08/07/56

1

. /.

20 2556 8:00-9:00 .

Dentist

?

08/07/56

2

4

/

(Health System)

5

08/07/56

3

(Subsystem) (Equity) (Quality) (Efficiency) (Transparency) (Accountability)

(Health System)

6

()

(health care system)

7

08/07/56

4

(Health Insurance) (Risk Pooling ) (premium)

(Health Insurance)

8

(Universal Health Security coverage)

()

(Health Security)

9

(Security) (Insurance)

08/07/56

5

Six Building Blocks of a Health System

Source: Monitoring the building blocks of health systems : A handbook of indicator and their measurement strategies WHO 2010

System Inputs Overall

Goals/Outcomes

10

Roemer (1993) 165 4

11

08/07/56

6

2

1.

2.

12

-

USA-Philippines 13

08/07/56

7

West Europe (German), Canada, Australia, Japan

Latin America, India, Malaysia 14

England, Scandinavia, Italy, Greece, Spain

Costarica & Srilanka 15

08/07/56

8

Russia, Cuba 16

B

/

A

/

C

DIRECT PAYMENTS

HEALTH SERVICES

INSURANCE

COVERAGE MONEY

(TAXES OR

PREMIUMS)

REGULATION

REGULATION CLAIMS

MONEY

PAYMENT

(FEES, GLOBAL

BUDGET) D

08/07/56

9

18

1. (Universal Coverage scheme : UC)

2. ( Civil servant medical benefit scheme : CSMBS

3. ( Social Security scheme : SSS)

4. / () .

19

08/07/56

10

2555 (.. 2555)

75.44%

(48.60

)

15.82%

(10.19

)

7.68%

(4.95

)

0.95%

(0.61

)

0.10%

(0.07

)

: . 2555, 20

21

08/07/56

11

20

4.9 60,000

Civil Servant Medical Benefit Scheme, CSMBS

22

3 ()

23

08/07/56

12

1. 2. 3. 4. (

)

5.

24

25

08/07/56

13

Baht

26

1. : 2. :

27

08/07/56

14

3%

3%

1%

0.5% 0.5% 0.25%

0.88 % 0.12 % 0.44% 0.06% 1.5 %

0.88 % 0.12 % 0.44% 0.06% 1.5 %

0.88 % 0.12 % 0.44% 0.06% 1.5 %

5% 2.75%

28

(Universal Coverage scheme : UC)

29

08/07/56

15

:

UC

30

Universal coverage of health care (UC) 2

(1) (health care) (2) (health

care financing)

UC

31

08/07/56

16

(Integrated care) (Market style mechanism in health care system) (Community involvement in health care system) (Decentralization) (Health promoting health

care system)

32

1. :

2. :

(1)

33

08/07/56

17

3. :

4. :

(2)

34

(Access to care )

2

1. 2.

35

08/07/56

18

36

/

( -70 )

-

-

(70 100)

6

37

08/07/56

19

.

: . 38

.. 2545

9 1 2 3 4 5 6 7 8 9

39

08/07/56

20

38

08/07/56

21

Health Need

42

Concept 2556

Allocative efficiency

43

2556 (Global Budget)

08/07/56

22

2556 4

133,495,042,000 3,276,830,000 4,120,785,000

410,088,000

141,302,745,000

44

45

2,755 /

133,495,042,000

08/07/56

23

2555

2554 2555 [] 2555 [] 1.

1.1 OP 757.39 959.02 912.62

1.2 OP 23.00 23.00 21.89

1.3 OP refer 15.00 15.00 14.27

1.4 34.16 38.88 37.00

2. 954.72 1,021.60 972.17

3. 64.09 64.09 60.99

4. HC/AE/DMI/ 209.45 263.22 250.49

5. (P&P) 289.58 329.65 313.70

6. 2.25 4.30 4.09

7. 12.00 13.73 13.07

8. 6.00 7.57 7.20

9. 148.69 148.69 141.50

10. 25.00 5.00 4.76

11. 1.50 - -

12. 41 2.68 1.10 1.10

13. 0.97 0.75 0.75

14. . - - -

[] 2,546.48 2,895.60 2,755.60 46

2556

47

1. 974.36 35.36% Diff capitation

2. 972.17 35.28% DRG

3. 60.99 2.21% Cost function

4. /

/

()

