INFORMATION TECHNOLOGY FOR UNIVERSAL HEALTH COVERAGE (IT4UHC) September 2013 Manila, Philippines

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1 INFORMATION TECHNOLOGY FOR UNIVERSAL HEALTH COVERAGE (IT4UHC) September 2013 Manila, Philippines

2 Thailand HIS and HIT: Before and After 10 years of Implementing Universal Health Care Scheme Boonchai Kijsanayotin Health Systems Research Institute Ministry of Public Health, Thailand

3 ศ นย พ ฒนามาตรฐานระบบข อม ลส ขภาพไทย Thai Health Information Standards Development Center Plenary Presentation 4: IT4UHC Conference 26 September 2013 Pan-Pacific Hotel, Manila, Philippines Boonchai Kijsanayotin MD., Ph.D. Health Information Standards Development Center (THIS) Health Systems Research Institute s Affiliated Agency, Ministry of Public Health Thailand

4 Located at the center of the Indochina Peninsula 64 millions population in 77 provinces One of the few middle-income countries successfully achieving universal coverage Three major public health insurance schemes 80% of hospitals are public Hospitals

5 Thailand Universal Health Coverage Social health protection schemes have covered all Thai citizen since 2002 Major Schemes Civil Servants Medical Benefit Scheme (CSMBS) Social Security Scheme (SSS) Universal Coverage (UCS) Introduced in 1960s 1990s 2002 Target beneficiaries Government employees & dependents, retirees Private sector employees Those not covered by CSMBS nor SSS Pop Coverage 7% (5 M) 16% (10 M) 75% (48 M) Funding Government budget Payroll contribution, Tripartite Payment to Fee-for-service for Capitation for OP From: health Health facilities Insurance OP, Systems DRG for Research IP Office, & HISRO IP, Government budget Capitation for OP, 5

6 Hospitals in Thailand Hospital Category Number of Hospitals Percentage of All Hospitals District hospitals (MOPH) % General hospitals (MOPH) % Regional hospitals (MOPH) % Other hospitals under MOPH* Other public hospitals outside MOPH % % Private hospitals % Total %

8 The UCS and Healthcare Systems Implemented in Cover the whole hole country within 1 year UCS improve access to necessary health services, UCS improve equity of service utilization UCS prevented medical impoverishment of Thai citizens.

9 Effect of UCS to Medical Impoverishment

11 Evaluation at Year 10 th of UCS 11

HIS & HIT impact on & affected by UCS http://www.

12 HIS & HIT impact on & affected by UCS 12

13 1. Computerized Civil Registration & Citizen IDs 2. Providers ICT adoption & country s ICT infrastructure 3. Administrative data standards, coding standards & DRG technology Universal Coverage Scheme Implementation

14 Computerized Civil Registration & Citizen Identification Number Enabled and facilitated the development of UCS s beneficiary and the other two insurance scheme s (CSBMS and Social security scheme) registration systems. The registration system completed within the first year of the UCS implementation

15 Computerized population database 1982 <<BACK

16 Citizen Identification Card Typing machine ID card Computer Printout ID card Current Smart card type ID card

17 Providers ICT adoption & country s ICT infrastructure (1) Hospitals embraced computer technology since 1980s 1990s, MOPH launched many large ICT projects, hospitals implement computerized HIS High penetration & adoption of ICT among hospitals and health facilities are high.

18 Providers ICT adoption & country s ICT infrastructure (2)

19 Administrative data standards, coding standards & DRG Information System 1990s Implemented ICD coding system & Created standard data set for health insurance and health center activity report DRG has been developed & piloted 20 years before implement UCS(2003) By 1999, about half of hospitals had experiences in submission DRG needed data electronically.

20 Impact of UCS on National HIS & HIT UCS HIS & HIT Health insurance beneficiary registration system DRG information systems Disease management information systems OP individual records initiative improve providers service workflow and country vital statistics stimulated health providers HIS and HIT capacity building, data and medical record quality, adoption of national administrative data standards. increased the fragmentation of HIS and increase burden on data management to providers. enhance providers HIS and HIT investment induce data fraudulence tendency.

Conclusions (1) Three major HIS & HIT context that positively affect the success of UCS implementation Computerized civil registration and Citizen ID number enables rapid creation of insurance

21 Conclusions (1) Three major HIS & HIT context that positively affect the success of UCS implementation Computerized civil registration and Citizen ID number enables rapid creation of insurance beneficiary roster and the registration maintenance system ICT infrastructure availability and high IT adoption enables the electronic data flow Administrative data standards, coding standards & DRG Information System already in-place to support the new UCS financing mechanism.

22 Conclusions (2) Implementation of UCS has largely favorable impact on the country HIS and HIT development. unfavorable effects are also evident. Positive improve providers service workflow and country vital statistics stimulated health providers HIS and HIT capacity building data and medical record quality, adoption of national administrative data standards. Negative increased the fragmentation of HIS increase burden on data management to providers. induce data fraudulence tendency.

Impact of universal health insurance scheme on health information systems and health information technology

Impact of universal health insurance scheme on health information systems and health information technology Boonchai Kijsanayotin Universal Coverage Scheme Assessment of the first 10 years : Impact on