Reaching the Poor: The Case of Universal Coverage in Thailand Chutima Suraratdecha Somying Saithanu Viroj Tangcharoensathien International Health Policy Program, Thailand Reaching the Poor Conference, Feb 2004, Washington DC

2 Program characteristics  Universal Coverage Policy UC, Gold card, 30 Baht Policy, 30 Baht treat all  April 2001, pilot project in 6 provinces  April 2002, national coverage

CharacteristicsMWSCSMBSSSSWCFHealth Card Scheme Nature of the scheme Social welfareFringe benefitCompulsory Voluntary ModelPublic integrated model Public reimbursement model Public contracted model Public reimbursement model Public integrated model Population covered The poor, elderly, children under 12 years old, secondary school student, the disabled, monks and veterans Government employees, pensioners and their dependents (parents, spouse, children) Private formal sector employees, >10 worker establishments Private formal sector employee, >10 worker establishments Non-poor households not eligible for medical welfare scheme, community leader and health volunteer’s families Source of fundsGeneral tax Tripartite 1.5% of payroll each (reduce to 1% since 1999) Employer, 0.2-2% of payroll with experience rating Household 500 Baht + tax 1000 Baht Financing bodyMinistry of Public Health Ministry of Finance SSO Ministry of Public Health Payment mechanism Capitation plus global budget Fee for serviceCapitationFee for serviceProportional reimbursement among primary, secondary, tertiary care Types of benefits Comprehensive package Non-work related illnesses, injuries Work related illness, injuries Comprehensive package

CharacteristicsUCSSS & WCFCSMBS Nature of the schemeSocial welfare ModelPublic contracted model Population covered*People not covered by SSS and CSMBS (45.7 million) Ambulatory servicesRegistered public & private Inpatient servicesRegistered public & private Choice of providerRegistration required Cash benefitNo Types of benefitsComprehensive package Conditions excluded12 conditions Maternity benefitYes Annual physicalsYes Prevention and promotion Yes Services not coveredPrivate bed, special nurses Source of fundsGeneral tax Financing bodyMinistry of Public Health Payment mechanismInclusive capitation or capitation for OP and DRG for IP Co-payment30 Baht per visit

5 Research questions  How effective is the UC implementation? Coverage? Indicators across insurance schemes? Impact on providers?

6 Methodology  Six-month sample of households interviewed by the 2002 SES  Random sample of 515 households (1834 individuals) in Tak, Sakolnakorn and Narathiwat representing 3 regions, low income and high HIV prevalence provinces

7 Respondents profile (1834 individuals)

8 Performance: coverage

9  164 respondents (8.9%) had no health insurance

10 Performance: coverage

11 Performance: across insurance schemes

12 Performance: across insurance schemes

13 Performance: Illness and health care seeking behavior ML probit estimation with selection

14 Performance: Illness and health care seeking behavior ML probit estimation with selection

15 Performance: impact on providers  857 health staff from 216 UC facilities Inadequate supply Inadequate financial resources Lack of understanding on benefits and coverage

16 Policy implications  Universal coverage  Targeting issue - UCE vs. UCP  Quality of care, long waiting time, poor attitude of health provider  Out-of-pocket expenditure  Inequality across health insurance schemes and economic classes