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Wickramage K, Gostin LO, Friedman E, Prakongsai P, Suphanchaimat R, Hui C, Duigan P, Barragan E, Harper DR. Missing: Where Are the Migrants in Pandemic Influenza Preparedness Plans? Health Hum Rights 2018; 20:251-258. [PMID: 30008567 PMCID: PMC6039731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Kolitha Wickramage
- The head of Migration Health Research and Epidemiology, Migration Health Division, the International Organization for Migration, the United Nations Migration Agency, Geneva, Switzerland
| | - Lawrence O. Gostin
- Professor of Global Health Law; Faculty Director, O’Neill Institute for National & Global Health Law; Director, World Health Organization Collaborating Center on Public Health Law & Human Rights, University Professor at Georgetown University, Washington, DC, USA
| | - Eric Friedman
- Project leader, Platform for a Framework Convention on Global Health (FCGH) at the O’Neill Institute for National and Global Health Law Georgetown University, Washington, DC, USA
| | - Phusit Prakongsai
- Senior advisor on Health Promotion, Office of Permanent Secretary, Ministry of Public Health of Thailand, Nonthaburi, Thailand
| | - Rapeepong Suphanchaimat
- Researcher at the Bureau of Epidemiology, Department of Disease Control, and the International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Charles Hui
- Chief of infectious diseases at the Department of Pediatrics, University of Ottawa, and chair of the Migration Health and Development Research Initiative, Faculty of Medicine, University of Ottawa, Canada
| | - Patrick Duigan
- Regional migration health thematic specialist at the International Organization for Migration’s Regional Office for Asia and the Pacific, Bangkok, Thailand
| | - Eliana Barragan
- Migration health programme officer at the International Organization for Migration, Geneva, Switzerland
| | - David R. Harper
- Senior consulting fellow at the Centre on Global Health Security, Catham House, London, UK
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Abstract
In the transition to the post-2015 agenda, many countries are striving towards universal health coverage (UHC). Achieving this, governments need to shift from curative care to promotion and prevention services. This research analyses Thailand's financing system for health promotion and prevention, and assesses policy options for health financing reforms. The study employed a mixed-methods approach and integrates multiple sources of evidence, including scientific and grey literature, expenditure data, and semi-structured interviews with key stakeholders in Thailand. The analysis was underpinned by the use of a well-known health financing framework. In Thailand, three agencies plus local governments share major funding roles for health promotion and prevention services: the Ministry of Public Health (MOPH), the National Health Security Office, the Thai Health Promotion Foundation and Tambon Health Insurance Funds. The total expenditure on prevention and public health in 2010 was 10.8% of the total health expenditure, greater than many middle-income countries that average 7.0–9.2%. MOPH was the largest contributor at 32.9%, the Universal Coverage scheme was the second at 23.1%, followed by the local governments and ThaiHealth at 22.8 and 7.3%, respectively. Thailand's health financing system for promotion and prevention is strategic and innovative due to the three complementary mechanisms in operation. There are several methodological limitations to determine the adequate level of spending. The health financing reforms in Thailand could usefully inform policymakers on ways to increase spending on promotion and prevention. Further comparative policy research is needed to generate evidence to support efforts towards UHC.
