Using U'lisa'on Data to Es'mate Future Demand of Health Care in Thailand Under The Na'onal Health Security

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1 Using U'lisa'on Data to Es'mate Future Demand of Health Care in Thailand Under The Na'onal Health Security Supasit Pannarunothai, MD, PhD Centre for Health Equity Monitoring Founda<on Phitsanulok, Thailand The Sriwijaya Interna<onal Conference of Public Health (SICPH) 5 October 2017 in Palembang, Indonesia

2 Scope Universal health coverage in Thailand U<lisa<on data sets Methods of forecast Demand for medical specialists Demand for medical subspecialists Demand for other health professionals Lessons learnt 2

3 Universal health coverage in Thailand Since 2001 Thailand has reached UHC The Na<onal Health Security Office was set up in 2002 to manage new scheme for 75% pop The Social Security Scheme enacted since 1990, now covering 16% pop (formal workers) The Civil Servant Medical Benefit Scheme as a decree of fringe benefit covering 9% pop Three schemes set their own e-claim systems Inpa<ent payment method by Diagnosis Related Group (DRG) provided good health system data. 3

4 U'lisa'on data sets Inpa'ent services Outpa'ent services 4

5 Table 5.3 Utilization of specialized hospital services within the UCS, Open-heart surgery Percutaneous transluminal coronary angioplasty (PTCA) Access to thrombolytic agent among STEMI patients (%) Renal replacement therapy Antiretroviral therapy Cataract Haemophilia Cleft lip & cleft palate STEMI: ST elevated myocardial infarction. Source: NHSO (2011a). HIT Thailand

6 Figure 5.2 Utilization rate of open-heart surgery of UCS members by province, Less than and more Source: Srithamrongsawat et al. (2008). HIT Thailand

7 Figure 4: Health system developments, ,400 1,300 1,200 1,100 1, Hospitals , , ,000 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Doctors and nurses All District Other public Private Doctors Nurses 1,400 1,300 1,200 1,100 1, Population per bed 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 Population per doctor and nurse Patcharanarumol et al 2011 in HSRI Doctor Nurse 7

8 Supply side in Indonesia & Thailand Indonesia Thailand Hospital beds/10, Physicians/100, Nurses/100, Midwives/100, USAID

9 Demand and gap in Indonesia Table 5-2: Current Capacity and Future Demand in I Service Current Demand in ca~acb 2020 (2m5) Hospital beds W~th prevalence rate change W~thout prevalence rat 64,100 change Physicians 27,191 World Bank

10 Figure 17: Magnitude of population ageing, Thailand and Southeast Asia Sources: Institute for Population and Social Research, Mahidol University, Population Projections for Thailand, , 2006; and United Nations, Department of Economic and Social Affairs Division, World Population Ageing , Population Division, New York HSRI 2012

11 Methods of forecast Popula<on ra<o Health needs method Health demands method Service target method; adjusted service based Budget driven Workloads; work points Wai<ng list Professional group planning model Needs assessment model Segal et al 2008; Thanawut & Upakdee

12 Demand for medical specialists Specialists Major Diagnostic Category/ Disease Cluster for workload calculation Ophthalmologist MDC02 (Disease and disorder of the Average time for surgical DCs in MDC02 eye) Otolaryngologist MDC03 (Disease and disorder of ear, Average time for surgical DCs in MDC03 nose and throat Orthopaedist MDC08 (Musculoskeletal system) Average time for surgical DCs in MDC08 Neurosurgeon MDC01 (Nervous system) Average time for surgical DCs in MDC01 OG MDC13 (Female reproductive Average time for surgical DCs in MDC13 and 14 system), MDC14 (Childbirth) Surgeon Surgical DRG except all above Average time for all other surgical DCs Anaesthesiologist Surgical cases of all above Half of average time for all surgical DCs Paediatrician Medical DRG except all above, age Average length of stay of DRG for ward round 0-18 Medical internist Medical DRG except all above, age >18 Average length of stay of DRG for ward round Phanthunane, Pannarunothai, Pakaiya

13 Study framework Health needs -Treated pa<ents -Untreated pa<ents -Hospital types -Demographics Doctors in prac'ce -Working hours -Work loads -Work processes -Availability/ Produc<vity of clinical <me -Demographic profile -Geographic distribu<on Entry Cer<fica<on Exit Re<rement -Career choice -Migra<on

14 Demand for Internal Medicine 2009 and Female 2021 Male 2021 Female 2009 Male

15 Demand for surgeons in Thailand Persons Male2009 Female2009 Mael2021 Females Age groups Phanthunane & Pannarunothai 2012

16 Demand for neurosurgeons Thailand Persons Male2009 Female2009 Mael2021 Females Age groups Phanthunane & Pannarunothai 2012

17 Demand for 2021 and expected supply!12,000!!!10,000!!!8,000!!!6,000!!!4,000!! Year!2021! Expected!!2,000!!!"!!!! Ana! ENT! Eye! Med! OG! Ort! Pae! Sur! N!Sur!

