Abstract
Managing public health system in Thailand has been a challenging mission of many governments. The system comprises various health insurance programs such as the civil service welfare system for civil servants, the social security scheme, the universal healthcare coverage, the health insurance fund for foreign workers, as well as the independently managed health care funds for local governments and state-owned enterprises. Each program has separated management system. This leads to an overlap between the benefits of each fund, and the lack of standard of operation in many ways such as managing patients’ data system and claimant procedure, as well as evaluating disbursement and treatment quality. These problems incur inappropriately high cost.
Every previous government has attempted to integrate the national health care system which has traditionally been under the management of three state departments namely Ministry of Finance, Ministry of Labor, and Ministry of Public Health. However, these attempts resulted in the form of ad- hoc committees appointed by the cabinet resolutions. For example, the Abhisit government appointed the National Health Care Financing Development Committee (NHFDC) to design an integrated public health system. Later the Yingluck administration cancelled the NHFC and replaced it with the Committee on Drugs and Health Care Reimbursement System Management (CDHRM). The committee was assigned to control the expenses in the national healthcare system, especially the medicine price.
The change in structure and management in Thailand’s health care system as a result of the shift in political situation raised a question of whether the appointed committees are capable of fulfilling their objectives if being evaluated by empirical evidences, and what should be the appropriate structure of such agency.
This study analyses the structure, mission, operation procedure, and performance of the two committees. It finds that the two committees which were appointed at different times had each own origin and objective. The NHFDC was appointed according to the recommendation of the Health Assembly in order to improve the efficiency of national healthcare financing system, while the CDHRM originated from political pressure which sought to reduce the cost of national health system by focusing on the welfare for civil servants system.
For these reasons, the structure of each committee differs. The NHFDC comprised representatives from many sectors such as people’s representatives, consumers group, informal workforce group, as well as distinguished health scholars. On another hand, most of the members of CDHRM are from government departments and professional organizations relating to the national health management.
In term of performance, the NHFDC had some policy achievements such as designing the desirable health and financing system, issuing the directive for the Jor(2) medicine list, and integrating the emergency system which led to the current practical operation. The CDHRM also demonstrated some distinct performances during its first phrase; for example, it initiated a project to evaluate the quality of integrated healthcare funds, produced the medicine database and codes for standard medicines, developed a program that links the codes for standard medicines with the codes in hospitals, as well as an agency overseeing the information system about medical services.
Nevertheless, the CDHRM’s achievements such as negotiating the medicine price, evaluating the quality of medical services, and developing the information system are essentially the tasks that had previously been handled by other agencies. The committee simply took over these continuous works as its missions. Therefore, it could be said that there is continuity in the practical level, despite the shift in main policy.
However, the committee’s structure which features the Health Minister as the President and the Comptroller-General as the Secretariat-General – which helps smoothen communication between the two departments – became problematic. As the Minister and Comptroller-General can directly give order to the responsible agents, who can also directly report the work progress to the two commanders, the practical roles of the committee are reduced.
This research team argues that the principle and direction of the national health system management need clarity and continuity and hence must be permanently managed by an agency, by enacting a law governing the national health system in order to lay out the form and structure of the desirable health system. The law shall also identify the authority that will direct the three health care funds integrally – instead of “asking for collaboration” as traditionally done – which resulted in some policies or measures that might have conflict of interest with one of the funds being ignored, even though they might be beneficial to the society.
The proposed agency should report directly to the Prime Minister and work under the Office of the Prime Minister. This is to prevent any state department from dictating the direction of health system management which involves many national departments. The structure of this agency should comprise two sets of committee namely the health system policy committee, and the health system management committee in order to separate the policy work from practical function, each of which requires a different set of committee members and form of authority.
