contemporary medicine

Healthcare  financial  insurance  System,Thailand

   

         The Medical Welfare Scheme (MWS), started in 1975, was the first

program to provide health care to the poors. Since then, a variety of insurance programs  have been established, and some of those programs have been incorporated into the UC scheme. Currently, Thai citizens have access to health insurance through one of three  programs: the Civil Service Medical Benefit Scheme (CSMBS), the Social Security Scheme (SSS), and the UC scheme. 

        The CSMBS was established in 1980 to provide health care to government employees, their dependents (children, spouses, and parents), and government retirees.This programe  provides comprehensive medical benefits, including coverage for in- and outpatient services, emergency treatment, and pharmaceuticals. Rapidly increasing in health care expenditure  due  to the  health care providers  charge  from fee-for-service, thus; the  Ministry of Finance proposed  limiting some benefits and initiating a shift from full payment for hospital charges to another  payment  system  using diagnosis-related groups (DRGs). The  program is fully financed through general tax revenue with no premium payments from the beneficiaries. Beneficiaries have  to copayments in case of  the room and board charges  associated with inpatient care in private hospitals, but not for care in public facilities. 

          The SSS scheme, established in 1990, is a compulsory insurance program for employees of private businesses. Dependents and retirees are not covered by SSS and are typically enrolled in the UC scheme. This program  provides a comprehensive benefit package  for non-work-related illnesses, and a separate workers compensation scheme covers  work-related  illnesses and injuries. Coverage is provided through a network of public  and private hospitals that are contracted to provide inpatient and outpatient services.Beneficiaries select a hospital contractor of his or her choice, and the SSS pays a fixed  capitation rate of 1,505 baht per enrollee  which intended  to control the cost of care. Additional payments are made for certain high-cost services and  chronic conditions. However, expenses  for  certain extremely costly treatments (including renal replacement therapy for patients with  end-stage renal disease and organ transplantation) are covered.The SSS scheme is  inter-copayment   among  employers, employees, and the government, each of which contribute  1.5 percent of taxable wages 

         The UC scheme is available to anyone who is not  eligible for CSMBS or SSS.Beneficiaries register with a primary care  provider, which acts as a gatekeeper to secondary and tertiary care. If beneficiaries   go  outside  the  health provider network  in which they are registered, they must pay the full  cost of that care out of  their  pocket. Capitation payments cover outpatient services, disease  prevention, and health promotion. Inpatient services are paid prospectively using DRGs.The UC scheme  is fully funded through general tax revenue with no premium payments from the beneficiaries. Recently, the medical  fee for service  30 baht per visit  was  no requirement.However;there are  gaps  in insurance benefits in the public programs, some people also purchase private insurance to supplement their coverage. In addition,some people do not participate in one of the  public insurance schemes, perhaps  due  to  they live in remote areas and have limited  access to public health providers, and must pay for care themselves. Also, some health services may be difficult to obtain within the insurance schemes but are available with direct payment. Pharmaceuticals, for example, that may be in limited supply through hospital pharmacies (which do not charge the patient) might be obtained through private pharmacies   that  are not covered by UC. Some people are willing to  purchase  pharmaceuticals in private pharmacies   rather than going through physicians   and hospitals. In addition, alternative  medicine is typically paid out-of-pocket  rather than through insurance. Nevertheless;financial performance alone is not a sufficient indicator of the success of health system .

 

Reference: Joseph R.;Wilson H. Taylor. Healthcare  financing in Thailand, 2007