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International Health Systems: The Western, CMMU MGMG 548, Wk#12 2014.8.3
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International Health Systems: The Asian
Borwornsom Leerapan, MD PhD
MGMG 548: Health Service Systems and Health Systems
CMMU, Mahidol University Aug 3, 2014
Pix source: ra.mahidol.ac.th
Format
Pix source: online.wsj.com
F/U
Mini-lecture
Presentation Discussion
Q&A
Wrapup
To-do list
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Housekeeping Issues
1) [Confirmed] Guest lecturer on Aug 10th (week 13): – Thaworn Sakunphanit. MD, MSc (Social Policy Financing),
Director of Health Insurance System Research Office (HISRO)
2) [Canceled/Postponed] Scheduling a site visit to Ramathibodi Hospital & Somdech Phra Debaratana Medical Center (SDMC) – To settle down on your preferred dates
– To prepare a scope of your interviews with the executives
• How do the advanced Asian countries (e.g. Japan, Taiwan, Singapore) finance and organize health services?
• How such health systems have performed? • What would be the lessons learned for
healthcare managers currently working in Thai healthcare system?
• Discussions/Q&A
Outline for Today
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Reviewing what we have learned: Organizing & Financing Healthcare
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Major Mechanisms of Healthcare Financing
Healthcare Regulator(s)
2) Taxes Payers
4) Employer-based private
health insurance
3) Individual private health
insurance
Hospitals
Medical Specialists
Generalists & PCPs
1) Out-of-pocket
Payments
Ambulatory Facilities
Payment Mechanisms: Salary, Fee-for-Service,
Global Budget, Capitation, etc.
CGD (CSMBS),
NHSO (UCS)
Taxes Payers
Employer-based private health
insurance
Individual & Employer’s
private health insurance
(Voluntary)
Hospitals
Medical Specialists
Generalists & PCPs
Patients paying out-of-pocket
Ambulatory Facilities
Payment Mechanisms: Salary, Fee-for-Service,
Global Budget, Capitation, DRGs, etc.
Thai Healthcare Systems
Providers in Public & Private Sector
Commercial Insurance
Companies
Social Security
Office (SSS)
Motor vehicle’s owners (Mandatory by the Motor
Vehicle Victim Protection Law)
Federal Government
(e.g. Medicare, VA, Indian)
Taxes Payers
Employer-based private
health insurance
Individual private health
insurance
Hospitals
Medical Specialists
Generalists & PCPs
Uninsured Patients paying out-of-pocket
Ambulatory Facilities
Payment Mechanisms: Salary, Fee-for-Service,
Global Budget, Capitation, DRGs, etc.
US Healthcare System
Most Providers in the Private Sector
Commercial Health Plans/
HMOs (private health
insurance companies)
State Government (Medicaid,
CHIP)
German National Health Insurance System
Source: Bodenheimer TS, Grumbach K (2009). Understand health policy: a clinical approach
Employer-based private
health insurance
Most Providers in the Private Sector
British National Health Service System (the traditional model)
Source: Bodenheimer TS, Grumbach K (2009). Understand health policy: a clinical approach
Taxes Payers
Most Providers in the Public Sector
British National Health Service System (the model after recent reforms)
Source: Bodenheimer TS, Grumbach K (2009). Understand health policy: a clinical approach
Most Providers in the Public Sector
Taxes Payers
Comparing Asian Healthcare Systems: Organizing & Financing Healthcare
Pix source: online.wsj.com
Japanese Healthcare System
Source: Bodenheimer TS, Grumbach K (2009). Understand health policy: a clinical approach
Most providers are in the private sector, most small
facilities are private, but large facilities are in the public sector.
Taxes Payers
Negotiated standardized payment rates
(e.g. FFS, per diem)
Corporates
Central govt.
Local govt.
Employers &
Employees
Retirees & (ex-employers) Self-employed, Farmers,
Fishermen, etc.
Japanese Healthcare Systems Ø “Social Health Insurance” with standard comprehensive benefits, including
payment for hospital and physician services, prescription drugs, maternity care, and dental care, disable adults with long term insurance and earmarked income tax.
Healthcare financing mix
Figure source: Wagstaff (2005). World Bank Policy Research Working Paper 3790.