18 Agreed conceptual framework Total Minutes of care Other MDCs of other subspecialists Medical & surgical DRGs (severe cases) Same lists of ICD-10/ICD-9-CM codes Es'mate demand for subspecialists ç ç ê MDC(s) of the Subspecialist Medical DRGs (severe cases) Lists of ICD-10/ ICD-9-CM codes ê ç ç Same MDC(s) of the Subspecialist but Surgical DRGs (severe cases) Same lists of ICD-10/ ICD-9-CM codes Pannarunothai et al 2016

19 Demand for medical subspecialists Table 1. Allocation of Major Diagnostic Category and disease and procedure codes to subspecialists Subspecialty MDC ICD-10 ICD-9-CM Neurology Respiratory Cardiology Gastroenterology and Hepatology 06, Rheumatology Endocrinology Nephrology Hematology 16, Infectious Disease 18, Oncology Carcinoma as principal diagnosis Leelarasamee, Intaragumtornchai, Pannarunothai et al

20 Demand for medical subspecialists Table 3. Time (minutes) needed for subspecialist care and proportion of consultation as responded by the IM subspecialty Associations First visit (min) Subsequent visit (min) Inpatient Referral from peers in surgical subspecialists % of ICD-10 (A1) Neurologist By each ICD-10 % of ICD-9-CM (B1) By each ICD-9-CM Cardiologist By each ICD-9-CM Gastroenterologist and hepatologist Referral from other subspecialists % of ICD-10 (A2) By each ICD-10 % of ICD-9-CM (B2) By each ICD-9-CM 15 By each ICD-9-CM First visit (min) Outpatient Subsequent visit (min) Endocrinologist Nephrologist * 30 Oncologist Rheumatologist Hematologist Pulmonologist Infectious disease specialist A1, A2, B1, B2 were the referral or consultation rates as described in Figure 1 * 10 minutes for peritoneal dialysis or hemodialysis case of subsequent visit Leelarasamee, Intaragumtornchai, Pannarunothai et al 2017 % of ICD-10 20

21 Number needed by assump'ons 1, Regional Neuro Cardio GI Endocrine Nephro Onco 200 Regional 100 Teaching Excess Neuro Cardio GI Endocrin Nephro Onco Different assump<ons give different number of subspecialists needed Teaching Excess -1,000 When compared with the exis<ng number of subspecialists, the exis<ng number of oncologists was only 25 percent of the number needed; while the exis<ng number of cardiologists was 87 percent of the number needed. 21

22 Demand for den'sts specialists Specialty Public Private Total Public Private Total General dentists 2,063 1,528 3,591 9,956 4,969 14,925 Oro-Maxillofacial ,190 1,187 2,376 Oral surgeons Endodontists Periodontists Paediatric dentists Prosthodontists ,724 1,332 3,056 Orthodontists 53 3,901 3, ,683 12,941 Total 3,008 6,673 9,681 14,514 21,700 36,213 Suwatmaykin, Phanthunane, Pannarunothai

23 180, , , , ,000 80,000 60,000 40,000 20,000 Demand for hospital pharmacists กรณ ท 1 กรณ ท พ.ศ พ.ศ พ.ศ Scenario 1: Time based of all activities Upakdee et al 2015 Scenario 2: Time-based by level of service Scenario 3: P4P adjusted time based of all activities Scenario 4: P4P adjusted time cased by level of service

24 Discussion All assump<ons must be validated for befer es<ma<ons Not a projec<on % ac<ve subspecialists by age/sex Limita<on on private hospitals & others 24

25 Lessons learnt This evidence based health policy development with assump<ons for sustainable matching demand and supply of human resource for health was involved with ac<vi<es of pa<ent care All assump<ons must be validated for befer es<ma<ons Limita<on on data from private hospitals & others 25

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