Thailand's public payers

วารสารวิชาการสาธารณสุข ปี ที่ 29 ฉบับพิเศษ มกราคม - กุมภาพันธ์ 2563 : Thai Drug Systems 2020 (hsri.or.th)
https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---soc_sec/documents/publication/wcms_secsoc_6612.
https://www.researchgate.net/publication/324172288_Strategic_purchasing_and_health_system_efficiency_A_co
https://www.researchgate.net/publication/349198521_Purchasing_Case_Study_Thailand%27s_Universal_Coverag

Insurance types
Universal Coverage Scheme (UCS) Social Security Scheme (SSS)

Components
For the rest not covered by SSS and For formal workers, excluding
Beneficiaries CSMBS (cover ~75% of population per dependents (cover ~17% of population
2020) per 2020)
Financing authority Social Security Office of Ministry of
National Health Security Office (NHSO) Labor (MoL)
bodies
Social Security Fund under MoL -->
UCS budget (from MoPH) -->
Budget source contributed from employers, employee
contributed from general taxation
and general taxation

Contracted public health centers and district hospitals, and contracted private
Provider options
hospitals / clinics

Outpatient service
Capitation (per head per year) Capitation (per head per year)
payment method

- Capitation
Inpatient service Bundled payment according to - Additional bundled top-up according
payment method Diagnosis Related Group System to the severity of disease with close-
(DRGs)
ended budget

Drug benefit Essential Drugs included in National List of Essentional Medicines (NLEM)
package -

Formulary List National List of Essentional Medicines (NLEM)

Formulary List
National Drug System Development Committee, under MoH
Stakeholders

Coverage of non- Few, expensive non-essential anti-cancer drugs might be used and reimbursed,
essential but under a very limited payment scheme
medicines
Other stakeholders 1. HiTAP for NLEM consideration

Procurement
By NHSO By SSO
function

Public Hospital : Pharmacy and Therapeutic Committees (PTC) formulating an annual procurement plan for me
Formulary
Key consideration : cost-effectiveness, affordability, financial burden of households, social and ethical issues, and
factors
Challenges : tool for assesseent of cost-effectiveness and appropriate funding mechanisms under the cons

Procurrement : 1. Managed by MoF, using reference price established by MoH (Office of Permanent Secretary
Process: 2. Bidding using electronic system (e-auction, e-market, e-bidding, e-catalog)

Other References (below)

 Ministry of Public Health
agencies:
1 Office of the Minister
Office of the Permanent Secretary
2
3 Department of Medical Services
4 Department of Disease Control
Department for Development of
Thai Traditional and Alternative
5 Medicine
6 Department of Medical Sciences
Department of Health Service
7 Support
8 Department of Mental Health
9 Department of Health
10 Food and Drug Administration

(1) (PDF) Thailand Health Financing Review 2010 (researchgate.net)

 Stakeholders involved in drug listing process of National List of
0 (hsri.or.th) Revisiting Roles of Health Technology Assessment on Drug Policy
ation/wcms_secsoc_6612.pdf
h_system_efficiency_A_comparison_of_two_financing_schemes_in_Thailand
d%27s_Universal_Coverage_Scheme

Civil Servant Medical Benefit Scheme

(CSMBS)

For civil servants (cover ~8% of

population per 2020) 1. Requesters

Comptroller’s General Department of - By demand: healthcare providers (major

Ministry of Finance (MOF) hospitals), medical associations, or patient
organizations
MoF fund --> contributed from general - by supply: Pharma & med-dev suppliers
taxation

Free choice of all public

hospitals/clinics, and contracted
private hospitals for only emergency
cases

Fee-for-service at the price providers

charge

Bundled payment according to

Diagnosis Related Group System
(DRGs)

- Essential Drugs included in NELM

- Non-essential Drugs (beyond NELM)
listed in access program (eg. Oncology
Prior Authorization program,
Rheumatic PA, Derma PA), or in case of
the clinical necessitities declared -->
will be reimbursed on a fee-for-service
basis without ceiling

- NELM
- Access program
TBC (who manages the access
program?)

