Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand.

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ID: 90533
2018
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Abstract
Strategic purchasing is an essential health financing function. This paper compares the strategic purchasing practices of Thailand's two tax-financed health insurance schemes, the Universal Coverage Scheme (UCS) and the Civil Servant Medical Benefit Scheme (CSMBS), and identifies factors contributing to successful universal health coverage outcomes by analysing the relationships between the purchaser and government, providers and members. The study uses a cross-sectional mixed-methods design, including document review and interviews with 56 key informants. The Comptroller General Department (CGD) of Ministry of Finance manages CSMBS as one among civil servant welfare programmes. Their purchasing is passive. Fee for service payment for outpatient care has resulted in rapid cost escalation and overspending of their annual budget. In contrast, National Health Security Office (NHSO) manages purchasing for UCS, which undertakes a range of strategic purchasing actions, including applying closed ended provider payment, promoting primary healthcare's gate keeping functions, exercising collective purchasing power and engaging views of members in decision making process. This difference in purchasing arrangements resulted in expenditure per CSMBS member being 4 times higher than UCS in 2014. The governance of the purchaser organization, the design of the purchasing arrangements including incentives and use of information, and the institutional capacities to implement purchasing functions are essential for effective strategic purchasing which can improve health system efficiency as a whole.
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patcharanarumol2018strategicplos Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Patcharanarumol, Walaiporn;Panichkriangkrai, Warisa;Sommanuttaweechai, Angkana;Hanson, Kara;Wanwong, Yaowaluk;Tangcharoensathien, Viroj;
Journal PloS one
Year 2018
DOI
DOI not found
URL
http://europepmc.org/articles/PMC5880375?pdf=render
Keywords
Medicine Mechanical engineering and machinery Science public aspects of medicine gynecology and obstetrics political science (general) practical theology moral theology military science social legislation

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