The Study Programme
for the Improvement of Social Insurance System- Health Security and Vulnerable people-

Country Reports

Japan International Corporation of Welfare Services (JICWELS)Contents

1. Bangladesh

1

2. Indonesia

12

3. Kosova

24

4.Laos38

5.Mongolia

95

6.Myanmar

118

7.Thailand

139

The Study Programme
for the Improvement of Social Insurance System- Health Security and Vulnerable people-

Bangladesh-1-Country ReportCountry: Bangladesh
Course: Improvement of Social Insurance System

1. Geographical and Political features of Bangladesh
Bangladesh is a country in South Asia. It is located in the Bengal region of the eastern Indian
subcontinent and the name Bangladesh means "Country of Bengal" in the official Bengali
Language. It shares borders with India and Myanmar, and faces the Bay of Bengal to its south. Itlies between latitude 20° and 27°N, and longitudes 88° and 93°E.
Straddling the Tropic of Cancer Bangladeshi climate is tropical with a mild winter from October
to March, a hot, humid summer from March to June. Interestingly, the country has never frozen
at any point on the ground. A warm and humid monsoon season lasts from June to October andsupplies most of the country's rainfall. Natural calamities, such as floods, tropical cyclones,
tornadoes, and tidal bores occur almost every year combined with the effects of deforestation,soil degradation and erosion.
Bangladesh is now widely recognized to be one of the country’s most vulnerable to climatechange. Natural hazards that come from increased rainfall, rising sea levels, and tropical
cyclones are expected to increase as climate changes, each seriously affecting agriculture, waterand food security, human health and shelter. Also, there is evidence that earthquakes pose athreat to the country. Evidence shows that tectonics have caused rivers to shift course suddenly
and dramatically.
Bangladesh is a unitary state and parliamentary democracy Direct elections in which all citizens,aged 18 or over, can vote are held every five years for the unicameral parliament known as Jatiya
Sangsad. The parliamentary building is known as the Jatiyo Sangshad Bhaban and was designed
by architect Louis Kahn. Currently the parliament has 350 members including 50 reserved seats
for women, elected from single-member constituencies. The Prime Minister, as the head ofgovernment, forms the cabinet and runs the day-to-day affairs of state. While the Prime Minister-2-

is formally appointed by the President, he or she must be an Member of Parliament who
commands the confidence of the majority of parliament. The President is the head of state but
mainly a ceremonial post elected by the parliament.
2. Statistical data
Form 1-4 filled up with the data available

3. Outline of the Social Security System
In Bangladesh though typical SHI doesn’t exist, some types of NGO based and private
insurance exist. Actually National health system financed by tax revenue and donor
assistance is complementary to SHI.Essential Service Delivery (ESD) Package provided
at free of cost to all citizens in rural areas complementary to SHI.Services at secondary
and tertiary level are also free with some exception at specialized hospitals. Demand Side
Financing (DSF)/maternal health voucher scheme entitling pregnant women’s access tofree antenatal, delivery, emergency referral and postpartum care services.
4. Outline of the Object Tax for Social Security System
Not applicable
5.

5.1 Historical development of MIS
The NGOs/MFIs came in the Micro-insurance scene in late 1990s and early 2000s. They
are mostly insurer as well as service provider.The informal sector can be regarded as themain target group for community insurance. Important players are Grameen Kallyan(GK), BRAC, Gonoshashtho Kendra (GSK), Dhaka Community Hospital (DCH),
Dusthya Shasthya Kendra (DSK), Integrated Development Foundation (IDF), Nari
Uddug Kendra (NUK), Sajida Foundation, Society for Social Service (SSS) etc.
Gonoshashtho Kendra (GSK) pioneer to introduce HMI.GSK operates a healthmicroinsurance scheme based on the insured’s ability to pay .GSK Health Insurance
Scheme classifies four different groups according to their socioeconomic status:•

Group A: distressed women and poor people•

Group B: marginal farmers who face insufficiency and/or evenstarvation•

Group C: can afford to eat twice a day and have some surplus

-3-

•

Group D: represents those who do not have enough surplus but are
sufficient.

