1. Measuring achievement of the universal health coverage in Thailand
Viroj Tangcharoensathien 1
Supon Limwattananon 1, 2
Walaiporn Patcharanarumol 1
Jadej Thammathat-aree 3
1 International Health Policy Program, Ministry of Public Health, Thailand
2 Khon Kaen University, Thailand
3 National Health Security Office, Thailand
17-18 September 2013
Measurement and Monitoring UHC Technical Meeting
Singapore

2. UHC as the population covered by health insurance
% Population covered by various schemes and the uninsured, 1991 – 2009
Low-
Income
Health
Card
Universal
Coverage
Civil
Servant
Social
Security
UHC achievement
Source: Health and Welfare Surveys (various years)

3. Some results on UHC measurement
So, what we have achieved in Thailand, so far!

4. 1.1 Health financing Financing sources and household health spending
Reduced share by out-of-pocket payment
Reduced incidence of catastrophic exp.
Source: IHPP’s National Health Account
Source: NSO’s Socio-Economic Surveys, various years

5. 1.2 Health infrastructure and workforce Number of hospitals and doctor- and nurse- densities
1. Geographic expansion of district hospitals geographic disparity in workforces
District hospitals
Provincial hospitals
Private hospitals
Source: MOPH’s Health Resource Surveys, various years
Per 100,000 pop
1-10
11-20
21-30
31-40
41+
1-100
251+
Doctors Nurses/Midwives

6. 2.1 Access and utilization Increased OP visits and IP admissions
Source: NHSO’s OP-IP databases
NHSO’s UCS membership data

7. 1. Disproportionately more services used by the poor
Poorest
Richest
Source: NSO’s Health and Welfare Surveys, various years

8. 2. Less likely to pay and lower paid amount by the poor patients
Richest
Hospitalization
Poorest
Richest
Ambulatory care
Poorest
Source: NSO’s HWS

9. The pro-poor government subsidy in total
(Universal Coverage Scheme)
Poorest
Richest
Previous evidence revealed after the UHC, the government spending on health was in favor of the poor.
Source: NSO’s HWS

10. Linkage between inputs/outputs and outcomes
3.1 Service coverage Reproductive health and child health services
Source: IPSR; MOPH; various surveys
Source: IPSR; MOPH; various surveys
Source: IPSR; MOPH; various surveys
Source: IPSR; MOPH; various surveys
Linkage between inputs/outputs and outcomes
A close-link between outcomes and impact
Source: MOPH reports
BCG
DTP3
OPV3
TT2
MCV
HB3
Source: IHME estimates
Neonatal
Post-neonatal
Under-five

11. 3.2 Financial risk protection Reduced health impoverishment across provinces
Post-UCS Pre-UCS
Impoverished per 1,000 HH:
Source: NSO’s SES

12. 4.1 Improved health Reduced case fatality and all-cause mortality in UCS patients
Source: NHSO’s UCS IP data

13. Measuring overall survival is possible through linkage with Civil Vital Registry
Source: NHSO’s IP data; Civil Registry

14. 4.2 Increased satisfaction by population and providers % persons reported with satisfaction
1. The categorical scale % Survey respondents reporting satisfaction to UCS
Source: ABAC Poll, various years

15. 3. Challenges and lessons learned

16. Beyond the country average Monitoring area variations and provider performance
As Thailand is now in the second decade of UHC achievement,
strategic purchasing through tracking area-based health needs
and provider response is becoming a challenging issue.
So, what we have achieved in Thailand, so far!

17. 1. Tracking medicine and health technology inputs Hospitals’ prescriptions for non-essential medicines in open-end payment system
Source: CSMBS’ billing database

18. Variations in hospitalization across catchment areas
1. Acute illnesses and infectious diseases
Source: NHSO’ IP database

19. 2.1 Tracking disease severity inside catchment areas
Diarrhea and pneumonia
Source: NHSO’ IP database

20. Variations in hospitalization across catchment areas
2. Non-communicable chronic diseases
Source: NHSO’ IP database

21. 2.2 Tracking service use outside catchment areas
Diabetes and hypertension
Diabetes
Source: NHSO’ IP database

22. 3. Tracking hospital performance with ultimate health outcomes Hospital standardized mortality ratio (HSMR) in close-end payment system
Source: NHSO’ IP database

23. UHC-measured dimensions and required data sources
1. Inputs
2. Outputs
3. Outcomes
4. Impact
1.1 Financing
- NSO’s Socio-Economic Survey (SES, 2012 latest)
- IHPP’s National Health Account
1.2 Infrastructure/wkforce
- MOPH’s Health Resource Survey
1.3 Medicines/technology
- CSMBS’ prescription billing database
2.1 Access and utilization
- NSO’s Health and Welfare Survey (HWS, 2013 latest)
- UNICEF’s MICS (2005, 2011)
- MOPH’s adhoc surveys
- Health insurance’s IP admissions, OP visits, P&P databases
3.1 Service coverage
- NSO’s HWS
- Health insurance’s
membership databases
- NHSO’s vertical programs databases: NAP, RRT, Pap-smear, Influenza vaccine
3.2 Financial risk protection
- NSO’s SES
4.1 Improved health
- HSRI’s National Health Examination Survey (NHES, wave , planned 2014)
- MOI’s Civil Vital Registry
4.2 Increased responsiveness
- ABAC Poll (2011, latest)

24. The need for interlink between various data sources
4. Civil vital registry
Unique personal identifier
Demographic
All-cause death
1. Beneficiary registry
(Denominator)
Unique personal identifier
Demographic
Domicile
2. Facility records
(Numerator: IP, OP, PP, Rx, Lab)
Unique personal identifier
Service input/output
Financing/payment
Clinical condition
3. Beneficiary survey
Unique personal identifier
Demographic
Socio-economic
Health risk behavior
Responsiveness
Unclaimed service use/exp. 25