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Assessment ofPrimary medical care

in The Universal Coverage Scheme

Thaworn Sakunphanit, Director, Health Insurance System Research Office (HISRO)

Health Systems Research Institute (HSRI).Ministry of Public Health

Ningxia, China8-9 May 2014

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• Design• Accessibility

– Take up rate• Responsiveness of Health Care System

– Patient experiences• Clinical Output/Outcome

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Risk

stra

tifica

tion Low

Medium

High Perio

dic

Scr e

e nin

gM

o di fy

risk

pro

g ra m

s

Acute care

Chronic careand

Terminal care

DiseaseManagement

Case Management

Source: Modified from Kongstvedt, Peter R (2001).The Managed Health Care Handbook.

Care Program

Design:Continuum of Care & Strategic Purchasing

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Note: CI range from -1 to + 1. Minus 1 (plus 1 ) means in favour of the poor (rich), or the poor (rich) disproportionately use more services than the rich (poor).

Health centre Community hosp Provincial hosp Private hosp Overall

2001 -0.294 -0.271 -0.037 0.431 -0.090

2003 -0.365 -0.315 -0.080 0.348 -0.139

2004 -0.345 -0.285 -0.119 0.389 -0.163

2005 -0.380 -0.300 -0.100 0.372 -0.177

-0.50

-0.40

-0.30

-0.20

-0.10

0.00

0.10

0.20

0.30

0.40

0.50

Concentration Index of OP service by type of health facilities: 2001 - 2005

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Ambulatory Services In-patient Services

Perc

ent

Acu

te il

lnes

s

Acc

iden

tan

d In

jurie

s

Chr

onic

illn

ess

Illne

ss

Acc

iden

t

Chi

ld d

eliv

ery

Oth

ers

Prev

entio

n

Legally eligible, but do not claim for benefits

No eligibility

Don’t answer

Source: HISRO (2014) Analysis from Health Welfare Survey 2011 of the NSO

• Vary among different benefits• Still occur in low-income group

Legally eligible, and claim for benefits

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Source: NHSO

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Vaccines coverage in 2012

Source: NHSO

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Vulnerable Group• Qualitative study of take up benefits of the UCS in 2

urban areas showed 3 groups of legally eligible elders: Take-up, Temporary non-take-up and Non-take-up.

• Determinants of take-up decisions comprise cost, time of traveling, quality of care and quality of services

Source: Suwanrada (2010) In-depth study on utilization benefits of the Universal Health Coverage Scheme of urban elder

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Responsiveness of Health Care System for Beneficiaries of UCS

02

46

810

excludes outside values

Dignity AutonomyConfidentiality CommunicationPrompt BasicAmenities

choice

Client orientationRespect for person

• Lower in high education groups• Higher in private health care facilities

Source: HISRO (2012) Study for Development of Responsiveness Tools.

Note: Exit survey of 7,500 beneficiaries from 43 facilities (hospitals) using Stratified three-stage sampling techniques

Dignity

Autonom

y

Confiden

tialit

y

Comm

unicatio

n

Prom

pt

Basic

Amen

ities

Choices

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Health Care System:Why did patient choose this facility?

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Note: Exit survey of 7,500 beneficiaries from 43 facilities (hospitals) using Stratified three-stage sampling techniques

Source: HISRO (2012) Study for Development of Responsiveness Tools.

Reason for using outpatient service in the facilitesClose to home/ easy to go to this facility 14.5%Services are good 14.2%It is contracted facilities 13.3%It has specialist for the diseases 12.7%It has high technology equipments 11.3%It has high reputation 10.9%I don't have to spend too much time for the Outpatient service 10.5%Price is reasonable 8.9%I was refered from other facilities 3.5%

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(ACSC): Preventable Admission

Source: HISRO (2010);: Analysis of Inpatient Database of CSMBS, and UCS .

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Distribution of Patients by Treatment Outcome

0%

20%

40%

60%

80%

100%

2003-4 2008-9 2003-4 2008-9 2003-4 2008-9

Hypertension Diabetic Hypercholesterol

No diag No trearment Uncontrol Control

Source: Aekplakorn (2010): Analysis of Health Exam Survey 2003-2004 and 2008-2009.

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Diabetic Miletus Type II

13 Source: Rangsin et al (2011, 2012 and 2013).

Note: Percentage of Controlled cases using Fasting Blood Sugar was a little bit higher than using HbA1c

Stratified cluster sampling from 600 facilities out of total 1013 CUPs (hospitals and clinics)

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• Accessibility and quality of Primary medical care in The UCS has continuously improved

• However, low take up rate of Primary medical care is still challenge issue of the UCS

• Appropriate measures for different target groups to improve health literacy, self care and people participation

• More efficient “Chronic Care Model” is also needed for better quality and outcome of health care services.

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• Increase role of Local governments in health care e.g. decentralization of Primary Medical Care to Local governments

• Mitigate and cope with Aging Society– Community-based Long Term Care, which need

harmonization of Primary Medical Care and Social care, will affect the design and implementation of Primary Medical Care.

• Economic growth, which creates more middle income group, will also create more pressure for better hospitality services and choices

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Thank You

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