Grameen Kalyan (GK-‘Village Well-being’) was established in 1996 as a sister NGO of
the Grameen Bank.
Bangladesh Rural Advancement Committee established a pilot health microinsurance(HMI) in July 2001.
BRAC’s Micro Health Insurance for the Poor Rural Women in Bangladesh (MHIB)
launched in November 2001.
GK and MHIB differ in that GK is both a insurer and provider while MHIB is insurer
only. MHIB reimburses BRAC’s health centers for the services provided to the MHIB
members.
5.2 : Laws and regulations for MIS: In fact there is no specific rules or act for healthinsurance in Bangladesh but Health Policy and other policy documents urge for healthinsurance
5.3 Administration and management of MIS (Central Level) : Not applicable
5.4 Administration and management of MIS (Local Level) : Not applicable
5.5 MIS Structure in Bangladesh : Insurer, Number of Insured, of selected NGOs
Organisation
BRAC
GK
DSK
IDF
NUK
SajidaFoundation
SSS
GSK

DCH

HealthFacility
38
01
02
01
Hosp.
04

BeneficiaryMember
12,00051,0009,500
28,0007,000

NonMember
7,000
10,0008,000
3,500

Population(approx)350,000
500,000
500,000
180,000
600,000

70,000290,000
10,00036,000100,000
36,8407,861

24,193600,000

16
42,00001
37,183
Hosp.
04 Subcenter
01 Hosp.;19 Rural HC
12 School HC; 24
Industrial HC

42,000
n/a

n/a
n/a

250,000
165,364

On average 3000 – 4000 visitors per
month

-4-

Service Package and Price : Selected NGOs:
Organisation
BRAC

GK

IDF

NUK

Sajida Foundation

Service
ANC, PNC,
Consultation
Delivery, Medicine
Pathology

Package and Price
BDTk. 100 for VO; BDTk. 200
for non-VO(< 06 member family)
50% off pathology; ultra poor
80% off
10% off medication; ultra poor
80% off
BDTk. 500-1000 referral support
Free annual check up for head of
HH
25% off for non-use on renewal
General Consultation
BDTk. 05 for GB; BDTk. 10 for
Medicine (ED)non-GB
Other medicine
40% off for GB; 25% off for
Pathology/Check-up
non-GB
Referral/Hospitalisation
10% of MRP for both GB and
non-GB
30-50% off for both GB and
non-GB
50% (10% of total cost)
Consultation
BDTk. 10 for member; BDTk.
Medicine
50 for non-member
Pathology
RMP for member; MP for nonmember
50% off for member
Pathology
30% off for all pathological andMedicinediagnostic tests
Provision as cost recovery basis
Consultation
Free for member; BDTk. 30 for nonAntenatal carememberNormal delivery
Free for member; BDTk. 10 for nonAnnual check-up
memberPathology
BDTk. 225 for member; BDTk. 1000 for
Treatment Loan
non-member
Free for member
BDTk.15-40 for member; BDTk.20-50
for non-member

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SSS

Consultation
Investigation
Operation

GSK

Consultation
Pathology
Medicine
Delivery
Referral/Hosp.
Consultation
Pathology
Referral/Hosp.

DCH

Without interest for member
BDTk. 20 for member; BDTk. 40 for
non-member
30% of MP for member; 50% of MP for
non-member
BDTk. 3000 for member; BDTk. 6000
for non-member
BDTk. 03-10
50% off
00-75% based on SES
BDTk. 50-3000 based on SES
GSK sliding reimburse ratio
BDTk.05 for some card holders
Free for 03 simple tests
DCH price

Financial Situation of MIS -Premium structure: Selected NGOs
Organisation
BRAC

GK
IDF
NUK

Sajida Foundation

SSS

GSK

Premium Structure
Category
Family member
PremiumVO
up to 05
BDTk.100NVO
up to 05
BDTk.250
VO
up to 08
BDTk.150
NVO
up to 08
BDTk.300
VOmore than 08
BDTk.200
NVO
more than 08
BDTk.350
BDTk. 140 per anum per 08 member family for GB
BDTk. 180 per anum per 08 member family for non-GB
BDTk. 150 per annum per family member
Family Health Card: BDTk. 200 per card for 01 year
BDTk. 300 per card for 02 year
BDTk. 25 per lost card for replacement
Family Health Cards: BDTk. 200 per card for 01 year
BDTk. 300 per card for 02 year
BDTk. 350 per card for 03 year.
Family Health Cards: BDTk. 60 per annum for member,
BDTk. 80 per anum for staff
BDTk. 100 per anum for non-member
Sliding scale of premium & itemised co-payments as per SES

