Universal health coverage: A patientcentred

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Universal health coverage: A patientcentred vision Co-Chairs Orajitt Bumrungskulswat, Heart to Heart Foundation, Thailand Rachel Seal-Jones, IAPO Speakers Jon Pender, GlaxoSmithKline and

1 Universal health coverage: A patientcentred vision Co-Chairs Orajitt Bumrungskulswat, Heart to Heart Foundation, Thailand Rachel Seal-Jones, IAPO Speakers Jon Pender, GlaxoSmithKline and International Federation of Pharmaceutical Manufacturers & Associations (IFMPA) Evelyn Benmergui, Venezuelan Federation of Associations of People with Learning Disabilities and their families Penney Cowan, American Chronic Pain #GPC2014

2 Session Outline The session will explore : Current models of universal health coverage How these models can be adapted globally to different contexts The factors needed to move towards UHC #GPC2014

3 Universal Health Coverage in Thailand : Collaborative Patient Care Orajitt Bumrungskulswat Heart to Heart Foundation National Health Security Office

By early 2001, three public financing schemes covers 96% of Thai population, now= 99% CSMBS SSS UCS Introduced in 1960s 1990s 2002 Beneficiaries Govt.

4 By early 2001, three public financing schemes covers 96% of Thai population, now= 99% CSMBS SSS UCS Introduced in 1960s 1990s 2002 Beneficiaries Govt. employees & dependents, Private sector employees Rest of population retirees Pop Coverage 8% 15% 76% Funding Govt. budget Payroll contribution, Tripartite Govt. budget Payment to health facilities Fee-for-service, reimbursement & DRG for IP Source: Bureau of Policy and planning, NHSO Inclusive capitation Additional payments for utilization rate, chronic conditions, fee schedule for high cost services, and fixed amount for AE, dental care, maternity capitation for OP and PP, DRG weighted global budget for IP

5 National Health Security Act Enacted on 11 November 2002 Provides participation of people, patient, NGOs, private organization and local government in the Health Security System - 5 representatives from NGOs, 5 from local govt. in two Board s members and in Regional and Provincial Sub Board s members. - Establish Independent from the Accused Complaint Center operated by people/patient organization according to the Act section 50(5)

6 Universal Health Coverage (UHC) Policy Objective To improve health of all Thai people by providing equal access to quality of care in accordance with health need of population on equitable basis To prevent Thai households from being in catastrophic situations when facing with high cost care

7 Coverage, the 49 millions of Thais covered by the universal healthcare coverage scheme have received equal protection and ensure their equal access to public health services including health promotion, disease prevention, curative care and rehabilitation Coverage of health care: 2001 CSMBS SSS PI other MWS HC UC uninsure 2011 CSMBS SSS other UC

8 Basic Benefit Package Medical Treatment and Rehabilitation High Cost Medical Treatment Prevention and Promotion Service Emergency Medical Care (Harmonize of 3 schemes) Preliminary Assistance for Customers and Service Providers (No Fault Compensation)

9 People Participation Mechanisms in Health Security System National level Health Secur. Board Quality Contr. Board Sub Committee Regional level Provincial level Local level Region. HS Subcomm. Provincial HS Subcomm. Provinc. Qual. Contr. Subcomm. Compensat. Subcomm. Comm. Health Fund Comm. People HS Coordination and complaint Center People (PP, Provider, Consumer, local autho.)

10 High Cost Chronic Patient Network in Health Security System Heart Patient Network Diabetic Patient Network Cancer Patient Network เคร อข ายผ ป วยโรคไต Renal Patient Network เคร อข ายผ ป วยโรคไต Disability Network AIDs Patient Network เคร อข ายผ ป วยโรคเอดส 10

11 Collaborative Patient Care (NHSO & HHF in hospitals and communities) Collaboration since Promote good model of Humanize Healthcare and good collaboration between chronic disease patient and healthcare provider. Build up capacity of healthcare professionals and improve quality of services and referral system. Promote patient support groups/volunteers and Friendship support centers in hospitals and communities. Support activities of patient support groups both in hospital and community and create patient networks Provide knowledge and information about self care, health promotion and patient centred HC to patients/volunteers. 11

12 Results/Outcome Good relationship between patient and healthcare provider (reduce confront and complaints) Chronic disease patient have good/continuum care by professionals with good quality service. Emerging of Humanize Healthcare or PCH in every level of hospital and efficient referral system. Emerging of volunteer/patient support groups and networks in order to mutual support of health promotion both in and outside hospitals widely. Better access of healthcare with coordination between healthcare units, local authorities and communities. 12

