When universal coverage was achieved in 2002, two out of three public health insurance schemes in Thailand, Social Health Insurance (SHI) and Universal Coverage (UC), applied a capitation contracting model for paying healthcare providers while the Civil Servants Medical Benefit Scheme applied a fee for service reimbursement model for outpatient care, and conventional Diagnostic Related Group (DRG) with global budget for inpatient services. The very low prevalence of financially catastrophic health expenditure in Thailand reflects the capacities of public health insurance schemes to protect their members against financial risk from medical care costs. This study assessed the SHI and UC schemes in three dimensions: the purchasers’ capacity to manage and enforce contracts, the provider’s responses to such contracts, and the impact on patients in terms of access to and use of health services and financial risk protection.
In addition to capitation and global budget with DRG payment methods, the separate fee schedule and adequate payment for high cost services centrally managed by SSO and NHSO supported the schemes in providing adequate financial risk protection to SHI and UC members. A clear policy direction on equitable access to essential health services from health insurance purchasers, a comprehensive benefit package, and an active purchasing function based on evidence and clinical monitoring capacities were important foundations for successful financial risk protection.
Vongmongkol, V.; Patcharanarumol, W.; Panichkriangkrai, W.; Pachanee, K.; Prakongsai, P.; Tangcharoensathien, V.; Hanson, K.; Mills, A. Effectiveness of public health insurance schemes on financial risk protection in Thailand: the assessments of purchasers’ capacities, contractors’ responses and impact on patients. (2011) 38 pp.