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Affiliation(s)
- Akihito Watabe
- Department of Public Health, Graduate School of Medicine, Juntendo University, Japan.,Department of Health System Governance and Financing, World Health Organization, Geneva, Switzerland
| | | | - Thaksaphon Thamarangsi
- Department of Non-Communicable Diseases and Environmental Health, South East Asia Regional Office, World Health Organization, New Delhi, India
| | | | - Motoyuki Yuasa
- Department of Public Health, Graduate School of Medicine, Juntendo University, Japan
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Voorhoeve A, Tan-Torres Edejer T, Kapiriri L, Norheim OF, Snowden J, Basenya O, Bayarsaikhan D, Chentaf I, Eyal N, Folsom A, Halina Tun Hussein R, Morales C, Ostmann F, Ottersen T, Prakongsai P, Saenz C, Saleh K, Sommanustweechai A, Wikler D, Zakariah A. Making Fair Choices on the Path to Universal Health Coverage: Applying Principles to Difficult Cases. Health Syst Reform 2017; 3:301-312. [DOI: 10.1080/23288604.2017.1324938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Alex Voorhoeve
- Department of Philosophy, Logic, and Scientific Method, London School of Economics, London, UK
- Department for Bioethics at the National Institutes of Health, Bethesda, MD, USA
| | | | - Lydia Kapiriri
- Department of Health, Aging, and Society, McMaster University, Hamilton, ON, Canada
| | - Ole Frithjof Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - James Snowden
- Giving What We Can, Centre for Effective Altruism, Oxford, UK
| | | | - Dorjsuren Bayarsaikhan
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Ikram Chentaf
- Cooperation Division at the Ministry of Health, Rabat, Morocco
| | - Nir Eyal
- Department of Global Health and Population, TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Amanda Folsom
- Results for Development Institute, Washington, DC, USA
| | - Rozita Halina Tun Hussein
- National Health Financing, Planning and Development Division, Ministry of Health, Putrajaya, Malaysia
| | - Cristian Morales
- Pan American Health Organization/World Health Organization in Cuba, Havana, Cuba
| | - Florian Ostmann
- Kennedy School of Government, Harvard University, Boston, MA, USA
| | | | - Phusit Prakongsai
- Bureau of International Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Carla Saenz
- Pan American Health Organization, Washington, DC, USA
| | | | | | - Daniel Wikler
- Department of Global Health and Population, TH Chan School of Public Health, Harvard University, Boston, MA, USA
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Suphanchaimat R, Putthasri W, Prakongsai P, Tangcharoensathien V. Evolution and complexity of government policies to protect the health of undocumented/illegal migrants in Thailand - the unsolved challenges. Risk Manag Healthc Policy 2017; 10:49-62. [PMID: 28458588 PMCID: PMC5402917 DOI: 10.2147/rmhp.s130442] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Of the 65 million residents in Thailand, >1.5 million are undocumented/illegal migrants from neighboring countries. Despite several policies being launched to improve access to care for these migrants, policy implementation has always faced numerous challenges. This study aimed to investigate the policy makers' views on the challenges of implementing policies to protect the health of undocumented/illegal migrants in light of the dynamics of all of the migrant policies in Thailand. METHODS This study used a qualitative approach. Data were collected by document review, from related laws/regulations concerning migration policy over the past 40 years, and from in-depth interviews with seven key policy-level officials. Thematic analysis was applied. RESULTS Three critical themes emerged, namely, national security, economic necessity, and health protection. The national security discourse played a dominant role from the early 1900s up to the 1980s as Thailand attempted to defend itself from the threats of colonialism and communism. The economic boom of the 1990s created a pronounced labor shortage, which required a large migrant labor force to drive the growing economy. The first significant attempt to protect the health of migrants materialized in the early 2000s, after Thailand achieved universal health coverage. During that period, public insurance for undocumented/illegal migrants was introduced. The insurance used premium-based financing. However, the majority of migrants remained uninsured. Recently, the government attempted to overhaul the entire migrant registry system by introducing a new measure, namely the One Stop Service. In principle, the One Stop Service aimed to integrate the functions of all responsible authorities, but several challenges still remained; these included ambiguous policy messages and the slow progress of the nationality verification process. CONCLUSION The root causes of the challenges in migrant health policy are incoherent policy direction and objectives across government authorities and unclear policy messages. In addition, the health sector, especially the Ministry of Public Health, has been de facto powerless and, due to its outdated bureaucracy, has lacked the capacity to keep pace with the problems regarding human mobility.
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Affiliation(s)
- Rapeepong Suphanchaimat
- International Health Policy Program (IHPP), The Ministry of Public Health, Nonthaburi.,Banphai Hospital, Khon Kaen
| | - Weerasak Putthasri
- International Health Policy Program (IHPP), The Ministry of Public Health, Nonthaburi
| | - Phusit Prakongsai
- International Health Policy Program (IHPP), The Ministry of Public Health, Nonthaburi.,Bureau of International Health (BIH), The Ministry of Public Health, Nonthaburi, Thailand
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Voorhoeve A, Edejer TT, Kapiriri L, Norheim OF, Snowden J, Basenya O, Bayarsaikhan D, Chentaf I, Eyal N, Folsom A, Tun Hussein RH, Morales C, Ostmann F, Ottersen T, Prakongsai P, Saenz C, Saleh K, Sommanustweechai A, Wikler D, Zakariah A. Three Case Studies in Making Fair Choices on the Path to Universal Health Coverage. Health Hum Rights 2016; 18:11-22. [PMID: 28559673 PMCID: PMC5395011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
The goal of achieving Universal Health Coverage (UHC) can generally be realized only in stages. Moreover, resource, capacity, and political constraints mean governments often face difficult trade-offs on the path to UHC. In a 2014 report, Making fair choices on the path to UHC, the WHO Consultative Group on Equity and Universal Health Coverage articulated principles for making such trade-offs in an equitable manner. We present three case studies which illustrate how these principles can guide practical decision-making. These case studies show how progressive realization of the right to health can be effectively guided by priority-setting principles, including generating the greatest total health gain, priority for those who are worse off in a number of dimensions (including health, access to health services, and social and economic status), and financial risk protection. They also demonstrate the value of a fair and accountable process of priority setting.
