Strategic Purchasing: Thailand UC Scheme

Walaiporn Patcharanarumol
International Health Policy Program (IHPP)

Disclaimer: The views expressed in this paper/presentation are the views

of the author and do not necessarily reflect the views or policies of the
Asian Development Bank (ADB), or its Board of Governors, or the
governments they represent. ADB does not guarantee the accuracy of the
data included in this paper and accepts no responsibility for any
consequence of their use. Terminology used may not necessarily be
consistent with ADB official terms.

Thai UHC (Universal Health Coverage)

99% of 67 million population
Civil Servant
UC Scheme
Scheme

Social health
insurance

Act 2002

Royal Decree 1980

Act 1990

75% of pop, 50 mln pop

(reside in rural areas; Q1-2;
children, elderly, informal wker)

7 mln pop
(urban; Q4-5; children,
elderly, public sector)

10 mln pop
(city; Q4-5; only adult
wker in private)

Tax funded

Tax funded

Tripartite contribution

Close ended budget

Open ended budget

Close ended budget

Capitation, DRG, fee schedule

Fee-for-service, DRG

Capitation, DRG

National Health Security Office

(public independent body) governed Comptroller General
Department, MOF
by the Board chaired by Minister of Health,
Civil Society 5 seats (out of 32)

Social Security Office,

MOL

Public (75%) and private (25%) health facilities

Civil Servant Scheme using fee-for-service:

Uncontrollable Cost Escalation

OP: FFS

DRG for IP

Source: Analysis by Dr.Supon

UC Scheme: purchaser-provider split

Clear mission of a purchaser
Government: Cabinet,
Executive Board &
Quality Board
Direction e.g.
BP sub-committee

Member of the Board

Regular meetings
Annual report

UCS close ended-budget

Financial audit

Purchaser:
National Health
Security Office

Close Ended Provide Payment

Methods
Medical Audit
Member of the Board

48 mln population:
Rural areas, Q1-2,
informal workers
Members
Registration
Hotline 1330
Provide
services

Data submission
Hospital Accreditation

Providers:
Network of health center
&
district hospital

NHSO budget for medical fund (million baht)

Source: National Health Security Office

Strategic Purchasing of UC Scheme

1.

Cost containment

Close ended budget with mixed of provider payment methods (capitation, DRG
with global budget, fee schedule for high cost, medical devices)

Strong signal towards efficiency to the purchaser and providers e.g. use
generic medicines, prevent supply induced demand

2.

Managing benefit package

Extend coverage to high cost interventions e.g. Renal Replacement Therapy,

ART

Using evidence for inclusion of new interventions capacity to generate Thai

evidence by Thai staff

3.

NHSO prudent monopsonistic purchaser

Bargaining power of a purchaser (on behalf of 48 mln pop)

Central purchasing or constraint fee

Resulted in cost saving

6

Key messages: strategic purchasing

Comprehensive package and contracting DHS
Contribute to financial risk protection and propoor utilization

Provider payment
Close end payment contributes to efficiency and
cost containment
Prevent down side of close end payment needed
Unbundling high cost interventions with incentives to
boost service

Monopsonistic purchasing power

Increased value for money and efficiency
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Thank you for your attention