Case on case basis

- Non-essential medicines listed in
access program
 TBC

By CGD

l procurement plan for medicines and medical supplies. The plan must be annually submitted to the MoH

cial and ethical issues, and program feasibility

echanisms under the constraints of limited resources, especially for targeted drug or biological product which are the future trends.

ce of Permanent Secretary)

NHSO Executive
sting process of National List of Essential Medicines (NLEM)
ology Assessment on Drug Policy in Universal Health Coverage in Thailand: Where Are We? And What Is Next? | Elsevier Enhanced Reader

2. MoPH (Ministry of Public Health)

3. National Drug System Development

Committee (under MoPH)
ders (major
ns, or patient Submit proposal and
dossier - NLEM Sub Committee (Secretariate,
Theraupetic WGs, Health economics WGs)
ev suppliers -
--> Develop NLEM and reference price
hich are the future trends.
e? And What Is Next? | Elsevier Enhanced Reader

4. HiTAP (Health Intervention and Technology Assessment Program)

Committee

--> HiTAP recommendation can accelerate drug listing in NLEM

Collaboration for
health technology
assessment (HTA)

5. Payers
- NHSO, for UCS
- SSO, for SSS
- CDG, for CSMBS

--> Budget controllers, purchaser

Collaboration for
proposal and
budget review
Microsoft Word - Meet.ea.2_1.doc (ilo.org)
Assessment Program)

listing in NLEM
Key insights for PHI's significance in private market

a.

b.

c.
1
2
3
4
Key insights for PHI's significance in private market

Private health insurance companies play very limited additional role in Thailand due to their high premium rate and very stri
https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---soc_sec/documents/publication/wcms_secsoc_6612.pdf

PHI: 10% of healthcare expenditure in 2015

https://www.finddx.org/wp-content/uploads/2020/01/6A_Thailand_Healthcare-profile.pdf

Notable private health insurers

Bupa
AXA
Pacific Cross
Dhipaya
Top 10 Health Insurance companies in Thailand | Mister Prakan, https://thethaiger.com/guides/best-of/top-5-insurance-comp
ry strict under-write policies.

Out-of-pocket expenditure (% of current health expenditure) - Indonesia | Data (worldbank.org)

Domestic general government health expenditure (% of current health expenditure) - Indonesia | Data (worldbank.org)

-companies-for-expats-in-thailand
| Data (worldbank.org)
Indonesia's public payer

Insurance types
National Health Security (Jaminan Kesehatan Nasional / JKN)

Components
Beneficiaries All eligible residents
Financing authority bodies BPJS Kesehatan

Budget source Premium contributed from members

all public hospitals / clinics, and contracted private hospitals /

Provider options
clinics

- Primary care: Capitation

Outpatient service payment - Secondary & tertiary care: Bundled payment according to
method
Diagnosis Related Group System (DRGs)

Inpatient service payment Bundled payment according to Diagnosis Related Group System
method (DRGs) or known as Case Base Groups (CBGs)

Drug benefit package Essential Drugs included in National Formulary (e-Fornas)

Formulary List
Formulary List Stakeholders
Coverage of non-essential
medicines
Procurement function
Other stakeholders
National Formulary (e-Fornas)
Fornas Committee, under MoH
TBC
by LKPP: act as the national procurement agency --> manage e-
catalogue, e-purchasing, and bidding process (not a key decision-
maker)
1. LKPP

Proses Pendaftaran Produk ke e-Katalog LKPP | Pengadaan (Eprocurement)

Public payers' stakeholder mapping

No Key players Responsibilities in NHS

1 MoH a. Manage National Formulary

b. Manage reference price lists
c. Manage ceiling of capitation and
bundled costs for covered services
d. Manage stock demand and monitor
demand realization
e. Advise procurement process (including
bidding and negotiation), in collaboration
with LKPP (LKPP is the national
procurement agency)

2 BPJS Kesehatan The single payer in NHS --> manage

membership, collecting premiums,
administering contracts with providers
and paying providers, and claim process
and payment
 Relevant department within institution

Directorate of Pharmaceutical and Medical Devices

Directorate of Pharmaceutical and Medical Devices
Directorate of Financing Policy and Healthcare
Desentralization
Directorate of Pharmaceutical and Medical Devices

Directorate of Financing Policy and Healthcare

Desentralization

TBC
1
2
3
4
5
Private Health Insurance accounted for < 2% of national health expenditure (2014)

https://apps.who.int/iris/bitstream/handle/10665/254716/9789290225164-eng.pdf

Private Health Insurers' Formulary Team

Most of private insurers do not have Drug Formulary List. They include any approved medicines by Indonesian FDA (BPOM) th
Thus, they manage the diseases to be covered in the insurance products, but not the drug formularium

However, there is one notable private insurer, Mandiri InHealth that apply similar system like social insurance and develop the
Pharma companies need to go through listing process in Drug Formulary of InHealth, so their drugs can be eligible for reimbur

Direct Source: Market Access Manager, Novartis

Top Private Health Insurance

AXA
AIA
Prudential
Allianz
Manulife
https://www.mordorintelligence.com/industry-reports/indonesia-health-and-medical-insurance-market
https://assets.kpmg/content/dam/kpmg/id/pdf/id-ksa-insurance-in-indonesia.pdf