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DCH

80%, 46%, 20% and 10% off for Group A,B,C & D respectively(distance to GSK hospital also considered for lowest two groups)
e.g. C-section BDTk. 50, 500, 1500, 3000 for Group A, B, C & D
BDTk. 3500 for non-member
Family Health Card: BDTk. 40 per month (up to 12 members)
BDTk. 20 for renewal
School Children Card: Free to school children
Worker Health Card: BDTk. 02 per month per worker
Sport Card: Free to sport players (publicity)
Destitute Card: Free for poor households (BDTk. 05 per visit)

Private Health Insurance in Bangladesh:
Insurance Industry
Public Sector Life Insurers
Private Sector Life Insurers
Total Life Insurers
Public Sector General Insurers
Private Sector General Insurers
Total General Insurers

Number of Operators
01
16
17
01
42
43

5.7: MIS related policy within the National Development Plan : Our health policy has theindication about health care financing issues where it focuses on health insurance specially forthe poor segment of the society as a health protection scheme.
5.8: List of aid projects of MIS with other donors: KfW will provide fund for the
implementation of a pilot project on Social Health Insurance . It has also funded for thedevelopment of Concept Paper on health Insurance. However, there might be some otherorganization will extend financial or technical assistance for the implementation of the project.

6
6.1 . Problems are to be solved in current MIS
Our public health expenditure is about 1% of our GDP. It is suggested that we need to increase
public health expenditure through introducing social health protection scheme specially for thepoor segment of the country. We need to enact the law and other legal instruments to support
the social health insurance. Moreover, there are still some open ended questions which are to be-7-

solved before starting the pilot. There is no specific implementing organization of healthinsurance as the concept is very new in our context.
6.2. Contents of the reform to solve the problems: Public health expenditure might be increased
and initially supports from development partners would be explored. During the pilot period acell would be created for the implementation of the pilot activities through engaging Health
Insurance Company

6.3. Problems for carrying out this reform: It might be difficult but not impossible to convince
different stakeholders before finding the successful implementation of the Pilot.

-8-

ANNEX1-FORM 1
The State of the Nation
Area size (Area size K m2): 147570 sq-kilometer
Population by aged group

0-4
5-9
10-14
15-24
25-34
35-44
45-59
60+
65TotalYear
Male
FemaleMale
FemaleMale
FemaleMale
FemaleMale
FemaleMale
FemaleMale
FemaleMale
FemaleMale
FemaleMale
Female

1991
9482
9213
9505
8886
7175
6467
9175
9690
8032
8236
5886
4997
4762
4104
3298
2748

1996
7921
7581
9733
8947
7839
7616
10781
10516
8629
8745
6924
6458
5625
5062
5262
4486

2001
8327
7675
8749
7947
8389
7483
11250
11962
9300
10323
7678
6474
6130
4939
4268
3461

57314
54141

62714
59411

64091
60264

(in thousands)
2010

2006

ANNEX1-FORM 2

Year
Population growth rate(% per annum)
Birth rate
(per 1,000 population)
Mortality rate
(per 1,000 population)

1991
2.17

1996

2001
1.48

2006

2011
1.37

31.6

25.6

18.9

20.6

19.2

11.2

8.2

4.8

5.6

5.6

-9-

Infant mortality rate
(per 1,000 population)
The rate of the populationof 65 years and over to thetotal population (%)
Life expectancy
M
at birth
F
Life expectancy
at 60 and 65

87

82

66

52

43

5.42

7.98

6.38

60.5
59.8

59.1
58.6

64.0
64.5

64.5
66.6

66.80

4.3

4.3

60
65

Unemployment rate
(per 1,000 population)*Average rate

ANNEX1-FORM 3

Year
National Income(US$)
Average Wage (US$)
Average Wage of M
Male and Female F(US$)
Average Income(US$)
Total GNP (US$)
GNP per capita (US$)
Total GDP (US$)
GDP growth rate
GDP per capita (US$)
The rate of social
insurance
of

1991

1996
2001
Tk. 1655448 Tk. 2176503
mill.
mill.

