Lessons at Chiang Mai University

Hello friends, family and faculty!
Day 1 at Chiang Mai University was spent learning about the delivery of healthcare and role of the pharmacist  in Thailand.  I was excited to see on our schedule that staff would be explaining the Thai health insurance structure to us today. Heathcare coverage is a complex topic in the United States as we struggle to build a scheme that is adequate and fiscally responsible for the country as a whole. Therefore, one of the major reasons why I sought out the Thailand rotational experience was to investigate further how other countries provide healthcare coverage.
The staff graciously detailed the payment model for us and I will attempt to briefly explain what I learned to readers. Health insurance in Thailand is broken into 3 major schemes. The “best” insurance according to our informants is Government Welfare (CSMBS). This insurance is provided to government employees as well as their parents, spouse and children up to 20 years of age (a max of 3 children can be covered under the plan though). Recipients can afford higher priced  medications and this model follows a fee for service payment structure. Only approximately 8.6% of Thai people have this insurance. The insurance program that models the majority of US insurance is called Social Security (SSS). SSS consists of a three party payment plan where the gorverment, employer and patient each pay a percentage of the cost. Family members are not included under the plan and recipients must receive care at a registered hospital.  Only approximately 15% of the Thai population have this insurance.
The majority (75%) of insurance in Thailand comes from the Universal Coverage (UC) plan. Any citizen who does not fall into the over categories is provided coverage with this plan. Recipients receive services at a registered hospital that is located near their physical address. The flat copay rate is 30 baht (about $1 in the US) and the copay is waived if patients are elderly, children, poor or unable to pay. Drugs found on the national formulary list will be covered. In order to control costs, the Thai government strongly supports prevention programs and utilizes primary health care settings as gatekeepers for referrals. Wealthier Thai citizens  may choose to purchase private health insurance in addition to any of the other insurance which provides the advantage of service at private hospitals.

We learned that this system certainly has its own advantages and disadvantages. On one hand, healthcare is inexpensive for the individual and patients are not asked to pay out of their own pockets for costly services. However, many citizens abuse the low rate for service. Hospitals struggle to stay afloat with the low revenue provided by the government for payment which limits there abilities to deliver efficient and quality care. As in the US, the Thai government continues to explore how to improve their model.  It is reassuring to know that Thailand and the US have similar challenges in providing coverage to their citizens.

Thanks for reading!  

Kayla