Abstract
Health financing in Thailand : Technical reportFor the past, Thailand’s health care system has increasingly emphasised more advanced medical technologies and the Thai have been more reliant upon health care providers than self-care. Both public and private expenditures for health services consequently increased in real terms. 75% of health expenditures (the largest portion, 66% from the Ministry of Public Health (MOPH)) was incurred in the public sector compared with 25% in the private. During 1986 to 1996, the MOPH budget increased by 258% in real terms and then dropped since 1997 because of budget constraint caused by economic crisis. From 1995 to 1999, the budget grew about 6% in real terms. In consideration of the MOPH budget in 1998, 42%, 31% and 27% were gone for salaries, recurrent inputs and capital expenditures respectively. The budgeting was based on historical requirement leading to inequity of financing among provinces. Household expenditure became a portion of revenue to public health facilities. Whether the government budget for each public health facility was sufficient remained dubious due to poor cost accounting of public health facilities. Therefore, determining either capitation rates weighted by age, sex or DRGs was inconclusive.Thailand had 5 major health insurance schemes, Civil Servants’ Medical Benefits Scheme (SCMBS), Social Security Scheme (SSS), Voluntary Health Card Scheme (VCS), Low-income Card Scheme (LICS) and Private Indemnity Insurance. Around 76% of the Thai were covered by one of these. The CSMBS covered all government employees, pensioners and their dependents. The program was financed by government tax and managed by the Ministry of Finance. Since the economic crisis, the program did cost control by abolishing reimbursement for private care and imposing co-payment for some services e.g. for non-essential drugs. The SSS was premium-based by collecting 1.5% from the employee, the employer and the Ministry of Social Welfare. Payment to contracted hospitals was on capitation from 700-1000 Baht per head per year.The VHCS was community revolving funds targeting the near poor. The premium was 500 Baht supplementary to 1000 Baht, 500 Baht from the MOPH and 500 Baht from the ADB. The most problem of the program was ineffective targeting measure. The wealthy got the cards while a large number of the near poor were not covered. The LICS basically intended to cover the poor but its objective was enlarged to cover the elderly, children under 12, veterans, religious and community leaders and the handicapped. The program also had a problem of targeting the deserved. On the demand side, the insured often bypassed to their registered hospitals preferable to registered primary care centres or health centres. The paper recommends development of universal health coverage for all.
