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