13 Challenges for further reforms Harmonization of the three main schemes is challenging as individual fund has its own legal framework and governing board Burden Of Disease challenges Increased diseases burden from chronic NCD Little success in controlling traffic injuries Revitalizing HIV prevention in the light of universal ART Health systems capacity to cope with Increased workload and very strained health workforces Decentralization context threats and opportunities Public private dialogues, better trust and collaboration Medical tourism and internal brain drains Long term financial sustainability Universal access to renal replacement therapy-heavy fiscal pressure Second and third lines ARV Medical technology advancement-main drivers in OECD 13

14 How to hold partners accountable in UHC The UCS has emphasized the importance of protecting the rights to engagement of the people, patients, and all partners. The active engagement of the people allow their Voice to be heard and transformed into policies and implementations. The strong partnership between all partners : shared objectives and commitments (a shared agenda) more dialogue and negotiation building and maintaining the commitment - policy proposals development 14

15 Thank you for your attention 15

16 Presentation Title Jon Pender Chair, Global Health Committee, #GPC2014

17 The UHC Dilemma #GPC2014

18 Considerations No one size fits all in health systems design: every country is unique and tailored approaches are needed Common challenges still remain and could be addressed by realizing 8 key principles UHC is a powerful and important enabler to achieve healthier societies #GPC2014

19 8 principles: a common thread for UHC Equitable access Innovation Efficiency Choice Quality Adaptability Inclusiveness Availability #GPC2014

21 Affordable Health Care Act Obamacare American Chronic Pain Association

22 Everyone should have health care American Chronic Pain Association

23 Everyone should have health care Under the Affordable Care Act (ACA), patients can secure an affordable health plan through the new health insurance marketplace in their state, which began Oct. 1, Enrollment for 2014 will remain open through March 31. American Chronic Pain Association

24 Obamacare Pros 1. Reduce health care cost by making it available to 32 million uninsured 2. Preventative services are free 3. Government will pay states for Medicaid for those who can t afford insurance 4. Don t qualify receive tax credit if income is below 400% poverty level American Chronic Pain Association

Obamacare Pros 5. Cannot deny coverage for preexisting conditions. 6. Children covered until age 26 by parents 7. Eliminate the $2,800 up-front cost of Medicare 8.

25 Obamacare Pros 5. Cannot deny coverage for preexisting conditions. 6. Children covered until age 26 by parents 7. Eliminate the $2,800 up-front cost of Medicare 8. Keep your current insurance 9. Doesn t apply to employers with under 50 people 10. Act lowers the budget deficit by $143 billion American Chronic Pain Association

26 What do immigrant families need to know about the Marketplace? IT IS A MAZE American Chronic Pain Association

Obamacare Cons 1. 30.1 million had insurance and many have had it cancelled. To obtain a replacement would be at a much higher cost. 2.

27 Obamacare Cons million had insurance and many have had it cancelled. To obtain a replacement would be at a much higher cost. 2. Between 3-5 million people could lose their companysponsored insurance. 3. Increased coverage may actually raise overall health care costs in the short term. American Chronic Pain Association

Obamacare Cons 4. If you don t purchase insurance by March 31, 2014, and don t qualify for Medicaid, will be assessed a tax of $95 in 2014, $325 in 2015 and $695 in 2016. 5.

28 Obamacare Cons 4. If you don t purchase insurance by March 31, 2014, and don t qualify for Medicaid, will be assessed a tax of $95 in 2014, $325 in 2015 and $695 in About 4 million people will pay the tax, cost $54 billion. 6. Taxes were raised in 2013 on one million individuals to cover cost of Medicaid. American Chronic Pain Association

Obamacare Cons 7. In 2013, some businesses paid increased taxes which might discourage hiring new employees. 8. Deductions for medical expenses were increased. 9.

29 Obamacare Cons 7. In 2013, some businesses paid increased taxes which might discourage hiring new employees. 8. Deductions for medical expenses were increased. 9. Pharmaceuticals companies pay an extra $84.8 billion in fees over next ten years to pay cover the Medicare cost. 10. In 2018 insurance companies will be asked a 40% excise tax on top level plans. These are plans with $10,200 per individual and $27,500 for families. American Chronic Pain Association

30 Obamacare Even three years after it s been approved, 54% of American opposed the Act and many groups are still working to repeal Obamacare. American Chronic Pain Association

31 Obamacare So the questions is: have we improved access to health care or made it more difficult? It depends on who you talk to. American Chronic Pain Association

32 Discussion What similarities are there between the industry perspective on UHC and the patient principles of UHC? What do you think worked in the models shared and what do you think didn t work? Were they equitable? Affordable? Provide high quality healthcare? How do these models compare with your own system? What would a patient-centred healthcare system look like? #GPC2014

33 Contact Us Please visit our website to find out more: Tel: Fax: #GPC2014

Universal Health Coverage: Thailand experience

Universal Health Coverage: Thailand experience Ekachai Piensriwatchara, MD. Walaiporn Patcharanarumol, PhD. 17 July 2017 Yokohama, Japan ASEAN-Japan 15 July 2017 Statement of the Minister of Public Health,