Compulsory Savings Scheme
(Employees &
Employers)
Individual Insurers
Taxes payers
“Corporatized” public hospitals
& Private hospitals
Medical Specialists
Generalists & PCPs
Patients paying out-of-pocket
Ambulatory Facilities
Singaporean Healthcare Systems
Providers in Public & Private Sector
Medical Saving Accounts
(Medisave)
Catastrophic insurance program
(Medishield)
Central Provident Fund(CPF)
Public assistant program
(Medifund)
Severe disability insurance program
(Eldershield)
“3M”, “Means-testing”
Source: Hsiao (1995); Singapore's Ministry of Health (2003)
Ø Govt. subsidies aim to provide all Singaporeans basic health care defined as “good and affordable medical services”, but not provide “the latest and best of everything”
Ø Emphasize on greater transparency about costs and prices, more regulation of insurance company’s prices and policies.
Singaporean Healthcare Systems
Taiwanese Healthcare System
Most Providers in the Public Sector
Taxes Payers
Govt-run, Single fund,
National Health
Insurance
Ø “Consolidated System”: providing everyone equal access to health care, free choice of doctors, with no waiting time, and a system that encouraged a lot of competition among medical providers.
Ø Efficient administrative system: utilization of information technology, including smart cards, online medical information systems, and online billing systems.
Taiwanese Healthcare Systems
Figure source: Wagstaff (2005). World Bank Policy Research Working Paper 3790.
How have health systems performed?
Pix source: online.wsj.com
Health System’s Building Blocks
Pix source: WHO (2007).
Source: WHO (2000). The World Health Report 2000. Pix source: buelahman.files.wordpress.com
Health System’s Performance
Pix source: WHO (2000). World Health Report 2000.
What would be your lessons learned from these comparative health systems?
Pix source: online.wsj.com
What Level of Our Learning?
• Why Wisdom
• How Knowledge
• What, Who, When, Where Information
• Number, Text, Picture, Sound, etc. Data
Four Major Types of Healthcare Systems
Source: Adapted from Roemer (1993).
US Singapore Germany Japan Canada Taiwan UK Cuba
The least !market interventions"
-Private financing "-Private providers "
Socialist !Health Systems"
Entrepreneurial Health Systems"
Comprehensive !Health Systems"
Welfare-oriented !Health Systems"
The most !market interventions"
-Public financing "-Public providers "
Control Knobs Framework for Health Reform
Source: Adapted from Roberts et al. (2003).
Source: Mills A. Health Care Systems in Low- and Middle- Income Countries. N Engl J Med. 2014;370:552-7.
Source: Mills A. Health Care Systems in Low- and Middle- Income Countries. N Engl J Med. 2014;370:552-7.
Financing of Healthcare Systems
Financing of Thai Healthcare System CSMBS SSS UCS Motor Vehicle
Victim Protection Law
Private Health Insurance
Feature State/Employer welfare
Compulsory heath insurance with state subsidies
State welfare Compulsory heath insurance for vehicle owners
Voluntary health insurance
Targeted groups of beneficiaries
Civil servants, state enterprise employees and dependents
Employees in private sector and temporary employees in public sector
Thai citizens without the coverage of CSMBS & SSS
Victims of vehicle accidents
General public
Source of financing
Govt. budget
Tri-party (Employee, employer and govt. budget)
Govt. budget
Vehicle owners Household
Method of payment to health facilities
Fee-for-service Capitation and Fee-for-service
Capitation and Fee-for-service
Fee-for-service Fee-for-service
Major problems Rapidly and constantly rising costs
Covering while being employed only
Inadequate budget
Redundant eligibility and slow disbursement
Redundant eligibility and slow disbursement
Source: Adapted from Wibulpolprasert et al. (2011). Thailand Health Profile 2008-2010.
Source: Mills A. Health Care Systems in Low- and Middle- Income Countries. N Engl J Med. 2014;370:552-7.
Desirable Healthcare Systems
• Systems Thinking • Focus on quality,
efficiency & equity • Responsive (esp. to
health needs of certain disease and certain populations)
• Good governance in all level of health system
Source: Mills A. Health Care Systems in Low- and Middle- Income Countries. N Engl J Med. 2014;370:552-7.
Towards a Better Healthcare System
Source: Mills A. Health Care Systems in Low- and Middle- Income Countries. N Engl J Med. 2014;370:552-7.
Towards a Better Healthcare System
Source: Mills A. Health Care Systems in Low- and Middle- Income Countries. N Engl J Med. 2014;370:552-7.
Towards a Better Healthcare System
Food-for-Thought
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Pix source: en.wikipedia.org/
“The track of the previous cart is the teacher of the following cart.”
--A Chinese proverb
Q& A Discussions
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