1. 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz ILO - Social Security Department Holiday Inn Silom Hotel Bangkok, 11 & 12 June 2007 Modeling Sustainable Health Financing in Thailand

2. 2 The Model: overview Population (sex and single ages) Labour supply (sex and single ages) Economy (wages, prices, employment, etc.) Health expenditure (revenue) outputs NHSOSSOCSMBSIHPP Capitation Base RateNHA

3. 3 Health Expenditure Model Exp Scheme = Pop Scheme * Frequency of contacts Scheme * Costs per contact Scheme e 0 Sch e 1 Sch e 2 Sch... e 100 Sch p 0 Sch p 1 Sch p 2 Sch... p 100 Sch f 0 Sch f 1 Sch f 2 Sch... f 100 Sch c 0 Sch c 1 Sch c 2 Sch... c 100 Sch Costs per contact Scheme = Costs per contact Hospitals ? SUM e SUM p Capitation = SUM e / SUM p

4. 4 Health Expenditure Model: designing the population model with Pop TOT =:PopUC + PopSSO + PopCSMBS + PopOTH Pop UC =:UC covered population(age: 0 to 100) Pop SSO =:SSO covered population(age: 15 to [69]) Pop CSMBS =:CSMBS covered population(age: 15 to [100]) Pop OTH =:Residual (non-CSMBS public (age: 15 to [100]) schemes; residency abroad; others) Pop UC = Pop TOT – Pop SSO – Pop CSMBS – Pop OTH

5. 5 How do population models work? Population Stock (t+1) = Population Stock (t) + Immigration Flow (t+1) – Emigration Flow (t+1) alternative: [Entries Flow (t+1) – Exits Flow (t+1)] + Newborns Flow (t+1) – Deaths Flow (t+1)

6. 6 How do population models work?

7. 7

8. 8 Health Expenditure Model: designing the population model Pop TOT =:Data base MoI Weakness:fertility and mortality data Solution:standard UN parameters (?) Pop OTH =k * Pop TOT k =: Pop OTH / Pop TOT => exog; constant (?) Pop SSO =:Data base SSO Problem:labour market entries & exits; mortality Solution:construction of theoretical rates (?) Pop CSMBS =:Data base CSMBS Problem:dependents (children; spouses; parents) = f (actives) Solution:??? [under investigation] Problems / solutions:

9. 9 How do population models work? Population Stock (t+1) = Population Stock (t) + Immigration Flow (t+1) – Emigration Flow (t+1) alternative: [Entries Flow (t+1) – Exits Flow (t+1)] + Newborns Flow (t+1) – Deaths Flow (t+1)

10. 10 Health Expenditure Model: designing the population model Scheme specific l UC l SSO l CSMBS Frequencies of contacts:

11. 11 Health Expenditure Model: designing the population model Scheme specific l UC[« hospital costs / shadow fees »] l SSO[« hospital costs / shadow fees »] l CSMBS[« hospital fees for service »] Costs per contact:

12. 12 Health Expenditure Model: Hospital Expenditure Structure

13. 13 Hospital labour costs: Per capita wages(by profession (?))=: Cost index Number of staff(by profession (?))=: Volume index Hospital non-labour costs: ForSundries, Pharmaceutical drugs, Medical material (goods), Equipment, Other supplies, Electricity / energy Price Indexes to be developed =>Volume indexes follow Hospital Expenditure Structure: Cost and Volume Indicators

14. 14 Open questions Permanently many.