Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing

Abstract

Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser–provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite annual budget.

Fiscal space for domestic funding of health and other social services

“…Finally, efforts to increase domestic public funding of health services should be accompanied by strategic purchasing reforms to promote the efficient and equitable use of scarce resources as demonstrated in Thailand (Tangcharoensathien et al, 2015).…”

Developing and testing quality indicators for the Thai Quality and Outcomes Framework

“…District hospitals offer both primary and secondary care services whilst health-promoting hospitals provide ambulatory care and community services. These are staffed by nurse practitioners and public health officers [1].…”

Pay-for-performance in resource-constrained settings: Lessons learned from Thailand’s Quality and Outcomes Framework

“…Thailand achieved universal health coverage (UHC) in 2002 through the implementation of a universal coverage scheme (UCS) for the majority of the Thai population (75%) in addition to the existing government-funded health insurance schemes: the Civil Servant Medical Benefit Scheme for public employees and dependents, and Social Health Insurance for formal-sector private employees 1 . The Thai UHC focuses on promoting primary healthcare with an emphasis on disease prevention and health promotion, and these are also in line with new sustainable development goals 2 .…”

“…District hospitals, which are staffed with physicians, nurses and other allied health professionals, offer both primary and secondary care services. On the other hand, healthpromoting hospitals, which are staffed by nurse practitioners and public health officers, only provide primary care, community services, health promotion and disease prevention services 1 . The NHSO allocates the budget for ambulatory services on a prepaid capitation basis, i.e.…”