Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd Kanjana Tisayaticom

Shaheda ViriyathornVuthiphan Wongmongkol

Chitpranee VasavidWalaiporn Patcharanarumol

Supon LimwattananonViroj Tangcharoensathien, et al

International Health Policy ProgramSukosol Hotel, Bangkok

March 12, 2013

Thai National Health accountsby age group, health insurance scheme, and disease categories

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

2

Outlines of presentation

• Introduction• Objectives• Methodology• Data sources• Results• Conclusion

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

3

Objectives

• To develop the diversification of 2007NHA to reflect health expenditure by:

•Age group, •Gender, •Health insurance coverage, •Disease category.

• Application of disease category to NHA data from 2008-2010

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

4

Conceptual framework and Conceptual framework and process of analysis process of analysis

OP and IP individual dataset:

ICD 10, total costs or charges of services e.g. doctor fee, medicine, lab, room etc.

Group by ICD 10

A1: Tuberculosis

A2a: Syphilis

..

..

U: Injury

Charges by disease categories

Proportion of charge by disease categories

NHA: total OP and IP expenditure

Two major prerequisites

NHA: IP and OP expenditure by disease categories

STEP 1: To calculate proportion of charges

STEP 2: To break down NHA

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

5

Data sources

• NHA data– Public registration records– Secondary data from the national surveys

• Household and Enterprise surveys, (NSO)

– Primary surveys• State Enterprises • Public Independent Organizations

• IP database • IP database from Center of Health Information

(CHI)

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

Number of UC Admission

6

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

Disease Categories

7

dx Diagnosis by ICD10 ICD10 Code

1 HIV/AIDS B20-B24

2Injury code (S or T code in ICD10) without external cause S and T code

3 Cerebravascular disease I60-I694 Diabetes mellitus E10-E145 Liver cancer C226 Alcohol use/dependence F107 Major depression F32-F348 Ischaemic heart disease I20-I259 Chronic obstructive pulmonary disease J40-J44

10 Deafness H90-H9111 Osteoarthritis M15-M1912 Cirrhosis of the liver K70,K7413 Lower respiratory tract infections J10-J2214 Asthma J45-J4615 Bronchus & Lung cancer C33-C3416 Anxiety disorder F40-F42

17 Self-inflicted injuries (Suicide)X60-X84,Y87 0, Y87 1

18 Tuberculosis A15-A19,B9019 Nephritis and nephrosis N00-N1920 Homicide and violence X85-Y0988 All other

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

8

Results of NHA diversification

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

9

Percentage of estimated public curative expenditure for in-patient services by age

group, gender and health insurance scheme, 2007

Public curative expenditure for IP by age group, gender and health insurance scheme, 2007

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Infa

nts

Pre-

scho

ol 1

-4

Scho

ol a

ge5-

14

Rep

rodu

ctiv

eag

e 15

-44

Adu

lt 45

-64

Adu

lt 65

-74

Elde

rly 7

5-84

Old

est

85+

Age group

% I

P e

xpen

dit

ure

F UC

M UC

F SSS

M SSS

F CSMBS

M CSMBS

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

10

The estimated public curative expenditure for IP services by age group, gender and health

insurance scheme, 2007 (Million Baht)

Male CSMBS SSS UC All 3 schemesInfants 66 - 2,338 2,403Pre-school 1-4 149 - 1,327 1,477School age 5-14 195 - 1,788 1,982Adult 15-44 797 3,654 7,978 12,429Adult 45-64 2,971 1,378 7,908 12,257Adult 65-74 2,293 90 4,214 6,598Elderly 75-84 2,107 19 2,297 4,423Oldest 85+ 605 4 510 1,119All persons 9,183 5,146 28,360 42,689

Female CSMBS SSS UC All 3 schemesInfants 54 - 1,509 1,562Pre-school 1-4 96 - 943 1,039School age 5-14 144 - 1,246 1,390Reproductive age 15-44 1,209 3,304 9,288 13,801Adult 45-64 2,661 922 7,470 11,053Adult 65-74 2,334 32 4,260 6,625Elderly 75-84 2,159 5 2,519 4,683Oldest 85+ 741 0 705 1,446All persons 9,397 4,262 27,939 41,599

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

11

Percentage of estimated public curative expenditure for IP services by disease

category and health insurance scheme, 2007 BOD Male + Female CSMBS SSS UC All 3 schemes

