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

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  • Walaiporn Patcharanarumol
  • Warisa Panichkriangkrai
  • Angkana Sommanuttaweechai
  • Kara Hanson
  • Yaowaluk Wanwong
  • Viroj Tangcharoensathien

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.

Suggested Citation

  • Walaiporn Patcharanarumol & Warisa Panichkriangkrai & Angkana Sommanuttaweechai & Kara Hanson & Yaowaluk Wanwong & Viroj Tangcharoensathien, 2018. "Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-13, April.
    • Handle: RePEc:plo:pone00:0195179
    DOI: 10.1371/journal.pone.0195179
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    References listed on IDEAS

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    1. Kutzin, Joseph, 2001. "A descriptive framework for country-level analysis of health care financing arrangements," Health Policy, Elsevier, vol. 56(3), pages 171-204, June.
    2. Alexander S. Preker & John C. Langenbrunner, 2005. "Spending Wisely : Buying Health Services for the Poor," World Bank Publications - Books, The World Bank Group, number 7449.
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    3. Albino Kalolo & Ntuli A. Kapologwe & Hendry Samky & Stephen M. Kibusi, 2022. "Acceptability of the Direct Health Facility Financing (DHFF) initiative in Tanzania: A mixed methods process evaluation of the moderating factors," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(3), pages 1381-1401, May.

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