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Affiliation(s)
- Alex Voorhoeve
- Department of Philosophy, Logic, and Scientific Method, London School of Economics, London, UK and Visiting Scholar in the Department of Bioethics at the National Institutes of Health, Bethesda, US
| | - Tessa T.T. Edejer
- Coordinator of Costs, Effectiveness, Expenditure and Priority Setting, Health Systems Governance and Financing, and Health Systems and Innovation, World Health Organization, Geneva, Switzerland
| | - Lydia Kapiriri
- Associate Professor in the Department of Health, Aging, and Society, McMaster University, Hamilton, Ontario, Canada
| | - Ole F. Norheim
- Director of Global Health Priorities in the Department of Global Public Health and Primary Care University of Bergen, Bergen, Norway
| | - James Snowden
- Research Analyst at Giving What We Can, Centre for Effective Altruism, Oxford, UK
| | - Olivier Basenya
- Performance-Based Financing Expert in the Ministry of Health, Bujumbura, Burundi
| | - Dorjsuren Bayarsaikhan
- Health Economist in the Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Ikram Chentaf
- International and Intergovernmental Cooperation Program Manager in the Cooperation Division at the Ministry of Health, Rabat, Morocco
| | - Nir Eyal
- Associate Professor, Department of Global Health and Population, TH Chan School of Public Health, Harvard University, Boston, US
| | - Amanda Folsom
- Program Director at the Results for Development Institute, Washington, DC, US
| | - Rozita Halina Tun Hussein
- Deputy Director, Unit for National Health Financing, Planning and Development Division, Ministry of Health, Putrajaya, Malaysia
| | | | - Florian Ostmann
- School of Public Policy, University College London, London, UK
| | - Trygve Ottersen
- Research Fellow, Department of Global Public Health and Primary Care, University of Bergen and Associate Professor, Oslo Group on Global Health Policy, Centre for Global Health, University of Oslo, Bergen, Norway
| | - Phusit Prakongsai
- Director, Bureau of International Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Carla Saenz
- Bioethics Regional Advisor, Pan American Health Organization, Washington, DC, US
| | - Karima Saleh
- Senior Economist in Health at the World Bank, Washington, DC, US
| | | | - Daniel Wikler
- Saltonstall Professor of Ethics and Population Health, Department of Global Health and Population, TH Chan School of Public Health, Harvard University, Boston, US
| | - Afisah Zakariah
- Director, Policy, Planning, Monitoring and Evaluation, Ministry of Health, Accra, Ghana
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Suphanchaimat R, Prakongsai P, Limwattananon S, Mills A. Impact of the health insurance scheme for stateless people on inpatient utilization in Kraburi Hospital, Thailand. Risk Manag Healthc Policy 2016; 9:261-269. [PMID: 27942240 PMCID: PMC5140032 DOI: 10.2147/rmhp.s117173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives This study sought to investigate the impact of the Thai “Health Insurance for People with Citizenship Problems” (HI-PCP) on access to care for stateless patients, compared to Universal Coverage Scheme patients and the uninsured, using inpatient utilization as a proxy for impact. Methods Secondary data analysis of inpatient records of Kraburi Hospital, Ranong province, between 2009 (pre-policy) and 2012 (post-policy) was employed. Descriptive statistics and multivariate analysis by difference-in-difference model were performed. Results The volume of inpatient service utilization by stateless patients expanded after the introduction of the HI-PCP. However, this increase did not appear to stem from the HI-PCP per se. After controlling for key covariates, including patients’ characteristics, disease condition, and domicile, there was only a weak positive association between the HI-PCP and utilization. Critical factors contributing significantly to increased utilization were older age, proximity to the hospital, and presence of catastrophic illness. Conclusion A potential explanation for the insignificant impact of the HI-PCP on access to inpatient care of stateless patients is likely to be a lack of awareness of the existence of the scheme among the stateless population and local health staff. This problem is likely to have been accentuated by operational constraints in policy implementation, including the poor performance of local offices in registering stateless people. A key limitation of this study is a lack of data on patients who did not visit the health facility at the first opportunity. Further study of health-seeking behavior of stateless people at the household level is recommended.
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Affiliation(s)
- Rapeepong Suphanchaimat
- International Health Policy Program (IHPP), Ministry of Public Health, Faculty of Public Health and Policy, Nonthaburi, Thailand; London School of Hygiene and Tropical Medicine, London, UK
| | - Phusit Prakongsai
- International Health Policy Program (IHPP), Ministry of Public Health, Faculty of Public Health and Policy, Nonthaburi, Thailand
| | - Supon Limwattananon
- International Health Policy Program (IHPP), Ministry of Public Health, Faculty of Public Health and Policy, Nonthaburi, Thailand; Khon Kaen University, Khon Kaen, Thailand
| | - Anne Mills
- London School of Hygiene and Tropical Medicine, London, UK
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Suphanchaimat R, Kantamaturapoj K, Putthasri W, Prakongsai P. Challenges in the provision of healthcare services for migrants: a systematic review through providers' lens. BMC Health Serv Res 2015. [PMID: 26380969 DOI: 10.1186/s12913-015-1065-z.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, cross-border migration has gained significant attention in high-level policy dialogues in numerous countries. While there exists some literature describing the health status of migrants, and exploring migrants' perceptions of service utilisation in receiving countries, there is still little evidence that examines the issue of health services for migrants through the lens of providers. This study therefore aims to systematically review the latest literature, which investigated perceptions and attitudes of healthcare providers in managing care for migrants, as well as examining the challenges and barriers faced in their practices. METHODS A systematic review was performed by gathering evidence from three main online databases: Medline, Embase and Scopus, plus a purposive search from the World Health Organization's website and grey literature sources. The articles, published in English since 2000, were reviewed according to the following topics: (1) how healthcare providers interacted with individual migrant patients, (2) how workplace factors shaped services for migrants, and (3) how the external environment, specifically laws and professional norms influenced their practices. Key message of the articles were analysed by thematic analysis. RESULTS Thirty seven articles were recruited for the final review. Key findings of the selected articles were synthesised and presented in the data extraction form. Quality of retrieved articles varied substantially. Almost all the selected articles had congruent findings regarding language andcultural challenges, and a lack of knowledge of a host country's health system amongst migrant patients. Most respondents expressed concerns over in-house constraints resulting from heavy workloads and the inadequacy of human resources. Professional norms strongly influenced the behaviours and attitudes of healthcare providers despite conflicting with laws that limited right to health services access for illegal migrants. DISCUSSION The perceptions, attitudes and practices of practitioners in the provision of healthcare services for migrants were mainly influenced by: (1) diverse cultural beliefs and language differences, (2) limited institutional capacity, in terms of time and/or resource constraints, (3) the contradiction between professional ethics and laws that limited migrants' right to health care. Nevertheless, healthcare providers addressedsuch problems by partially ignoring the immigrants'precarious legal status, and using numerous tactics, including seeking help from civil society groups, to support their clinical practice. CONCLUSION It was evident that healthcare providers faced several challenges in managing care for migrants, which included not only language and cultural barriers, but also resource constraints within their workplaces, and disharmony between the law and their professional norms. Further studies, which explore health care management for migrants in countries with different health insurance models, are recommended.
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Affiliation(s)
- Rapeepong Suphanchaimat
- International Health Policy Program (IHPP), Ministry of Public Health of Thailand, Tiwanon road, Nonthaburi, 11000, Thailand. .,Banphai Hospital, Banphai district, Khon Kaen, 40110, Thailand.
| | - Kanang Kantamaturapoj
- Department of Social Sciences, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, 73170, Thailand.
| | - Weerasak Putthasri
- International Health Policy Program (IHPP), Ministry of Public Health of Thailand, Tiwanon road, Nonthaburi, 11000, Thailand.
| | - Phusit Prakongsai
- International Health Policy Program (IHPP), Ministry of Public Health of Thailand, Tiwanon road, Nonthaburi, 11000, Thailand.
