMC Public Health 2012, 12:923 http://www.biomedcentral.com/1471-2458/12/923
• Supon Limwattananon, Viroj Tangcharoensathienb & Phusit Prakongsaib, “Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand”, Bulletin of the World Health Organization, August 2007, 85 (8)
12
Top Related