1. International Health Policy Program -Thailand Kanjana Tisayaticom Shaheda Viriyathorn Vuthiphan Wongmongkol Chitpranee Vasavid Walaiporn Patcharanarumol Supon Limwattananon Viroj Tangcharoensathien, et al International Health Policy Program Sukosol Hotel, Bangkok March 12, 2013 Thai National Health accounts by age group, health insurance scheme, and disease categories

2. International Health Policy Program -Thailand 2 Outlines of presentation Introduction Objectives Methodology Data sources Results Conclusion

3. International Health Policy Program -Thailand 3 Objectives To develop the diversification of 2007NHA to reflect health expenditure by: Age group, Gender, Health insurance coverage, Disease category. Application of disease category to NHA data from 2008-2010

4. International Health Policy Program -Thailand 4 Conceptual framework and process of analysis OP and IP individual dataset: ICD 10, total costs or charges of services e.g. doctor fee, medicine, lab, room etc. Group by ICD 10 A1: Tuberculosis A2a: Syphilis.. U: Injury Charges by disease categories Proportion of charge by disease categories NHA: total OP and IP expenditure Two major prerequisites NHA: IP and OP expenditure by disease categories STEP 1: To calculate proportion of charges STEP 2: To break down NHA

5. International Health Policy Program -Thailand 5 Data sources NHA data – Public registration records – Secondary data from the national surveys Household and Enterprise surveys, (NSO) – Primary surveys State Enterprises Public Independent Organizations IP database IP database from Center of Health Information (CHI)

6. International Health Policy Program -Thailand Number of UC Admission 6

7. International Health Policy Program -Thailand Disease Categories 7 dxDiagnosis by ICD10ICD10 Code 1 HIV/AIDS B20-B24 2 Injury code (S or T code in ICD10) without external cause S and T code 3 Cerebravascular diseaseI60-I69 4 Diabetes mellitusE10-E14 5 Liver cancerC22 6 Alcohol use/dependenceF10 7 Major depressionF32-F34 8 Ischaemic heart diseaseI20-I25 9 Chronic obstructive pulmonary diseaseJ40-J44 10 DeafnessH90-H91 11 OsteoarthritisM15-M19 12 Cirrhosis of the liverK70,K74 13 Lower respiratory tract infectionsJ10-J22 14 AsthmaJ45-J46 15 Bronchus & Lung cancerC33-C34 16 Anxiety disorderF40-F42 17 Self-inflicted injuries (Suicide)X60-X84,Y87 0, Y87 1 18 TuberculosisA15-A19,B90 19 Nephritis and nephrosisN00-N19 20 Homicide and violenceX85-Y09 88 All other

8. International Health Policy Program -Thailand 8 Results of NHA diversification

9. International Health Policy Program -Thailand 9 Percentage of estimated public curative expenditure for in-patient services by age group, gender and health insurance scheme, 2007

10. International Health Policy Program -Thailand 10 The estimated public curative expenditure for IP services by age group, gender and health insurance scheme, 2007 (Million Baht)

11. International Health Policy Program -Thailand 11 Percentage of estimated public curative expenditure for IP services by disease category and health insurance scheme, 2007

12. International Health Policy Program -Thailand 12 The estimated public curative expenditure for IP services by disease category and health insurance scheme, 2007 (Million Baht)

13. International Health Policy Program -Thailand 13 Services Charge by Age groups 200820092010 Infants3,274,939,4893,495,307,4593,825,822,992 Pre-school 1-42,354,127,0512,380,109,5612,895,306,277 School age 5-142,591,423,1533,003,185,3403,016,465,488 Reproductive age 15-4414,097,866,84715,339,417,26916,489,499,653 Adult 45-6414,019,798,39315,991,961,79417,773,404,994 Adult 65-747,514,502,1548,270,077,4769,206,530,987 Elderly 75-844,527,330,1135,141,993,4685,926,145,520 Oldest 85+1,165,137,9221,253,824,7791,486,445,729 All persons49,545,125,12254,875,877,14660,619,621,640

14. International Health Policy Program -Thailand Proportion by age groups 14 200820092010 Infants6.61%6.37%6.31% Pre-school 1-44.75%4.34%4.78% School age 5-145.23%5.47%4.98% Reproductive age 15-4428.45%27.95%27.20% Adult 45-6428.30%29.14%29.32% Adult 65-7415.17%15.07%15.19% Elderly 75-849.14%9.37%9.78% Oldest 85+2.35%2.28%2.45% All persons100.00%

