Abstract
Strategic purchasing is an essential health financing function. This paper compares the strategic purchasing practices of Thailand’s two tax-financed health insurance schemes, the Universal Coverage Scheme (UCS) and the Civil Servant Medical Benefit Scheme (CSMBS), and identifies factors contributing to successful universal health coverage outcomes by analysing the relationships between the purchaser and government, providers and members. The study uses a cross-sectional mixed-methods design, including document review and interviews with 56 key informants. The Comptroller General Department (CGD) of Ministry of Finance manages CSMBS as one among civil servant welfare programmes. Their purchasing is passive. Fee for service payment for outpatient care has resulted in rapid cost escalation and overspending of their annual budget. In contrast, National Health Security Office (NHSO) manages purchasing for UCS, which undertakes a range of strategic purchasing actions, including applying closed ended provider payment, promoting primary healthcare’s gate keeping functions, exercising collective purchasing power and engaging views of members in decision making process. This difference in purchasing arrangements resulted in expenditure per CSMBS member being 4 times higher than UCS in 2014. The governance of the purchaser organization, the design of the purchasing arrangements including incentives and use of information, and the institutional capacities to implement purchasing functions are essential for effective strategic purchasing which can improve health system efficiency as a whole.
Highlights
Purchasing is one among three key health financing functions [1], involving the transfer of pooled funds to healthcare providers to secure services for a population
This paper focuses on efficiency as it is measured by expenditure per member
Similarities are the dominant role of public healthcare providers and comprehensive benefit package; both schemes are managed by the public agencies (CGD and National Health Security Office (NHSO)) which are financed by general tax through an annual budget allocation
Summary
Purchasing is one among three key health financing functions [1], involving the transfer of pooled funds to healthcare providers to secure services for a population. Strategic purchasing has the potential to increase health system equity, efficiency and quality [2, 3]. A multi-country study of strategic purchasing arrangements was undertaken by the Resilient and Responsive. International Development (DFID) for the benefit of developing countries. The views expressed and information contained in it are not necessarily those of or endorsed by DFID, which can accept no responsibility for such views or information or for any reliance placed on them
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