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Kovindha A, Kammuang-Lue P, Prakongsai P, Wongphan T. Prevalence of pressure ulcers in Thai wheelchair users with chronic spinal cord injuries. Spinal Cord 2015; 53:767-71. [PMID: 25939607 PMCID: PMC5399151 DOI: 10.1038/sc.2015.77] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 03/02/2015] [Accepted: 04/03/2015] [Indexed: 11/12/2022]
Abstract
Study design: A cross-sectional study. Objectives: To study prevalence of pressure ulcers (PrUs), quality of life (QoL) and effect of wheelchair cushions used by Thai wheelchair users with chronic spinal cord injury (SCI). Setting: Maharaj Hospital, Chiang Mai, Thailand. Methods: Thai chronic SCI wheelchair users, aged over 18 years and non-ambulatory with ASIA impairment scale A, B or C were recruited. They completed the PrUs questionnaire and rated the EuroQoL-5D and their health status with a visual analog scale (VAS). Demographic data of each participant were extracted from medical records. The EQ-5D health states were transformed to utility scores by using the Thai algorithm and the prevalence of PrUs was reported. The EQ-5D, the utility scores and the health status VAS were compared between those with and without current PrUs and between those participants using foam and air-filled cushions. Results: Of 129 participants, 26.4% had current PrUs at the time of the study, 27.9% had healed PrUs and 45.7% never had PrUs. The median VAS score for health status was 70 (Q1=50, Q3=80). Based on the EQ-5D, only one dimension (anxiety/depression) was significantly different between those with and those without current PrUs (P=0.015). Those using an air-filled cushions had a mean utility score four times higher than of those using a foam cushion (0.131 vs 0.032, P=0.089) but not statistically significant. Conclusions: PrUs are still prevalent among Thai wheelchair users with chronic SCI. Anxiety/depression is associated with current ulcers.
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Affiliation(s)
- A Kovindha
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - P Kammuang-Lue
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - P Prakongsai
- International Health Policy Program, Nonthaburi, Thailand
| | - T Wongphan
- International Health Policy Program, Nonthaburi, Thailand
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Suphanchaimat R, Putthasri W, Prakongsai P, Mills A. Health insurance for people with citizenship problems in Thailand: a case study of policy implementation within a complex health system. BMC Health Serv Res 2014. [PMCID: PMC4123138 DOI: 10.1186/1472-6963-14-s2-p121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mohara A, Youngkong S, Velasco RP, Werayingyong P, Pachanee K, Prakongsai P, Tantivess S, Tangcharoensathien V, Lertiendumrong J, Jongudomsuk P, Teerawattananon Y. Using health technology assessment for informing coverage decisions in Thailand. J Comp Eff Res 2014; 1:137-46. [PMID: 24237374 DOI: 10.2217/cer.12.10] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This article aims to illustrate and critically analyze the results from the 1-year experience of using health technology assessment (HTA) in the development of the Thai Universal Coverage health benefit package. We review the relevant documents and give a descriptive analysis of outcomes resulting from the development process in 2009-2010. Out of 30 topics nominated by stakeholders for prioritization, 12 were selected for further assessment. A total of five new interventions were recommended for inclusion in the benefit package based on value for money, budget impact, feasibility and equity reasons. Different stakeholders have diverse interests and capabilities to participate in the process. In conclusion, HTA is helpful for informing coverage decisions for health benefit packages because it enhances the legitimacy of policy decisions by increasing the transparency, inclusiveness and accountability of the process. There is room for improvement of the current use of HTA, including providing technical support for patient representatives and civic groups, better communication between health professionals, and focusing more on health promotion and disease prevention.