262.1 9.51% Fee schedule

5. (P&P) (

) 313.7 11.38% capitation

6. 12.88 0.47% Fee schedule

7. 7.2 0.26% Fee schedule

8. 141.5 5.13% Item +capitation

9. 4.76 0.17% P4P

10. 41 5.19 0.19% Case

11. 0.75 0.03% Case

2,755.60 100.0%

08/07/56

24

(1) NPP& Central

procurement 25.72 .(11%)

(2) PP E

124.96 . (54%)

(3) PPA

57.4. (25%)

(4)

7.68.(3%)

(5)

16.60. (7%)

CUP//

P&P Capitation ( 232.36 x . 65.404 )

313.70 /.UC

48.445

P&P 2556 ()

. 10 () PPE PPA

(.)

(40)

/ (17.4)

Capitation+ Workload 99.96 .

Quality Performance

25 .

Fee Schedule

49

4

1

DRGs AdJRW 2

Central Reimbursement 3

4 Disease Management Initiative

08/07/56

25

Fee Schedule () :

Capitation () :

Base Rate

: (AdjRW) (IP-Global Budget)

50

()

08/07/56

26

3 1. (P&P)

- - 2. ( OP-IP) -

3. ()

( : )

68.39 75.79

49.04

62.67

77.87 72.2

60

25

0

10

20

30

40

50

60

70

80

90

100

2548 2549 2550 2551 2552 2553 2554

comprehensive care

: 26 ..55,.13 . 4 ..55

.1 2548-2554

08/07/56

27

-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

51 52 53 54

28,390

46,242

57,300

63,280

10,988

24,330

33,891 35,396

60

: ;51-53 22/11/2554; 54 24/04/2555 54

2551 2552 2553 2554

60

38.70 52.61 59.15 55.93

60 2551-2554

2555 ( 2553 2555)

(60 )

9202 1 ( 2,400)

45,000

1,275 1,432

3,327,092

9203 2 ( 4,400) 6,777 6,801

29,734,894

9204 1-5 (....) 978 1,214

1,547,400

9205 5 (........) 1,775 2,434

3,623,037

10,805 11,881

38,232,423

: 24 ..55

08/07/56

28

.

2556

22 .. 2556

4.5

2556 ( 23 ..56)

57

(.)

(.)

(.)

%

1,085,706,400.00

778,660,318.81

307,046,081.19

28.28%

1)

1,033,383,200.00

745,729,455.81

287,653,744.19

27.84%

2)

52,323,200.00

32,930,863.00

19,392,337.00

37.06%

- 19,852,741.00 11,631,572.00 8,221,169.00 41.41%

- . .

32,470,459.00 21,299,291.00 11,171,168.00 34.40%

: E-Budget 23 2556

08/07/56

29

2556

58

1) .1

70

2) .1 (comprehensive care)

20

3) (Smart Health)

45,000

1. ( comprehensive care)

08/07/56

30

60

.1 2548 2555 (..55-..56)

: 48-54 , 55 7 . 2556

comprehensive care .1 55 (..55 - ..56)

61

61.12

comprehensive care 29.04

: . 7 .. 2556 , , , , . Secondary Data

08/07/56

31

62

comprehensive care .1 56 (..55 ..56)

: . 7 .. 2556 , , , , . Secondary Data

22.55

comprehensive care 50.01

2. ( 60 ( Smart Health))

08/07/56

32

() 2551-2556 ()

: 25 .. 56

() 51-56 60 60

: 25 .. 56

()

35,000 45,000 45,000

08/07/56

33

( 60 ) 56 (..55-..56) .

: 25 . 56

()

3

Percent

Year

: 7 .. 2555 ,

08/07/56

34

12

: 7 .. 2555 ,

69