2006
$ 43735.40
mill.

Tk. 13318
Tk. 16534
mill.
mill.
Tk. 809554 Tk. 2356025
mill.
mill.
Tk. 14558
Tk. 17898
mill.
mill.
Tk. 1752847 Tk. 2252609
mill.
mill.
3.34
4.62
5.27
Tk. 14102
Tk. 17112
mill.
mill.

$ 311.08
mill.
$ 73587
mill.
523$ 121019
mill.
818$ 68475
mill.
6.43
487

$ 111750
mill.
6.6
755

-10-

2011

contribution as apercentageofNational Income
Premium
contributionofemployee
Premium
contributionof employer
Premium
contributionof selfemployer
etc
ANNEX1-FORM 4
Number and percentage of workers engaged in industrial classification
Year

1991

1996

2001

(in Million)
2006

2011

Primary industry

34.1

Secondary industry

13.5

Tertiary industry

6.7

Five leading causes of death
Year

1st

2nd

Unspecified

Cardiovascular

3rd

4th

5th

Injuries

Perinatal

Respiratory

causesdiseases

1991
1996
2001
2006
2011

-11-

The Study Programme
for the Improvement of Social Insurance System- Health Security and Vulnerable people-

Indonesia-12-

INDONESIACOUNTRY REPORTSOCIAL SECURITY IN INDONESIA
2012

-13-

I. Introduction
The Republic of Indonesia (RI), or familiarly known as Indonesia, is the world’s fourthmost populous country, a continent-sized archipelago of 17,000 islands across three timezones. It is the third largest democracy in the world, with more Muslim citizens than any
other state. It is the biggest economy in South East Asia and predicted to be the tenthlargest in the world by 2030.
The Indonesian economy survived the recent global economic crisis well. Indonesia
continues to post significant economic growth. As of April 2012, the country's economy isexpected to grow by 6,1 percent in 2012 and increase to 6,4 percent in 2013. The country’s
gross national income per capita has steadily risen from $2.200 in the year 2000 to $3.720 in2009. The economy was helped by its robust domestic consumption base and a limited
exposure to exports. In terms of macroeconomic stability, Indonesia has managed to fulfill
many of its fiscal targets, including a significant drop in Debt-to-GDP ratio from 61 percent in2003 to 27.5 percent in 2009. Meanwhile, the budget deficit is projected to be as little as 0.4
percent of GDP in 2011.
Indonesia has formulated a long-term development plan which spans from 2005 to 2025.
It is segmented into 5-year medium-term plans, each with different development priorities.
The current medium-term development plan covering 2009-2014 is the second phase andfocuses on: (a) promoting quality of human resources; (b) development of science andtechnology; and (c) strengthening economic competitiveness.

II. Contents (Social Security in Indonesia)
In order to increase the quality of life society, the past several years government ensure
and committed to continue to improve the implementation of social security for all people ofindonesia especially in terms of principle, which is education and health. In the field of
education, the government continues to carry out the program and assistance poor students
to improve public education. Meanwhile, in the field of health, the Government has been
implementing healthcare for the poor programs (Jamkesmas)and a maternity benefit for theuninsured persons (Jampersal) to improve the quality of health services to the society.

-14-1. System and Organization
Currently, the Indonesian system of social protection is not organized according to one
universal criterion. For each program and group of population, there is one regulation andone special administration which are responsible for the collection of contribution andprovision of benefits. The implementation of legislation and supervisory activities are
assumed by different Ministries.
The form of social protection includes public intervention and privates initiatives. The
current