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Affiliation(s)
- Adun Mohara
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
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Prakongsai P. ASEAN Health in the post-2015 development agenda. BMC Public Health 2014. [PMCID: PMC4094206 DOI: 10.1186/1471-2458-14-s1-i2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Tangcharoensathien V, Pitayarangsarit S, Patcharanarumol W, Prakongsai P, Sumalee H, Tosanguan J, Mills A. Promoting universal financial protection: how the Thai universal coverage scheme was designed to ensure equity. Health Res Policy Syst 2013; 11:25. [PMID: 23919275 PMCID: PMC3735425 DOI: 10.1186/1478-4505-11-25] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 06/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Empirical evidence demonstrates that the Thai Universal Coverage Scheme (UCS) has improved equity of health financing and provided a relatively high level of financial risk protection. Several UCS design features contribute to these outcomes: a tax-financed scheme, a comprehensive benefit package and gradual extension of coverage to illnesses that can lead to catastrophic household costs, and capacity of the National Health Security Office (NHSO) to mobilise adequate resources. This study assesses the policy processes related to making decisions on these features. METHODS The study employs qualitative methods including reviews of relevant documents, in-depth interviews of 25 key informants, and triangulation amongst information sources. RESULTS Continued political and financial commitments to the UCS, despite political rivalry, played a key role. The Thai Rak Thai (TRT)-led coalition government introduced UCS; staying in power 8 of the 11 years between 2001 and 2011 was long enough to nurture and strengthen the UCS and overcome resistance from various opponents. Prime Minister Surayud's government, replacing the ousted TRT government, introduced universal renal replacement therapy, which deepened financial risk protection.Commitment to their manifesto and fiscal capacity pushed the TRT to adopt a general tax-financed universal scheme; collecting premiums from people engaged in the informal sector was neither politically palatable nor technically feasible. The relatively stable tenure of NHSO Secretary Generals and the chairs of the Financing and the Benefit Package subcommittees provided a platform for continued deepening of financial risk protection. NHSO exerted monopsonistic purchasing power to control prices, resulting in greater patient access and better systems efficiency than might have been the case with a different design.The approach of proposing an annual per capita budget changed the conventional line-item programme budgeting system by basing negotiations between the Bureau of Budget, the NHSO and other stakeholders on evidence of service utilization and unit costs. CONCLUSIONS Future success of Thai UCS requires coverage of effective interventions that address primary and secondary prevention of non-communicable diseases and long-term care policies in view of epidemiologic and demographic transitions. Lessons for other countries include the importance of continued political support, evidence informed decisions, and a capable purchaser organization.
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Affiliation(s)
- Viroj Tangcharoensathien
- International Health Policy Program, Ministry of Public Health, Tivanon Road, Nonthaburi Province 11000, Thailand.
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Limwattananon S, Tangcharoensathien V, Tisayaticom K, Boonyapaisarncharoen T, Prakongsai P. Why has the Universal Coverage Scheme in Thailand achieved a pro-poor public subsidy for health care? BMC Public Health 2012; 12 Suppl 1:S6. [PMID: 22992431 PMCID: PMC3382631 DOI: 10.1186/1471-2458-12-s1-s6] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Thailand has achieved universal health coverage since 2002 through the implementation of the Universal Coverage Scheme (UCS) for 47 million of the population who were neither private sector employees nor government employees. A well performing UCS should achieve health equity goals in terms of health service use and distribution of government subsidy on health. With these goals in mind, this paper assesses the magnitude and trend of government health budget benefiting the poor as compared to the rich UCS members. METHOD Benefit incidence analysis was conducted using the nationally representative household surveys, Health and Welfare Surveys, between 2003 and 2009. UCS members are grouped into five different socio-economic status using asset indexes and wealth quintiles. FINDINGS The total government subsidy, net of direct household payment, for combined outpatient (OP) and inpatient (IP) services to public hospitals and health facilities provided to UCS members, had increased from 30 billion Baht (US$ 1 billion) in 2003 to 40-46 billion Baht in 2004-2009. In 2003 for 23% and 12% of the UCS members who belonged to the poorest and richest quintiles of the whole-country populations respectively, the share of public subsidies for OP service was 28% and 7% for the poorest and the richest quintiles, whereby for IP services the share was 27% and 6% for the poorest and richest quintiles respectively. This reflects a pro-poor outcome of public subsidies to healthcare. The OP and IP public subsidies remained consistently pro-poor in subsequent years.The pro-poor benefit incidence is determined by higher utilization by the poorest than the richest quintiles, especially at health centres and district hospitals. Thus the probability and the amount of household direct health payment for public facilities by the poorest UCS members were less than their richest counterparts. CONCLUSIONS Higher utilization and better financial risk protection benefiting the poor UCS members are the results of extensive geographical coverage of health service infrastructure especially at district level, adequate finance and functioning primary healthcare, comprehensive benefit package and zero copayment at points of services.
