Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand
Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand
复制标题
DOI：
10.1371/journal.pone.0195179
复制
发表时间：
2018-04-02
期刊：
影响因子：
3.7
通讯作者：
Tangcharoensathien, Viroj
中科院分区：
文献类型：
--
作者：
Patcharanarumol, Walaiporn;Panichkriangkrai, Warisa;Tangcharoensathien, Viroj
战略采购是一项基本的卫生筹资职能。本文比较了泰国两个由税收资助的医疗保险计划--全民医保计划和公务员医疗福利计划--的战略购买做法，并通过分析购买者与政府、提供者和成员之间的关系，确定了促成成功的全民医保结果的因素。这项研究采用横断面混合方法设计，包括文献回顾和对56名关键线人的访谈。财政部主计长司长将CSMBS作为公务员福利方案之一进行管理。他们的购买是被动的。门诊服务费导致费用迅速攀升，年度预算超支。相比之下，国家医疗保障办公室(NHSO)负责管理UCS的采购，后者承担一系列战略采购行动，包括应用封闭式提供者支付、促进初级医疗保健的把关功能、行使集体购买力以及让成员的意见参与决策过程。采购安排上的这种差异导致2014年每个CSMBS成员的支出是统一计算中心的4倍。采购商组织的治理、包括奖励和信息使用在内的采购安排的设计以及履行采购职能的机构能力对于有效的战略性采购至关重要，因为战略采购可以提高整个卫生系统的效率。
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.