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not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board
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Health Systems and Financing:

Experiences from Thailand

Alia Luz
HITAP International Unit (HIU)
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Global Trend of Universal Health

Coverage (UHC)
More than 80
countries since
2010 have asked
the WHO for
technical assistance
in moving toward
UHC
UN December 2012
Resolution for UHC
made it a top
priority for the
WHO and other
IGOs and
multilateral
institutions
WHO Brief: Global Push For UHC.

Priority setting is indispensable!

Research should inform health policy in countries

to focus on their current health challenges and
make concrete recommendations - More Health
3
for Money

DEVELOPING EVIDENCE-BASED
POLICY MAKING AND CAPACITY
BUILDING
4

Summary of health insurance schemes

CSMBS
5 Million (8%)
Population
Beneficiaries Civil servant +
spouse + vertical
relatives
Source of
General tax
(~11,000
finance
Baht/Cap*)

Purchaser

Comptroller
General's
Department,
Ministry of
Finance

Providers

Public provider only,

Private in emergency
3,000 Baht/episode
No preventive care
No explicit exclusion
Special bed
OP: Fee-for-service
IP: DRG since 2009

Benefit package

Payment

SHI
9.84 Million (15.8%)
Employees in private
sector

UCS
47 Million (75%)
Those who are
not covered by
CSMBS and SHI
General tax
(2,100 Baht/Cap)

Tripartite from
employer, employee,
government rate 1.5%
of salary
Social Security Office, National Health
Ministry of Labour
Security Office

Public and private hospital more

than 100 beds (>60%
contractors are private)
Small number of limited
condition e.g. Non medical
plastic surgery
Capitation

Public and private

contracting unit for
primary care
Small number of limited
condition
Prevention & promotion
OP: Capitation
IP: global budget + DRG

Managing the benefit package:

gradual expansion of coverage
Negative list approach: comprehensive with few in the exclusion
list
No maximum ceiling of financial coverage, free at point of service,
High level financial risk protection

Extend coverage to high cost RRT

Initially excluded from UCS due to high cost (Kasemsup et al 2006).
RRT not cost-effective, long-term fiscal burden (Tangcharoensathien et al
2005), But catastrophic for UCS members (Prakongsai et al 2007).
Despite being cost ineffective, RRT was included by 2006
To prevent catastrophic spending and ensure equity across 3 Schemes
(Tangcharoensathien et al 2013). PD first was adopted (Tantivess 2013).

Processes of inclusion of new interventions

Rigorous economic evaluation: cost effectiveness + budget impact
Home-grown HTA capacities,
HITAP established in 2007 contribute significantly
Benchmark of one GNI per capita for one QALY gain (Tantivess et al 2009)

Institutionalized research capacity

Establishment of associated institutes such as HSRI,
HISRO, HITAP, IHPP
Contributed to evidence generation
Independent research institutes
Institutionalization of capacity

Health Intervention and Technology Assessment

Program (HITAP)
Established in 2007 to assess health interventions and
technologies efficiently and transparently
Develop systems and mechanisms to promote the
management of health technology and appropriate health
policy determination
Distribute research findings and educate the public

HTA process at HITAP

Dissemination of results and recommendations
Publication, presentation and dialogues
HITAP, funding agencies, the media, consumer groups and other NGOs

Conducting HTA research

Consultation and technical
collaboration
HITAP, experts and
relevant stakeholders

Topic Selection
Consultation

Appraisal of results
Peer review, submission
of comments and
discussion
HITAP, experts, private
business/industry,
policy makers,
consumers/beneficiaries

HITAP, policy makers, healthcare providers,

consumer groups, professional associations, etc.

Development of the National List of Essential Medicine (NLEM) (5

topics/year)
Development of UC Benefit Package (5 topics/year)

10

RECOMMENDED ACTIVITIES AND

AREAS OF WORK
11

1) Work with local researchers and institutes to build

capacity and help them establish their own mechanisms

Introducing HTA
concepts and
principles for Free
Drugs List
development in
Nepal

Technical Assistance for the Myanmar Maternal

and Child Health Voucher Scheme feasibility
study and implementation assessment

Capacity
Building and
Technical
support in the
Philippines for
economic
evaluations

2) Implement long-term capacity

building programs, e.g. HITAP

3) Develop the countrys research institutes

through the INNE model

Develop the INNE model:

Individual, Node, Network and Environment
Key factors

A critical mass of qualified researchers (good at head, hand,

heart)

Institutional umbrella for them to work in a sustainable

way
Knowledge brokers and a platform where evidence
interacts with policy makers
Produce policy relevant research with political impartiality
Long term fellowship program
Linkages and supports from international partners and
civic groups

4) Conduct policy-relevant research that is selected

through a transparent and participatory process
Included:
Not Included:
Imiglucerase is an enzyme for
Absorbent products for urinary
Gaucher disease treatment
and fecal incontinence among
Budget impact of using imiglucerase
disabled and elderly people in
in GD1 patients: 5.3 M USD in 5
Thailand topic was proposed by
years
lay people group
Increase: 24 M USD in 20 years
ICER: 4,300 USD per QALY gained
Budget impact: 90 M USD per
Imiglucerase is NOT COSTyear
EFFECTIVE for treating GD1 patients,
although it can help patients to live The SCBP decided to NOT
longer and increase quality of life
INCLUDE the absorbent products
The Subcommittee for the
in the benefit package according
development of the NLEM decided
to very high budget impact,
to INCLUDE imiglucerase in the
administrative systems, and
NLEM since it can prevent
environmental issues
15
impoverishment

Conclusion: Potential Areas of Work

1. Developing evidence-based decision making

Doing policy relevant research that addresses the

countrys needs: health technology assessments,
health policy and systems research, health
financing research
Instituting key platforms for evidence informed
decisions in order to link policy and research

2. Interactive learning through action

Research must be done alongside local researchers

Long-term capacity building nationally and in the
region

3. Developing INNE for countries - building strong

institutional capacities nationally and
internationally

Kob Khun Kha

Thank you for your attention

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