1. 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

2. 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

3. 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

4. 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.

5. 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.

6. 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%.

7. 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

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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

15. 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.

16. Questions and Discussions