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UHC in developing countries, Health system : Ethical dilemmas. Dr. Peerapol Sutiwisetsak Deputy Secretary General National Health Security Office Thailand.

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Presentation on theme: "UHC in developing countries, Health system : Ethical dilemmas. Dr. Peerapol Sutiwisetsak Deputy Secretary General National Health Security Office Thailand."— Presentation transcript:

1 UHC in developing countries, Health system : Ethical dilemmas. Dr. Peerapol Sutiwisetsak Deputy Secretary General National Health Security Office Thailand 1

2 National Health Security Office – NHSO – 2 Population - 64 million GNI 2012 US$5,090 per capita, Gini 42.5 UHC achieved in 2001 under 3 scheme civil servants, social security and UC Health status  Life expectancy at birth 74 years  IMR 20/1000 LB, MMR 30/100,000 LB  Physicians per capita 5/10,000  ANC & hospital delivery (2009) Total Health Expenditure  US$300 per capita, 6% GDP  Half from public, 14% of National budget  Less than 40% out of pocket Thailand: country profiles

3 National Health Security Office – NHSO – 3 UHC can be started and achieved at low level of income year GDP/capita 20% 29% 42% 53% The children n elderly 71% 100% Suwit Wibulpolprasert, MoPH, Thailand

4 National Health Security Office – NHSO – 4 Health Insurance Schemes

5 National Health Security Office – NHSO – 5 1.Ensure Healthcare for all and poverty reduction 2.The Development of benefit package 3.The Transparency and participatory mechanism. 4.The Strategic purchasing under fiscal constraint 5. The Preliminary assistance for damage or injury caused by any services 6.The 24 hr services of the call center Ethical point

6 National Health Security Office – NHSO – 6 Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand Fast tracking rural health No investment in urban areas for 5 yrs. 1. Ensure availability of quality health care for all

7 National Health Security Office – NHSO – 7 Rural health centers with 3-6 nurses n CHWs cover 2,000-5,000 population Rural community hospital with 2-8 doctors cover 30-80,000 population Extensive production of appropriate cadres and motivated health personnel with mandatory public works and adequate support are essential. Adequate and appropriately manned rural health facilities

8 National Health Security Office – NHSO – 8 Medical school hospital For more complex service, secondary and tertiary hospitals with specialized personnel, highly diagnostic and treatment technology are available. Referral system was set up. Seamless Health Service Networks General hospital in every province Regional hospital in every region

9 National Health Security Office – NHSO – 9 46% (5.5) 29% (3.5) 24% (2.9) 1977 Regional H./General H. Rural Health Centres District Hospital 27% (11.0) 35% (14.6) 38% (15.7) 1987 Regional H./General H. District Hospital Rural Health Centres % (51.8) 35.7% (40.2) 18.2% (20.4) Regional H./General H. District Hospital Rural Health Centres % (78.0) 33.4% (33.4) 12.6% (18.1) Regional H./General H. District Hospital Rural Health Centres ( ) : Number of OPD visits (millions) Source: Rural Health Division, MoPH 1. Healthcare for all : Changes in out-patient utilization:

10 National Health Security Office – NHSO – 10 UHC is effective for poverty reduction UHC achieved Source: Viroj Tangcharoensathien Suwit Wibulpolprasert, MoPH, Thailand

11 National Health Security Office – NHSO – 11  Evidence base transparent n participatory processes  Life saving non cost-effective treatments but high impoverishment tendency w low budget impact  Increase access at affordable budget by using mix payment methods to control cost and also stimulate demand and services  The use of quality generic medicines, TRIPs flexibilities, and the promotion of rational drug use 2. The Ethic in the benefit packages development

12 National Health Security Office – NHSO – 12 Use of Lopinavir/Ritonavir (200/50mg) bottles CL UC Scheme CL Suwit Wibulpolprasert, MoPH, Thailand

13 National Health Security Office – NHSO – 13  By law National Health Security board consists of Minister of Health chair the Board, 8 Government Ex-officio 4 Local Government Representatives, 5 representatives selected from 9 NGO constituencies 4 representatives from four Professional Councils, 1 representative from Private Hospital Association, 7 experts appointed by Cabinet [insurance, medical and public health, traditional medicines, alternative medicines, financing, lawyer and social science], Secretary General serves as secretary of the Board  Public hearing from provider, people every year  Annual accounting audit  Satisfaction survey every year 3.The Transparency and participatory mechanism

14 National Health Security Office – NHSO – 14 Percent Expand financial incentives Source: Satisfaction survey NHSO & ABAC University in various years Satisfaction: UC members and providers

15 National Health Security Office – NHSO – 15  Close end capitation based budget with mixed payment mechanisms mainly on capitation (OP) and Case Mix (IP) and some FFS and PC as gate keeper  Involvement of the private providers, e.g, providing primary care in the urban areas, emergency medical services, and some specific tertiary care, e.g., cardiac surgery  Central bargaining and purchasing with VMI (Vendor Managed Inventory) 4.Strategic purchasing : Better Value for Money

16 National Health Security Office – NHSO – The Preliminary assistance for damage or injury caused by any service From: NHSO data 2011

17 National Health Security Office – NHSO – The 24 hrs services of the call center 1330 Total call 743,744 (3) Information 729,320 (98.35%) (1) Complaint – quality care 4,386 (0.51%) (2) Complaint - general 5,758 (0.75%) (4) Inpatient bed finding 4,280 (0.39%) 96.18% Complete cases in 30 days 96,45% Complete cases in 30 day From : NHSO data 2011

18 National Health Security Office – NHSO – Three key take home messages  UHC is the accesses to health services without financial barrier, not merely financial protection. It is can be achieved at low level of income and it is effective for poverty reduction  Fiscal spaces and innovative financing are possible with political leadership - resources must be used cost-effectively thru Health Technology Assessment and strategic purchasing  Mechanisms to assure sustainable financing and meeting the emerging challenges are needed and should be developed thru evidence based health systems researches 18 Suwit Wibulpolprasert, MoPH, Thailand

19 National Health Security Office – NHSO – Thank you

20 National Health Security Office – NHSO – TRIPS flexibilities  TRIPS stands for Trade-Related Aspects of Intellectual Property Rights agreed in DOHA, 2001  Flexibilities : special mechanism is allowed for developing countries to gain access to essential drugs and or to protect health system  Such as to import some generic drugs aiming to lower ARV cost for HIV patients  The example of flexibilities is CL in ARV drug Thailand, 20

21 National Health Security Office – NHSO – MDG 1  The Millennium Development Goals (MDGs) are eight international development goals that were officially established following the Millennium Summit of the United Nations in 2000, following the adoption of the United Nations Millennium Declaration. All 193 United Nations member states and at least 23 international organizations have agreed to achieve these goals by the year  The first goal is : Eradicating extreme poverty and hunger 21


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