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Affiliation(s)
- Supon Limwattananon
- Khon Kaen University, Thailand
- International Health Policy Program, Ministry of Public Health, Thailand
| | | | | | | | - Phusit Prakongsai
- International Health Policy Program, Ministry of Public Health, Thailand
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Kongsri S, Limwattananon S, Sirilak S, Prakongsai P, Tangcharoensathien V. Equity of access to and utilization of reproductive health services in Thailand: national Reproductive Health Survey data, 2006 and 2009. Reprod Health Matters 2011; 19:86-97. [PMID: 21555089 DOI: 10.1016/s0968-8080(11)37569-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This study assessed trends in equity of access to reproductive health services and service utilization in terms of coverage of family planning, antenatal care and skilled birth attendance in Thailand. Two health indicators were measured: the prevalence of low birthweight and exclusive breastfeeding. Equity was measured against the combined urban-rural areas and geographic regions, women's education level and quintiles of household assets index. The study used data from two nationally representative household surveys, the 2006 and 2009 Reproductive Health Surveys. Very high coverage of family planning (79.6%), universal antenatal care (98.9%) and skilled birth attendance (99.7%), with very small socioeconomic and geographic disparities, were observed. The public sector played a dominant role in maternity care (90.9% of all deliveries in 2009). The private sector also had a role among the higher educated, wealthier women living in urban areas. Public sector facilities, followed by drug stores, were a major supplier of contraception, which had a high use rate. High coverage and low inequity were the result of extensive investment in the health system by successive governments, in particular primary health care at district and sub-district levels, reaching universality by 2002. While maintaining these achievements, methodological improvements in measuring low birthweight and exclusive breastfeeding for future reproductive health surveys are recommended.
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Limwattananon S, Tangcharoensathien V, Prakongsai P. Equity in maternal and child health in Thailand. Bull World Health Organ 2010; 88:420-7. [PMID: 20539855 PMCID: PMC2878146 DOI: 10.2471/blt.09.068791] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 10/12/2009] [Accepted: 10/15/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess equity in health outcomes and interventions for maternal and child health (MCH) services in Thailand. METHODS Women of reproductive age in 40 000 nationally representative households responded to the Multiple Indicator Cluster Survey in 2005-2006. We used a concentration index (CI) to assess distribution of nine MCH indicator groups across the household wealth index. For each indicator we also compared the richest and poorest quintiles or deciles, urban and rural domiciles, and mothers or caregivers with or without secondary school education. FINDINGS CHILD UNDERWEIGHT (CI: -0.2192; P < 0.01) and stunting (CI: -0.1767; P < 0.01) were least equitably distributed, being disproportionately concentrated among the poor; these were followed by teenage pregnancy (CI: -0.1073; P < 0.01), and child pneumonia (CI: -0.0896; P < 0.05) and diarrhoea (CI: -0.0531; P < 0.1). Distribution of the MCH interventions was fairly equitable, but richer women were more likely to receive prenatal care and delivery by a skilled health worker or in a health facility. The most equitably distributed interventions were child immunization and family planning. All undesirable health outcomes were more prevalent among rural residents, although the urban-rural gap in MCH services was small. Where mothers or caregivers had no formal education, all outcome indicators were worse than in the group with the highest level of education. CONCLUSION Equity of coverage in key MCH services is high throughout Thailand. Inequitable health outcomes are largely due to socioeconomic factors, especially differences in the educational level of mothers or caregivers.
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Affiliation(s)
- Supon Limwattananon
- Khon Kaen University, Thanon Mitraparp, Amphoe Muang, Khon Kaen, 40002, Thailand.
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Prakongsai P, Patcharanarumol W, Tangcharoensathien V. Can earmarking mobilize and sustain resources to the health sector? Bull World Health Organ 2009; 86:898-901. [PMID: 19030701 DOI: 10.2471/blt.07.049593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Phusit Prakongsai
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
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Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: Lessons from Thailand. Innovations in Health System Finance in Developing and Transitional Economies 2009. [DOI: 10.1108/s0731-2199(2009)0000021006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. Adv Health Econ Health Serv Res 2009; 21:57-81. [PMID: 19791699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This chapter assesses health equity achievements of the Thai health system before and after the introduction of the universal coverage (UC) policy. It examines five dimensions of equity: equity in financial contributions, the incidence of catastrophic health expenditure, the degree of impoverishment as a result of household out-of-pocket payments for health, equity in health service use and the incidence of public subsidies for health. METHODOLOGY The standard methods proposed by O'Donnell, van Doorslaer, and Wagstaff (2008b) were used to measure equity in financial contribution, healthcare utilization and public subsidies, and in assessing the incidence of catastrophic health expenditure and impoverishment. Two major national representative household survey datasets were used: Socio-Economic Surveys and Health and Welfare Surveys. FINDINGS General tax was the most progressive source of finance in Thailand. Because this source dominates total financing, the overall outcome was progressive, with the rich contributing a greater share of their income than the poor. The low incidence of catastrophic health expenditure and impoverishment before UC was further reduced after UC. Use of healthcare and the distribution of government subsidies were both pro-poor: in particular, the functioning of primary healthcare (PHC) at the district level serves as a "pro-poor hub" in translating policy into practice and equity outcomes. POLICY IMPLICATIONS The Thai health financing reforms have been accompanied by nationwide extension of PHC coverage, mandatory rural health service by new graduates and systems redesign, especially the introduction of a contracting model and closed-ended provider payment methods. Together, these changes have led to a more equitable and more efficient health system. Institutional capacity to generate evidence and to translate it into policy decisions, effective implementation and comprehensive monitoring and evaluation are essential to successful system-level reforms.
