Reason for Selecting Types of Provider Payment of the 30 Baht Scheme in Thailand, 2002 - รูปแบบและเหตุผลในการเลือกวิธีจ่ายเงินให้กับหน่วยบริการในโครงการหลักประกันสุขภาพถ้วนหน้า, ๒๕๔๕

Abstract

                In 2002, Thailand implemented universal coverage of health insurance for the entire population through the 30 baht scheme, which merged welfare schemes protecting the lower income groups, and extended insurance cover to those previously unprotected. Within the 30 baht scheme, payment for health services has been changed from a historical global budget to per capita funding for the catchment population. Provinces were permitted to choose the provider payment method, either exclusive capitation or inclusive capitation. Provinces could also choose the level of the system at which salaries were deducted, either at contracting unit for primary care (CUP) level or at provincial level. The aims of this study were to understand the reasons behind the selection of provider payment type of each province and to illustrate the impact of such payment on the initial budget of hospitals. A telephone interview survey was used to explore the reasons for the choice of provider payment type and budget allocation. Cases studies are selected to explore the impact of alternative provider payments on the initial budget of hospitals. The results of the study indicated that each province had their own reasons to select their types of payment. The main reason for selecting exclusive capitation were helping each other and sharing risk together and concerns about the quality of care and referral reimbursement problem from inclusive capitation whereas the main reason for selecting inclusive capitation were improving hospital efficiency and reforming the health system and requesting CF. The main reason for selecting salary deduction at CUP were having an appropriate worker distribution and requesting CF whereas the main reason for selecting salary deduction at provincial level were helping each other at all level of health services to survive as a whole province and advocating or looking after staff during the reform situation. Community hospitals are better off when they have salary deduction at CUP level. On the other hand, general hospitals and regional hospitals are better off when they have salary deduction at provincial level.