1. From principle to practice: Experience from Thailand in Amending the social security law:
Training Seminar on Social Security
Standards, Policy and Implementation
Luang Prabang, Lao PDR
28 August 2013
Dr. Thaworn Sakunphanit
Boonyawee Aueasiriwon

2. Thai Social Security Act (SSA)
Situation in 1990 (Enact of the SSA)
Expansion to Universal Health Coverage
Forecast of Financial Status of the Social Security Scheme

3. Development of Thai Social Security Act
Did not
implement
Amend
SSA
1954
SSA
1990
SSA
1994
SSA
1999
40 Years
Merge?
Amend
Workmen’s
Compensation
Announcement
1972
Workmen’s
Compensation
Announcement
Act 1994

4. Summary of SSS implementation
coverage
benefit
mandatory
voluntary
2010 -
Informal sector
Sickness (cash benefit only), invalidity, death, OAP
2004
Unemployment
2002
1 employee
1996
OAP, child allowance
1994
Self employed
Maternity, invalidity, death
(had been revoked in 2010)
1993
10 employees
1991
20 employees
Sickness, maternity, invalidity, death

5. Situation in 1990

6. Centralized (Public) health care coverage
Low-income Country
Low-income Country
Decade of hosp
Decade of health centre
Low-income Country
Low-income Country
1000 (1986) -> 1300 (2005) Dr. 10,000 (1986) -> 20,000 (2005) 1: > 1: 800 Nurese 50% 1: :4000
Source: Patcharanarumol W et al (2011). Why and how did Thailand achieve good health at low cost?10

7. Step by Step Approach Health - A few trained health policy analysts
Card
Health
Care
Facilities
- No computers
- Simple report, no coders
- A few trained health policy analysts
- Short course training on Health Economics for director of community hospitals
-Two Cost accounting Studies
Exiting Schemes

8. Challenge of Implementation
Social Security Act was enacted in 1990
Implementation of 4 short term benefits (Sickness, Maternity, Invalidity and Death benefits) had to started in 1991
Regarding Social Health Insurance
Established responsible unit in the Social Security Office (SSO)
Registration/ Contribution collection
Benefit package / Service provision
Payment mechanism
Information system

9. Overcome Challenges: Registration/ Contribution collection
Lack of trained staff, equipment, office building and operating procedures
tremendous increasing of workload
SSO decided to implement centralized registration system using its own ID number. Since the Citizen ID was not completed at that time

10. Overcome Challenges: Benefit package / Service provision
Using “Exclusive” List approach for Benefit package
Working with the ILO and Ministry of Public Health on actuarial issue
Using existed public and private health care facilities
Cabinet Order
Force every public health care facilities providing services for member of SHI
Lead to amendment for more flexible financial procedure in public health facilities include compensation to staffs
Competition among Public and Private Providers

11. Overcome Challenges: Payment mechanism
Debate between payment mechanisms
Fee for services, which is used under Civil Servant Medical Benefits Scheme and Workmen Compensation Fund
Moral hazard: High risk to SSO->workload to adjudication and utilization review
Capitation
High risk to provider-> decrease quality
Case Based (DRG)
Data was in paper-based discharge summary

12. Overcome Challenges: Information System
Ministry of Public Health (MOPH) officially announced to use ICD10 (2nd country in the world)
SSO decided to asking computerized report from contracted health care providers
Every contracted providers got a PC computer
A stand alone computer application for contracted providers was developed
Nation wide training for using the application with the new standard coding system by SSO and MOPH

13. Expansion to Universal Health Coverage

14. Hurdles Social Security Act has potential to expand for UHC Hurdles
Mission for UHC is not clear
Vision and leadership of Secretary General
Flexibility of orgnisation to new demand of member and new initiative e.g. new payment mechanism
Composition of Triparty Committee, Ownership of the funds
Specific scheme for specific population VS Universal
Representative of new member (self-employed, government officers)
Result: Expansion to other group of population is very slow
Sickness benefit for spouse in the law was suspend
Voluntary insurance for informal employee was delay

15. Result New Law is enacted Impact to the Social Security Act
National Health Security Act
Only member of SSS has to pay contribution for sickness benefits, the rest enjoy health care benefit using tax
Impact to the Social Security Act
Argument from members why do they have to pay contribution and tax?

16. There Should be The New Amendment of The Social Security Act.

17. Forecast of Financial Status of the Social Security Scheme

18. Projection Health Care Expenditure: From Actuarial Model
Source: Health Care Reform Project (2008)

19. Contribution for Pension From Actuarial Models