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Affiliation(s)
- Phusit Prakongsai
- International Health Policy Program, Ministry of Public Health, Thailand
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Tangcharoensathien V, Prakongsai P. Regional public health education: current situation and challenges. Bull World Health Organ 2008; 85:903-4. [PMID: 18278242 DOI: 10.2471/blt.07.048587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Limwattananon S, Tangcharoensathien V, Prakongsai P. Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand. Bull World Health Organ 2007; 85:600-6. [PMID: 17768518 PMCID: PMC2636377 DOI: 10.2471/blt.06.033720] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Revised: 01/05/2007] [Accepted: 01/14/2007] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To estimate the incidence and describe the profile of catastrophic expenditures and impoverishment due to household out-of-pocket payments, comparing the periods before and after the introduction of universal health care coverage (UC). METHODS Secondary data analyses of socioeconomic surveys on nationally representative households pre-UC in 2000 (n = 24,747) and post-UC in 2002 (n = 34,785) and 2004 (n = 34,843). FINDINGS Households using inpatient care experienced catastrophic expenditures most often (31.0% in 2000, compared with 15.1% and 14.6% in 2002 and 2004, respectively). During the two post-UC periods, the incidence of catastrophic expenditures for inpatient services at private hospitals was 32.1% for 2002 and 27.8% for 2004. For those using inpatient care at district hospitals, the corresponding catastrophic expenditures figures were 6.5% and 7.3% in 2002 and 2004, respectively. The catastrophic expenditures incidence for outpatient services from private hospitals moved from 27.9% to 28.5% between 2002 and 2004. In 2000, before universal coverage was introduced, the percentages of Thai households who used private hospitals and faced catastrophic expenditures were 35.8% for inpatient care and 36.0% for outpatient care. Impoverishment increased for poor households because of payments for inpatient services by 84.0% in 2002, by 71.5% in 2004 and by 95.6% in 2000. The relative increase in out-of-pocket impoverishment was found in 98.8% to 100% of those who were poor following payments made to private hospitals, regardless of type of care. CONCLUSION Households using inpatient services, especially at private hospitals, were more likely to face catastrophic expenditures and impoverishment from out-of-pocket payments. Use of services not covered by the UC benefit package and bypassing the designated providers (prohibited under the capitation contract model without proper referrals) are major causes of catastrophic expenditures and impoverishment.
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Affiliation(s)
- Supon Limwattananon
- Department of Social and Administrative Pharmacy, Khon Kaen University, Khon Kaen, Thailand
| | | | - Phusit Prakongsai
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand
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Jan S, Bian Y, Jumpa M, Meng Q, Nyazema N, Prakongsai P, Mills A. Dual job holding by public sector health professionals in highly resource-constrained settings: problem or solution? Bull World Health Organ 2005; 83:771-776. [PMID: 16283054 PMCID: PMC2626421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
This paper examines the policy options for the regulation of dual job holding by medical professionals in highly resource-constrained settings. Such activity is generally driven by a lack of resources in the public sector and low pay, and has been associated with the unauthorized use of public resources and corruption. It is also typically poorly regulated; regulations are either lacking, or when they exist, are vague or poorly implemented because of low regulatory capacity. This paper draws on the limited evidence available on this topic to assess a number of regulatory options in relation to the objectives of quality of care and access to services, as well as some of the policy constraints that can undermine implementation in resource-poor settings. The approach taken in highlighting these broader social objectives seeks to avoid the value judgements regarding dual working and some of its associated forms of behaviour that have tended to characterize previous analyses. Dual practice is viewed as a possible system solution to issues such as limited public sector resources (and incomes), low regulatory capacity and the interplay between market forces and human resources. This paper therefore offers some support for policies that allow for the official recognition of such activity and embrace a degree of professional self-regulation. In providing clearer policy guidance, future research in this area needs to adopt a more evaluative approach than that which has been used to date.
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Affiliation(s)
- Stephen Jan
- Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel Street, Londoin WC1E 7HT, England.
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