1. Sharing Innovative Experiences on Social Protection Floor: Case Studies From Thailand ITC, Turin, Italy 8-9 July 2010 Worawet Suwanrada Faculty of Economics Chulalongkorn University Thaworn Sakunphanit Health Insurance System Research Office

2. Social Protection in Thailand Source: Modified from Worawan (2008) General Tax State enterprise WCF and SSF PSTWF UCS Universal Tax Financed 500 Baht Pension Scheme

3. Universal Coverage Scheme

4. Current Social Health Protection Schemes Major Schemes Civil Servant Medical Benefit Scheme (CSMBS) Social Security Scheme (SSS) Universal Coverage (UCS) Introduced in1960s1990s2002 Target beneficiaries Govt employees & dependents, retirees Private sector employees: To whom which not covered by CSMBS nor SHI, Pop Coverage7%13%80% FundingGovt budgetPayroll contribution, Tripartite Govt budget Payment to health facilities Fee-for-service for OP, and DRG for IP Capitation (use DRG in risk adjusted part) Capitation + DRG Social health protection schemes have covered all Thai citizen since 2002

5. Step by Step Approach

6. Chronological Events of UC Policy Development Process Source: NHSO (2009)

7. Costing UC Scheme Design Continuous capacity building of Thai researchers – Since 1981: Cost accounting of health facilities – Since 1984: Health Economics & health care financing Working together with International Experts – Since 1992: Actuarial model (ILO) – Others: WHO, World Bank, 3M etc. Learn from previous schemes and model development – Money follow patients/clients Most of works are done by Thai Research Teams

8. Impacts of UC (Not only UCS) Decrease Poverty from Health Care Spending Improve Health Outcome Source: National Health Examination Survey 2003-2004 and 2008-2009 Source: Limwattananon (2010): analysis of Socioeconomic Survey (various years) 1.7% 0.5%

9. Future Health Care Reform? A Never Ending Story National Health Commission Cabinet Net work of technocrats Net work of medias Net work of Civil societies Prime Minister National Heath Security Office Civil Servant Medical Benefit National health assembly Social Security Office Minister of Health Minister of Labour Minister of Finance Parliaments System governance and Harmonisation - “Tax (Contribution)” - Benefits - Administration

10. Universal tax financed 500 Baht Pension

11. Step by Step Approach Means tested scheme for indigent elders – 1993: 200 Baht/month for 2-3 persons/village – 1999: 300 Baht/month Elderly Act 2003 – Elderly council which is chaired by Prime minister – Provide non-contributory old age benefit to indigent elders – 2 nd National elder plan (2002-2021) 2005: from Central Govt. to Local Authorities, esp. Targeting 2006: increase cash benefit to 500 Baht/month, coverage expanded sharply Qualifications: 60 up with inadequate income, be abandoned, no supporters or unable to work Higher priority (from 2000): several unprivileged situations or inhabiting in remote area Qualifications: 60 up with inadequate income, be abandoned, no supporters or unable to work Higher priority (from 2000): several unprivileged situations or inhabiting in remote area

12. 2007 Constitution (Article 53) – Elder, who is older than 60 years old and does not have enough income for daily living, has entitlement to get welfare and other support from state. 2008: National elder assembly called for pension for people in informal sector – After 2006: Empirical research and pension models development – Most of works are done by Thai research scholars. End of 2008: Government policy – Provide “universal” non-contribution old age benefit for last 6 month of fiscal year 2009 ( April – sep 2009) – Abolish Means tested – Prepare registration system 2009: Implement of universal non-contribution old age benefit and amend the Elderly act according to the constitution Step by Step Approach

13. Coverage universal Local Authorities Village Public Welfare Assistance Committee

14. Previous System

15. Current System

16. Current Situation There are 2 bills for income security of informal sector – Amendment of Elderly Act Provide non-contributory benefit to all Thai citizen, who are 60 years old up, and do not get other pension from government Wait for official announce in Royal Gazette – National Saving Fund Bill Provide define contribution pension for to all Thai citizen, who are 60 years old up, and do not get other pension from government Cabinet approved the bill in December 2009 and hope to enact next year, 2011. Government also started to subsidize some part of community saving fund (Community-based Social Welfare Scheme)

17. Universal tax financed 500 Baht Pension as a part of Pension System Government Officer Private Employee The Rest (Informal sector, etc.) Government Pension Fund (contributory DC) Government Pension (tax-financed) Old-Age Benefits (contributory, DB) 500 Baht Pension Scheme National Pension Fund Bill (contributory, DC) Provident Fund (DC)

18. Lesson learnt and Conclusion: Reform Social Movement Accumulation of Knowledge Political Linkage Source: Dr. Prewase Wasi: “Triangle that moves mountain”

19. THANK YOU Open questions