1 HIV/AIDS 0.1% 0.3% 0.8% 1.2%

2 Injury code (S or T code in ICD10) without external cause1.5% 2.3% 8.1% 11.9%3 Cerebravascular disease 1.1% 0.2% 2.3% 3.6%4 Diabetes mellitus 0.4% 0.1% 1.0% 1.5%5 Liver cancer 0.3% 0.1% 0.4% 0.8%6 Alcohol use/dependence 0.1% 0.0% 0.2% 0.2%7 Major depression 0.0% 0.0% 0.0% 0.0%8 Ischaemic heart disease 1.8% 0.2% 2.4% 4.5%9 Chronic obstructive pulmonary disease 0.4% 0.1% 1.3% 1.8%10 Deafness 0.0% 0.0% 0.0% 0.0%11 Osteoarthritis 0.6% 0.0% 0.5% 1.2%12 Cirrhosis of the liver 0.0% 0.0% 0.1% 0.1%13 Lower respiratory tract infections 1.0% 0.2% 3.3% 4.5%14 Asthma 0.1% 0.1% 0.4% 0.6%15 Bronchus & Lung cancer 0.3% 0.1% 0.4% 0.7%16 Anxiety disorder 0.0% 0.0% 0.0% 0.1%17 Self-inflicted injuries (Suicide) - - - - 18 Tuberculosis 0.1% 0.1% 0.6% 0.9%19 Nephritis and nephrosis 0.7% 0.2% 1.5% 2.5%20 Homicide and violence - - - -

All others 90 specific disease categories 13.5% 7.1% 43.3% 63.9%Grand total 110 specific disease categories 22.0% 11.2% 66.8% 100.0%

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

12

The estimated public curative expenditure for IP services by disease category and

health insurance scheme, 2007(Million Baht)

BOD Male + Female CSMBS SSS UC All 3 schemes1 HIV/AIDS 55 271 653 979

2Injury code (S or T code in ICD10) without external cause 1,241 1,950 6,851 10,043

3 Cerebravascular disease 901 207 1,968 3,0764 Diabetes mellitus 305 83 849 1,2385 Liver cancer 249 58 360 6676 Alcohol use/dependence 50 13 129 1927 Major depression 13 2 21 368 Ischaemic heart disease 1,547 183 2,030 3,7609 Chronic obstructive pulmonary disease 346 50 1,111 1,50610 Deafness 19 2 3 2411 Osteoarthritis 487 33 461 98112 Cirrhosis of the liver 19 20 75 11513 Lower respiratory tract infections 866 146 2,779 3,79114 Asthma 79 55 365 49915 Bronchus & Lung cancer 253 50 314 61716 Anxiety disorder 9 7 28 4417 Self-inflicted injuries (Suicide) - - - - 18 Tuberculosis 120 102 533 75519 Nephritis and nephrosis 618 201 1,285 2,10520 Homicide and violence - - - -

Total of 20 BOD 7,175 3,434 19,816 30,425All others 90 specific disease categories 11,405 5,974 36,483 53,863Grand total 110 specific disease categories 18,580 9,409 56,299 84,288

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

13

Services Charge by Age groups

2008 2009 2010

Infants 3,274,939,489 3,495,307,459 3,825,822,992

Pre-school 1-4 2,354,127,051 2,380,109,561 2,895,306,277

School age 5-14 2,591,423,153 3,003,185,340 3,016,465,488Reproductive age 15-44

14,097,866,847

15,339,417,269

16,489,499,653

Adult 45-6414,019,798,39

315,991,961,79

417,773,404,99

4

Adult 65-74 7,514,502,154 8,270,077,476 9,206,530,987

Elderly 75-84 4,527,330,113 5,141,993,468 5,926,145,520

Oldest 85+ 1,165,137,922 1,253,824,779 1,486,445,729

All persons49,545,125,12

254,875,877,14

660,619,621,64

0

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

Proportion by age groups

14

2008 2009 2010

Infants 6.61% 6.37% 6.31%

Pre-school 1-4 4.75% 4.34% 4.78%

School age 5-14 5.23% 5.47% 4.98%Reproductive age 15-44 28.45% 27.95% 27.20%

Adult 45-64 28.30% 29.14% 29.32%

Adult 65-74 15.17% 15.07% 15.19%

Elderly 75-84 9.14% 9.37% 9.78%

Oldest 85+ 2.35% 2.28% 2.45%

All persons 100.00% 100.00% 100.00%

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

IP NHA 2008-2010 by age groups

15

Age Group 2008 2009 2010

Infants 2,493 2,171 1,998

Pre-school 1-4 1,792 1,478 1,512

School age 5-14 1,973 1,866 1,575 Reproductive age 15-44 10,732 9,529 8,609

Adult 45-64 10,673 9,934 9,280

Adult 65-74 5,720 5,137 4,807

Elderly 75-84 3,446 3,194 3,094

Oldest 85+ 887 779 776

All persons 37,716 34,088 31,650

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

Services Charge by Disease

16

2008 2009 2010

HIV/AIDS 535,609,352 584,380,622 639,162,735 Injury code (S or T code in ICD10) without external cause 5,594,794,958 6,296,467,248 6,196,716,468

