The overall objective of the study tour was to improve the National Health Insurance Policy (including appending guideline and act) as a major reform document on the path towards universal health coverage.
The specific objectives were to:
- Observe and learn from the implementation of national health insurance in Thailand and the Philippines
- Learn how legal arrangements for the implementation of national health insurance influences its management and service delivery
The take home messages from Thailand include:
- The efficiency can be improved through:
- The rational use of healthcare by level, starting with primary care while ensure proper referral
- Long-term cost containment through capitation contract model
- The quality of services can be ensured through a sound accreditation and quality control system.
- Strengthening the health system including through infrastructure, human resources, quality service availability and in terms of access to population should be in place to build the trust of the population and for high coverage of population in the health insurance scheme.
- Partnerships with private sector actors including micro-institutions, civil society organisations, networks and association are important.
- Case-based purchasing is more cost efficient than fee for services and plan for a Diagnostic Related Group (DRG) system in the future.
- A good IT system and smooth operation and monitoring is essential to the operation and success of the health insurance scheme.
Take home learning from the Philippines included:
- Mandatory participation of whole population
- Mode of provider payment: fee for services or case-based payment
- Implementation of a Diagnostic Related Group (DRG) system in the future
For details see study tour report: