Debriefing Study Visit in Thailand (6-9 Oct 2014) 6/5/2018 Debriefing Study Visit in Thailand (6-9 Oct 2014) Lesson Learnt and Next Step Financially supported by

Outline Overview of a Study Visit Lesson Learned III. Next Step 1. Registration and contribution collection 2. Provider Partnership Contracting Process 3. Member pathway and consumption management 4. Auditing System III. Next Step

Overview of Study visit A delegation learned real experiences from four institutions as follow: Health Benefit Consultants Co., Ltd Social Security Office The Pranangklao Hospital National Social Security Office

Overview of Study visit Health Benefit Consultants Co., Ltd Heath Benefit Consultants Co., Ltd (HBC) is a private company which roles as a third party claim administrator. HBC services claim assessment, product design and provider contractor for private health insurance. HBC has insured more than 2.4 million members and manage in average around 30,000 cases every month.

Overview of Study visit 2. Social Security Office (SSO) SSO is a department under Ministry of Labor which was established in 1990 and is responsible for insuring social protection for formal private workers, the same as NSSF. SSO has two funds which is Workmen Compensation Fund (WCF) and Social Security Fund (SSF). Health Insurance, under SSF, is composed of 4 benefits including sickness, maternity, invalidity and death with 4.5% of a tripartite contribution rate (each 1.5% from employer, employee and government.

Overview of Study visit 3. The Pranangklao Hospital It is the public tertiary hospital and have total catchment population around 1,394,335 persons. The hospital has insured 353,121 members which is CSMBS 21%, SS 18%, UC 57% and alien workers 2%.

Overview of Study visit 4. National Social Security Office (NHSO) NHSO is the autonomous public establishment which was built in 2002 NHSO insures the informal sectors which exclude SSO and CSMBS (civil servant). NHSO covers about 75% of total Thai population

1. Registration and contribution collection Lesson Learned 1. Registration and contribution collection We learned that Thai social security in the first stage of operating scheme, they facing problem as Cambodia now. National Identification Cards are not available for all citizens, then the registration process used family book, birth certificate, name, sex, or biometric as the key to identify.

1. Registration and contribution collection (cont.) Lesson Learned 1. Registration and contribution collection (cont.) The contribution process can be made through the bank reconciliation. Banks deal directly with the scheme. Employers just send the relevant updating documents (worker declaration form…etc) to the scheme via internet only. These experiences can be a lesson for NSSF.

2. Provider Partnership Contracting Process Lesson Learned 2. Provider Partnership Contracting Process We learned from SSO that contracting process can be done both public and private provider. Public health facilities are compulsory contracted (Cabinet decision). This lesson, NSSF should have either sub-degree or joint Prakas in this process. PPM should be in join prakas with MoH. NSSF should adopt its own criteria to select private provider align with MoH policy.

3. Member pathway and consumption management Lesson Learned 3. Member pathway and consumption management We learned from Pranangklao, Provincial Hospital that receptionist counter located in the hospital. It is responsible for: Welcome member Check National ID (13 digits) Check eligible status Check/provide hospital number (historical medical profile number) and identify the medical purpose. After these process of verification, members have access to consume hospital services. NSSF should use this experience to improve the existing process which is implementing by the current hospital agent.

3. Member pathway and consumption management (cont.) Lesson Learned 3. Member pathway and consumption management (cont.) In addition to the service improvement, call center play a significant role to help members. Experience from National Health Security Office (NHSO), call center room equip with advance IT technology. It can satisfy members via quick respond to the member’s questions, record and problem solving…etc. In order to function well NSSF should design call center with well-organized platform to communicate with members and also providers.

Lesson Learned 4. Audit System NHSO use audit bureau to control quality of medical provided and monitor financial management through some selected key performance indicators (KPI). NSSF should take into account in design auditing procedure.

Next Step Based on the lesson learned stated above, NSSF team that attended this study tour will be able to finalize the pending topic below: 1. Draft of institutional arrangement in future of health care Department Service Quality Assurance division Health Facilities Affaire division Health Care Compensation division Plan, Statistic and Financial Analysis division Health Care Prevention and Promotion division

Next Step 2. After validate of institutional arrangement, we will define the TOR of each positions. 3. Develop training curriculum for each position. 4. Finalize working flow process and starting to develop Standard Operation Procedure guideline.

Questions and Discussions