Health financing profile 2017 Thailand Context: Macroeconomic situation Population (million) General financing GDP (billion current US$) GDP per capita (current US$) GDP annual growth (%) Total government revenue* as % of GDP Population living below poverty line at $1.90 a day (2011 PPP) (% of population) Health financing CHE as % of GDP CHE per capita (current US$) GGHE-D as % of GDP GGHE-D per capita (current US$) Out-of-pocket payment as % of CHE 2015 2015 2015 2015 2015 3.76 216.31 2.90 166.76 11.81 2016 2016 2016 2014 2013 406.84 5907.9 3.2 19.63 0.04 % of GGE
Government spending on health 68.87
2016
Fig. 3: Domestic general government health expenditure (GGHE-D) as a % of general government expenditure (GGE), 2002–2015 18 16 14 12 10 8 6 4 2 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
CHE: current expenditure on health; GDP: gross domestic product; GGHE-D: domestic general government health expenditure * Total taxes and other revenues received by the national government (excluding grants)
* GGE series 2000-2014 referred to the Thailand government final consumption expenditure (GFCE), reported by WDI, World Bank; for 2015 is estimated by WHO HQ
Since 2000, how has health financing changed? Overall spending on health Fig. 1: Current expenditure on health as a % of GDP, 2000–2015 10 9 8 7 6 5 3.87 3.63 3.83 3.53 3.46 3.71 3.76 4 3.19 3.15 3.53 3.46 3.36 3.39 3.32 3.40 3.70 3 2 1 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 GGHE-D + external resources PVT-D CHE
Spending per person on health ($), by source Fig. 4: Current health expenditure (CHE), domestic general government health expenditure (GGHE-D), out-of-pocket (OOP) payment, per capita US$, 2000–2015 250 200 Per capita in US$ 150 100 50 0
% of GDP
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
CHE: current expenditure on health; GDP: gross domestic product; GGHE-D: domestic general government health expenditure; PVT-D: domestic private health expenditure *PVT-D refers to spending on health including voluntary health insurance schemes, enterprise financing schemes and household out-of-pocket payment
CHE
GGHE-D
OOP
Share of OOP expenditure (%) Fig. 5: OOP payment as a % of current expenditure on health, 2000–2015 90 80 70 60 % of CHE 50 40 30
Sources of health revenue Fig. 2: Share of revenues for health as a % of current expenditure on health, 2000–2015 90 80 70 60 50 40 30 20 10 0
% of CHE
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 GGHE-D PVT-D EXT
20 10 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
CHE: current expenditure on health; GGHE-D: domestic general government health expenditure; PVT-D: domestic private health expenditure; EXT: external health expenditure
Funding for health by donors Fig. 6: External health expenditure (EXT) as a % of current health expenditure (CHE), 2000–2015 30 25 20 % of CHE 15 10 5 0
Key messages ~~
Current expenditure on health (CHE) as a share of gross domestic product (GDP) has slightly increased since 2000, reaching 3.76%. Government spending on health has significantly increased from 12.6% in 2000 to average 16.2% of total government spending since 2002, linked to the UHC efforts. Out-of-pocket (OOP) expenditure has reduced from almost 34% of CHE in 2000 to less than 15%. There is a low incidence of catastrophic expenditure, as 2.0% of population spent more than 10% of their entire budget on health, and less than 0.4% spent more than 25%. Impoverishment due to health is low.
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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Sources 1. World development indicators. In: The World Bank [website]; 2017 (https://data.worldbank.org/indicator/, accessed 23 November 2017). 2. Indicators and data: In: WHO Global Health Expenditure database [online database] updated 20 November 2017 (http:// apps.who.int/nha/database/Select/Indicators/en, accessed 23 November 2017). 3. Tangcharoensathien V. (editor). The kingdom of Thailand Health System Review: Health Systems in Transition, 5(5), 2015.
How many households experience financial hardship from health-care expenditure? Table 1: Catastrophic health expenditure and impoverishment due to health spending, Thailand, 2015 Catastrophic expenditure Impoverishment due to OOP Poverty line = PPP$ 3.10 0.003 0.0021
Population
Threshold Threshold Poverty line = 10% = 25% = PPP$ 1.90 2.01 1.38 0.38 0.26 0.003 0.0021
% Headcount (million)
Source: Thailand: Health and Welfare Survey and The Household SocioEconomic Survey, 2015. Calculations by International Health Policy Program (IHPP), Thailand.
Health financing flows Fig. 7: Health financing flow General tax
CGD, Ministry of Finance (CSMBS, ≈ 5 million members)
General tax
National Health Security Office (UCS, ≈ 48 million members)
Standard health benefit package
General tax Tripartite; payroll contribution from employers & employees Risk - related premium
Social Security Office (SHI, ≈ 11 million formal employees)
Private health insurance firms (Voluntary) Capitation (OP, IP); Additional for high cost, high risk
Population Patients
Copayment / OOP Health services
Public & Private Providers (Contractor networks)
Capitation (OP, PP); DRG with global budget for IP; Additional for high cost DRG (IP)
Fee - for - service (OP, IP), retrospective reimbursement Fee - for - service (OP)
CGD: The Comptroller General’s Department; CSMBS: Civil Servant Medical Benefit Scheme; UCS: Universal Coverage Scheme; SHI: Social Health Insurance; DRG: Diagnosis-related groups ; OP: Outpatient; IP: Inpatient Source: Adapted from Tangcharoensathien V. (editor). The kingdom of Thailand Health System Review: Health Systems in Transition, 2015.