Comparative Management and Benefit Packages between Social Security Scheme and Universal Coverage Scheme in 2020
Keywords:
benefit package, management, social health insurance, universal coverage schemeAbstract
Thailand achieved universal health coverage (UHC) since 2002. There are 3 main health insurance schemes with differences in agencies in charge, benefit packages, management, and payment mechanisms operationalizing UHC in Thailand. The aim of this study was to compare the differences in management of and benefit packages between the Social Security Scheme (SSS) and the Universal Coverage Scheme (UCS) in 2020. We applied a descriptive study, and reviewed related documents as of 1 January 2020. The results indicated that there were 11 different benefit packages between SSS and UCS. UCS had 7 more benefit packages than SSS, while SSS had 2 more benefit packages than UCS. However, the similar 20 benefit packages had different management. Seven benefit packages of SSS had special management or higher rate of reimbursement than UCS whereas 13 benefit packages of UCS had special management or higher rate of reimbursement than SSS. Furthermore, when compared results with the similar study in 2011, SSS changed inpatient payment mechanisms from capitation to diagnosis related groups (DRGs), implemented special drug management system and increased annual budget per person and reimbursement rate for inpatient higher than UCS. SSS added 27 new benefit packages and added new equipment and prostheses from 81 to 291 items. UCS added 30 new benefit packages and added new equipment and prostheses from 270 to 316 items. The differences in benefit packages between 2 schemes reduced from 15 services in 2011 to 11 services in 2020 and the differences in the similar benefit packages but different management reduced from 26 services in 2011 to 20 services in 2020. In conclusion, UCS had more special management and benefit packages than SSS whereas SSS had higher budget per person per year and higher rate of inpatient reimbursement than UCS. Further studies on access, cost effectiveness and quality outcome were recommended to compare between SSS and UCS. The set up of national organization to harmonize the health insurance schemes in Thailand as mandated in the latest constitution of the Kingdom of Thailand was also recommended.
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Journal of Health Systems Research is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license, unless otherwise stated.
