1. International Health Policy Program -Thailand IHPP : International Health Policy Program, Thailand 12 March 2013 Thai National Health Accounts: sustainable updates of 2009-2010 Chitpranee Vasavid Somjit Janyapong Taweesri Greetong Shaheda Viriyathorn Tanavij Pannoi Phusit Prakongsai Viroj Tangcharoensathien, et al

2. International Health Policy Program -Thailand 2 Acknowledgements Health Systems Research Institute (HSRI) Thailand Research Fund (TRF) Bureau of Policy and Strategy, Ministry of Public Health WHO, Thailand for financial supports The Central of Health Information (CHI) Partners for 1994-2010 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 – Ministry of Finance – The National Health Security Office – The Social Security Office

3. International Health Policy Program -Thailand 3 Outlines of presentation Introduction Objectives Methodology Data sources Results Conclusions Application of Thai NHA Diversification of Thai NHA

4. International Health Policy Program -Thailand 4 Introduction National Health Account (NHA), What are its potential uses? - NHA is an important tracking tool depicting how a country’s health resources are spent, on what services, and who pays for them

5. International Health Policy Program -Thailand 5 Evolution and institutionalization of NHA in Thailand Phase I - Incubation - the 1994 NHA – Capacity building, the College of Public Health- CU Phase II - Consolidation - 1996,1998 NHA, – Fine tune methodology – Standardization for international comparison Phase III - Institutionalization - 2001 NHA onward – Fine tune methodology and matrix, adaptation of OECD - Systems of Health Account (SHA), 3 dimensional matrix – Major revision of the whole series of 1994-2001 The following phases - Continuation of NHA development and diversifications - 2002-2010 NHA The focal point - The International Health Policy Program (IHPP), MOPH All phases funded by local resources: Health System Research Institute (HSRI) and Ministry of Public Health (MOPH)

6. International Health Policy Program -Thailand 6 Methodology The methodological approach in updating 2009-2010 NHA was based on – OECD Systems of Health Account (SHA) version 1.0 using a 3 dimensional matrix [Financing Agent X Healthcare Function X Providers]. – the International Classification of Health Account (ICHA)

7. International Health Policy Program -Thailand 7 Data sources Public registration records – CGD, MOPH, SSO, MOI, etc,. Secondary data from the national surveys – Household and Enterprise surveys, (NSO) Primary surveys – State Enterprises – Public Independent Organizations

8. International Health Policy Program -Thailand 8 Results of NHA: 1994-2010

9. International Health Policy Program -Thailand 9 Total health expenditure and selected indicators on health spending, 1994 to 2010 (current year prices), Million Baht

10. International Health Policy Program -Thailand 10 Government and Non-government financing source, 1994-2010 UC inception Economic crisis

11. International Health Policy Program -Thailand 11 Total health expenditure by financing source, 1994-2010 UC inception Economic crisis

12. International Health Policy Program -Thailand 12 Health expenditure by function 1994-2010 (current prices)

13. International Health Policy Program -Thailand 13 Conclusions From 1994 to 2010, THE as % of GDP ranged from 3.3% to 4.2% of GDP despite of achieving universal health coverage in 2002  “Good Health at Low Cost” Increasing trend of government spending on health, Decrease in HH out-of-pocket payments for health  protection of HH catastrophic health spending, Still high spending on curative care, rather than health promotion and disease prevention, The Asian Financial Crisis in 1997 and the UHC implementation in 2002 had impacts on the Thai health expenditure structure, The main financing agents in 2010 are: 1) the UHC; 2) the Central government; 3) the household out-of-pocket payments and; 4) the CSMBS.

14. International Health Policy Program -Thailand 14 Limitations and lesson learned Data and information needed for compiling NHA are belong to various organizations, both in public and private sector, – Incomplete, not fit with the NHA matrix, – Not available every year  time lag for two years, Methodology to breakdown data into the NHA tables, Structure of organization in the Thai context – New established organizations based on the Thai Constitution, – Public Independent organizations, Variations in collaboration and commitment of key partners.

15. International Health Policy Program -Thailand 15 THE projection: 2006-2026 Application of Thai NHA

16. International Health Policy Program -Thailand THE projection: 2006-2026 based on 1994-2005 NHA 16

17. International Health Policy Program -Thailand National AIDS Spending Assessment (NASA), 2010-2011 Diversification of Thai NHA 17

18. International Health Policy Program -Thailand What is NASA? NASA is a tool that produces strategic information in the framework of national HIV responses, It measures and tracks the use of financial resources for HIV, NASA methodology focuses on expenditure and consumption, NASA analyses the activities implemented by governments, bilateral aid, multilateral programs, private households and NGOs as part of the HIV response. 18

19. International Health Policy Program -Thailand AIDS Spending Categories Prevention Care and Treatment Orphans and Vulnerable Children (OVC) Program Management Administration Strengthening Incentive Human Resources Social protection and social services excluding Orphans and vulnerable Children Enabling Environment and community Development Research excluding operational research 19

20. International Health Policy Program -Thailand National AIDS spending 2008-2011 20 2008200920102011 Total AIDS expenditure, million Baht6,9287,2087,7339,922 Total Health Expenditure, million Baht360,272377,226392,368408,718 Total AIDS expenditure, as · per capita population, Baht 110114121154 · per capita PLWHA, Baht 14,27514,47115,48720,594 · per capita population, US$ 3.3 3.85.1 · per capita PLWHA, US$ 431415489675 · % GDP 0.08 0.09 · % THE 1.9 2.02.4 Source Domestic, % of total AIDs exp. 85 93 85 86 International, % of total AIDs exp. 15 7 14 Expenditure profiles Prevention, % of total AIDs exp. 21.7 13.7 13.1 13.4 Care and treatment, % of total AIDs exp. 65.8 76.1 73.4 73.2

21. International Health Policy Program -Thailand Total AIDS expenditure by beneficiary populations 21 2010 2011 Adult and young people (15 years and over) living with HIV not disaggregated by gender Others: for example; Children (under 15 years) living with HIV not disaggregated by gender, Injecting drug users (IDU) and their sexual partners, Female sex workers and their clients, Men who have sex with men (MSM), Orphans and vulnerable children (OVC), Migrants/mobile populations

22. International Health Policy Program -Thailand 22 Limitations and lesson learned HIV/AIDS expenditure in Thailand has increased for 4 consecutive years  care and treatment, in particular Antiretroviral Therapy (ART) was a majority of HIV/AIDS spending in Thailand, From the analysis of NASA 2008 to 2011, HIV/AIDS spending is financially affordable in long-term, as it relies mostly on domestic resources, During 2008 to 2011, domestic resources was dominant in supporting curative care, while international source was dominant in supporting prevention programs, Adult and young people (15 years and over) living with HIV are the major share of expenditure spent to Beneficiary populations (BP). Furthermore, they were spent more care and treatment than prevention program, HIV/AIDS prevention activities should be highly promoted from domestic financing sources enabling to ensure the sustainability of HIV/AIDS prevention activities.

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