Cerebravascular disease 1,685,248,944 1,911,158,136 2,154,149,193

Diabetes mellitus 705,100,536 709,989,905 748,517,257

Liver cancer 344,916,590 504,976,976 465,557,279

Alcohol use/dependence 116,745,540 126,604,087 149,046,750

Major depression 17,762,584 22,267,121 26,242,022

Ischaemic heart disease 2,094,643,872 2,496,514,499 2,460,727,940

Chronic obstructive pulmonary disease 943,667,870 986,713,391 1,103,776,634

Deafness 7,898,985 3,147,066 4,305,544

Osteoarthritis 471,802,693 451,125,245 558,750,460

Cirrhosis of the liver 163,630,497 162,214,401 204,477,948

Lower respiratory tract infections 2,510,195,383 2,764,184,535 3,516,172,845

Asthma 316,757,742 313,383,849 345,854,234

Bronchus & Lung cancer 292,358,089 339,119,580 369,718,215

Anxiety disorder 16,631,690 16,180,763 15,213,677

Self-inflicted injuries (Suicide) 19,278,077 9,696,797 157,287,211

Tuberculosis 470,531,821 574,276,096 649,325,066

Nephritis and nephrosis 1,157,533,200 1,347,071,528 1,638,439,999

Homicide and violence 60,715,596 22,527,109 579,735,972

All others 32,019,301,103 35,233,878,192 38,636,444,191

Grand total 49,545,125,122 54,875,877,146 60,619,621,640

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

IP NHA 2008-2010 by Disease

17

2008 2009 2010HIV/AIDS 407.73 363.01 333.72 Injury code (S or T code in ICD10) without external cause 4,259.03 3,911.30 3,235.39 Cerebravascular disease 1,282.89 1,187.19 1,124.71 Diabetes mellitus 536.76 441.04 390.81 Liver cancer 262.57 313.69 243.07 Alcohol use/dependence 88.87 78.65 77.82 Major depression 13.52 13.83 13.70 Ischaemic heart disease 1,594.54 1,550.81 1,284.78 Chronic obstructive pulmonary disease 718.37 612.94 576.30 Deafness 6.01 1.95 2.25 Osteoarthritis 359.16 280.23 291.73 Cirrhosis of the liver 124.56 100.77 106.76 Lower respiratory tract infections 1,910.88 1,717.08 1,835.84 Asthma 241.13 194.67 180.57 Bronchus & Lung cancer 222.56 210.66 193.03 Anxiety disorder 12.66 10.05 7.94 Self-inflicted injuries (Suicide) 14.68 6.02 82.12 Tuberculosis 358.19 356.73 339.02 Nephritis and nephrosis 881.17 836.79 855.45 Homicide and violence 46.22 13.99 302.69 All others 24,374.63 21,886.90 20,172.59

Grand total

37,716.1

3

34,088.2

9

31,650.2

9

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

19

Limitations and lesson learned

• Expenditure by disease category is possible given: – Well established NHA by healthcare

function (spending on OP and IP) – Availability and continued update of

national clinical data covering ICD10 including charge or expenditure data for OP and IP

– Institutional capacity to apply national clinical dataset for the estimate expenditure by disease categories

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

20

Acknowledgements

• Health Systems Research Institute (HSRI)• Thailand Research Fund (TRF)• Bureau of Policy and Strategy, Ministry of

Public Health, • WHO-Thailand• The Central of Health Information (CHI)• Partners for 1994-2008 NHA for their hard

work and commitment:– College of Public Health, Chulalongkorn University– National Statistical Office– National Economic and Social Development Board– Ministry of Public Health, Thailand – Ministry of Finance of Thailand (MOF)– The National Health Security Office (NHSO)– The Social Security Office (SSO)

Inte

rna

tio

na

l H

ea

lth

Po

lic

y P

rog

ram

-T

ha

ila

nd

Inte

rnati

onal H

ealt

h P

olic

y P

rogra

m -

Thaila

nd

Sawasdee Thank you for your attention

21