15. International Health Policy Program -Thailand IP NHA 2008-2010 by age groups 15 Age Group 200820092010 Infants 2,493 2,171 1,998 Pre-school 1-4 1,792 1,478 1,512 School age 5-14 1,973 1,866 1,575 Reproductive age 15- 44 10,732 9,529 8,609 Adult 45-64 10,673 9,934 9,280 Adult 65-74 5,720 5,137 4,807 Elderly 75-84 3,446 3,194 3,094 Oldest 85+ 887 779 776 All persons 37,716 34,088 31,650

16. International Health Policy Program -Thailand Services Charge by Disease 16 200820092010 HIV/AIDS 535,609,352 584,380,622 639,162,735 Injury code (S or T code in ICD10) without external cause 5,594,794,958 6,296,467,248 6,196,716,468 Cerebravascular disease 1,685,248,944 1,911,158,136 2,154,149,193 Diabetes mellitus 705,100,536 709,989,905 748,517,257 Liver cancer 344,916,590 504,976,976 465,557,279 Alcohol use/dependence 116,745,540 126,604,087 149,046,750 Major depression 17,762,584 22,267,121 26,242,022 Ischaemic heart disease 2,094,643,872 2,496,514,499 2,460,727,940 Chronic obstructive pulmonary disease 943,667,870 986,713,391 1,103,776,634 Deafness 7,898,985 3,147,066 4,305,544 Osteoarthritis 471,802,693 451,125,245 558,750,460 Cirrhosis of the liver 163,630,497 162,214,401 204,477,948 Lower respiratory tract infections 2,510,195,383 2,764,184,535 3,516,172,845 Asthma 316,757,742 313,383,849 345,854,234 Bronchus & Lung cancer 292,358,089 339,119,580 369,718,215 Anxiety disorder 16,631,690 16,180,763 15,213,677 Self-inflicted injuries (Suicide) 19,278,077 9,696,797 157,287,211 Tuberculosis 470,531,821 574,276,096 649,325,066 Nephritis and nephrosis 1,157,533,200 1,347,071,528 1,638,439,999 Homicide and violence 60,715,596 22,527,109 579,735,972 All others 32,019,301,103 35,233,878,192 38,636,444,191 Grand total 49,545,125,122 54,875,877,146 60,619,621,640

17. International Health Policy Program -Thailand IP NHA 2008-2010 by Disease 17 200820092010 HIV/AIDS 407.73 363.01 333.72 Injury code (S or T code in ICD10) without external cause 4,259.03 3,911.30 3,235.39 Cerebravascular disease 1,282.89 1,187.19 1,124.71 Diabetes mellitus 536.76 441.04 390.81 Liver cancer 262.57 313.69 243.07 Alcohol use/dependence 88.87 78.65 77.82 Major depression 13.52 13.83 13.70 Ischaemic heart disease 1,594.54 1,550.81 1,284.78 Chronic obstructive pulmonary disease 718.37 612.94 576.30 Deafness 6.01 1.95 2.25 Osteoarthritis 359.16 280.23 291.73 Cirrhosis of the liver 124.56 100.77 106.76 Lower respiratory tract infections 1,910.88 1,717.08 1,835.84 Asthma 241.13 194.67 180.57 Bronchus & Lung cancer 222.56 210.66 193.03 Anxiety disorder 12.66 10.05 7.94 Self-inflicted injuries (Suicide) 14.68 6.02 82.12 Tuberculosis 358.19 356.73 339.02 Nephritis and nephrosis 881.17 836.79 855.45 Homicide and violence 46.22 13.99 302.69 All others 24,374.63 21,886.90 20,172.59 Grand total 37,716.13 34,088.29 31,650.29

18. International Health Policy Program -Thailand 18 Conclusions The study of NHA diversification (2007) shows that: – the UC members benefited 67%, – the CSMBS and the SSS consumed 22% and 11% of the total public spending on IP services. The female reproductive age of UC and the working age employees of the SSS are the major beneficiary of their scheme while the adult age 45-64 and the elderly of the CSMBS are the main beneficiaries.

19. International Health Policy Program -Thailand 19 Limitations and lesson learned Expenditure by disease category is possible given: – Well established NHA by healthcare function (spending on OP and IP) – Availability and continued update of national clinical data covering ICD10 including charge or expenditure data for OP and IP – Institutional capacity to apply national clinical dataset for the estimate expenditure by disease categories

20. International Health Policy Program -Thailand 20 Acknowledgements Health Systems Research Institute (HSRI) Thailand Research Fund (TRF) Bureau of Policy and Strategy, Ministry of Public Health, WHO-Thailand The Central of Health Information (CHI) Partners for 1994-2008 NHA for their hard work and commitment: – College of Public Health, Chulalongkorn University – National Statistical Office – National Economic and Social Development Board – Ministry of Public Health, Thailand – Ministry of Finance of Thailand (MOF) – The National Health Security Office (NHSO) – The Social Security Office (SSO)

21. International Health Policy Program -Thailand Sawasdee Thank you for your attention 21