NHSO pushing reforms to unify national health security
The National Health Security Office (NHSO) is collaborating with multiple stakeholders to achieve single-payer healthcare reform.
On March 1, the NHSO board chaired by Public Health Minister Anutin Charnvirakul approved the implementation of the "national health security reform" roadmap, aiming to create unity and fairness in Thai health systems as well as ensure sustainable health financing.
The Cabinet acknowledged the roadmap during its meeting in December last year. It sets nine goals to be achieved in the coming years:
1. Unify the healthcare reimbursement system, starting from healthcare claims for health promotion and disease prevention services, primary care, community/home care, and inpatient care. Currently, there are three healthcare schemes – the Universal Coverage Scheme (UCS), Social Security Scheme, and Civil Servant Medical Benefits Scheme – run separately by various government agencies.
2. Unify government healthcare schemes under the same management, reimbursement system and benefits package, to increase Thailand's capacity to handle future health crises and emerging diseases. The management will include a shared beneficiary registration system, data exchange between healthcare schemes, and collaborative support for health facilities to improve the quality and standard of health services.
3. Prioritise health promotion and disease prevention programmes. The government shall set the budget for the programme separately from the budgets for medical treatment. The health promotion and disease prevention programmes are currently funded by the government's health budget, prioritising medical treatment rather than health promotion and disease prevention activities despite their considerable benefits for national health security.
4. Expand the long-term care programme to beneficiaries of all healthcare schemes while increasing its funding to address Thailand's ageing society. The programme is currently available only for UCS beneficiaries.
5. Health insurance must be compulsory for all migrant workers in Thailand. They shall have different health insurance options.
6. Set targets and indicators to achieve value-based healthcare. Pilot these in selected health facilities or health region areas.
7. Achieve Universal Coverage for Emergency Patients (UCEP) with a single-payer system, and define the reimbursement rates, terms, and criteria acceptable for state and private hospitals.
8. Establish a health database that includes data on people and health services in all healthcare schemes. The data, which shall be shared with relevant parties based on mutual benefits, shall cover vulnerable populations, including elderly and dependent patients.
9. Use data from the reimbursement system to design effective health systems for all stakeholders.
Dr Jadej Thammatacharee, NHSO deputy secretary-general, said the NHSO has set up a subcommittee on unifying the government's health insurance system to monitor and push the implementation of the reform roadmap. From January 2021 to December 2022, goals one, five, six, and eight mentioned above will be prioritised.
Dr Akejit Changloa, the subcommittee’s chairman, emphasised that health promotion and disease prevention programmes would reduce the burden caused by disease.
"To implement the programme effectively, we need to increase people's health literacy. We also need to empower vulnerable populations, including people with disabilities and dependent people, to help them move forward with the society," he said.
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