Health Insurance System Research Office Health System Research Institute Assessment of Primary medical care in The Universal Coverage Scheme Thaworn Sakunphanit, Director, Health Insurance System Research Office (HISRO) Health Systems Research Institute (HSRI). Ministry of Public Health Ningxia, China 8-9 May 2014

Health Insurance System Research Office Health System Research Institute Design Accessibility –Take up rate Responsiveness of Health Care System –Patient experiences Clinical Output/Outcome 2

Health Insurance System Research Office Health System Research Institute Risk stratification Low Medium High Periodic Screening Modify risk programs Acute care Chronic care and Terminal care Disease Management Case Management Source: Modified from Kongstvedt, Peter R (2001).The Managed Health Care Handbook. Care Program Design: Continuum of Care & Strategic Purchasing

Health Insurance System Research Office Health System Research Institute Take Up Rate of UCS: Equity in utilization 4 Note: CI range from -1 to + 1. Minus 1 (plus 1 ) means in favour of the poor (rich), or the poor (rich) disproportionately use more services than the rich (poor). Concentration Index of OP service by type of health facilities:

Health Insurance System Research Office Health System Research Institute Problem of Take Up Rate Ambulatory ServicesIn-patient Services Percent Acute illness Accident and Injuries Chronic illness Illness Accident Child delivery Others Prevention Legally eligible, but do not claim for benefits No eligibility Don’t answer Source: HISRO (2014) Analysis from Health Welfare Survey 2011 of the NSO Vary among different benefits Still occur in low-income group Legally eligible, and claim for benefits

Health Insurance System Research Office Health System Research Institute Take Up Rate of the UCS: Risk screening in 2011 Source: NHSO

Health Insurance System Research Office Health System Research Institute Take Up Rate of the UCS: Vaccines coverage in 2012 Source: NHSO

Health Insurance System Research Office Health System Research Institute Take Up Rate of the UCS: Vulnerable Group Qualitative study of take up benefits of the UCS in 2 urban areas showed 3 groups of legally eligible elders: Take-up, Temporary non-take-up and Non-take-up. Determinants of take-up decisions comprise cost, time of traveling, quality of care and quality of services Source: Suwanrada (2010) In-depth study on utilization benefits of the Universal Health Coverage Scheme of urban elder

Health Insurance System Research Office Health System Research Institute 9 Responsiveness of Health Care System for Beneficiaries of UCS Client orientationRespect for person Lower in high education groups Higher in private health care facilities Source: HISRO (2012) Study for Development of Responsiveness Tools. Note: Exit survey of 7,500 beneficiaries from 43 facilities (hospitals) using Stratified three-stage sampling techniques Dignity Autonomy Confidentiality Communication Prompt Basic Amenities Choices

Health Insurance System Research Office Health System Research Institute Responsiveness of Health Care System: Why did patient choose this facility? 10 Note: Exit survey of 7,500 beneficiaries from 43 facilities (hospitals) using Stratified three-stage sampling techniques Source: HISRO (2012) Study for Development of Responsiveness Tools.

Health Insurance System Research Office Health System Research Institute Ambulatory Care Sensitive Conditions (ACSC): Preventable Admission Source: HISRO (2010);: Analysis of Inpatient Database of CSMBS, and UCS.

Health Insurance System Research Office Health System Research Institute Community Based National Survey Source: Aekplakorn (2010): Analysis of Health Exam Survey and

Health Insurance System Research Office Health System Research Institute Medical Record Reviewed of UCS: Diabetic Miletus Type II 13 Source: Rangsin et al (2011, 2012 and 2013). Note: Percentage of Controlled cases using Fasting Blood Sugar was a little bit higher than using HbA1c Stratified cluster sampling from 600 facilities out of total 1013 CUPs (hospitals and clinics)

Health Insurance System Research Office Health System Research Institute Challenges Accessibility and quality of Primary medical care in The UCS has continuously improved However, low take up rate of Primary medical care is still challenge issue of the UCS Appropriate measures for different target groups to improve health literacy, self care and people participation More efficient “Chronic Care Model” is also needed for better quality and outcome of health care services. 14

Health Insurance System Research Office Health System Research Institute Challenges (Cont.) Increase role of Local governments in health care e.g. decentralization of Primary Medical Care to Local governments Mitigate and cope with Aging Society –Community-based Long Term Care, which need harmonization of Primary Medical Care and Social care, will affect the design and implementation of Primary Medical Care. Economic growth, which creates more middle income group, will also create more pressure for better hospitality services and choices 15

Health Insurance System Research Office Health System Research Institute Thank You 16