form of publicly provided social protection is based on two kinds of public

intervention, namely (a) contributory social insurance and mandatory saving (social security),and (b) non-contributory provision of social support to targeted poor and vulnerable group ofsociety (social assistance). Private insurance plays for private old age provisions and private
health insurance.
2. Social AssistanceIndonesian social assistance involves two programs namely income support and social
service. The current program does not involve family benefits, the third type of social
assistance. In 2005, the new elected government extensively widened the scope of social
assistance through ‘Oil Subsidy Reduction Program’ (Program Kompensasi Pengurangan
Subsidi Bahan Bakar Minyak-PKPS BBM).
Many local governments jointly subsidize social assistance programs in addition to thenational social assistance program for local residents. Most of them extend the coverage ofhealthcare for the poor program (Askeskin/Jamkesmas) and school program to the nearpoor. In some provinces or districts, the local governments extend healthcare program to theentire local residents including the non-poor household.
The following programs of income supports in Indonesia:
a. Social Welfare Program (Bantuan Kesejahteraan Sosial Permanen), the oldest
program among social assistance programs in Indonesia, provides income support toneglected elderly, neglected children and poor disabled persons. A temporaryscheme istargeted at the victim of natural disasters/social disasters and troubled migrant workers.
The schemeis implemented by the Ministry of Social Affairs and Local Governments.
b. Cash Transfer (Bantuan Langsung Tunai) has been introduced in 2005. The
unconditional cash transfer (bantuan langsung tunai tidak bersyarat) was implemented
from October 2005 to December 2006 providing 19.2 million poor with income support.
The unconditional cash transfer has been replaced by conditional cash transfer (bantuan
langsung tunai bersyarat) since January 2007. In contrast to unconditional cash transfer,-15-

the conditional cash transfer provides income support to very poor family conditionally
upon investment in human capital – school attendance, healthcare, nutrition). The target
groups of conditional cash transfer program are very poor households with children
between 0 and 15 years and/or a pregnant mother at the time of registration. Each family
will receive funds for up to six years. During three years of implementation, in 2010 theconditional cash transfer namely Program Keluarga Harapan, was implemented in 20
provinces, 86 districts and 739 sub districts for 816.000 very poor households. The
program is targeted to reach 2.4 million poor households in 2014.
The following programs of social services in Indonesia:a. Healthcare for the Poor (Jaminan Kesehatan Masyarakat Miskin / Askeskin - Jaminan
Kesehatan Masyarakat / Jamkesmas) has been implemented since January 2005 for74,6 million the poor and the near poor to cover free-of-charge primary healthcare
services including maternity at public health center (PUSKESMAS) and inpatient
treatment in third-class hospital wards. The Ministry of Health assigned PT ASKES to run
this scheme until 2007. The Ministry of Health has been taking over the implementation
since 2008 to directly distribute the funds to Puskesmas and hospitals.
b. A maternity Benefit for the Uninsured Persons (Jaminan Persalinan/Jampersal) has
been implemented since 2011 for pregnant women who are not covered by any maternity
scheme.
c. School Aid Programs provide operational aid to primary and secondary schools (Bantuan
Operasional Sekolah-BOS) and scholarships for senior secondary school students(Bantuan Khusus Murid-BKM). The programs have been implemented since 2005.
d. Social Welfare Insurance Program (Asuransi Kesejahteran Sosial - ASKES) has been
implemented since 2003 by the Ministry of Social Affairs for the poor and near poor
working in informal sector of economy. The Program covers limited healthcare benefits
and death benefits for maximum 3 years of membership.
3. Private Insurance
Private Insurance comprises of pension funds and health insurance program. By the endof 2009, the number of operating pension funds were 279 plans, consisting of 251
employer’s pension funds-FIPFs (Dana Pensiun Pemberi Kerja-DPPK) and 25 Financial
Institution Pension Funds-EPFs (Dana Pensiun Lembaga Keuangan-DPLK). Of the total
plans, there were 2.67 million registered as participants in the plans, both as active
participants and passive participants (retirees, widows/widowers, children, deferredpensioners).

-16-

FIPFs is a pension fund established by any individual or entity having employees, as it
founder, to implement a defined benefit pension program or a defined contribution pension
program, for the interests of all or part of such founder’s employees, as participants, andcreating obligations on the employer’s part. EPFs is a pension fund established by a bank ora life insurance company to implement a defined contribution pension program forindividuals, either employees or self employed.

III. Closure
1. Problems
Out of a population of 230 million, more than 30 million Indonesians currently live below
the poverty line and approximately half of all households remain clustered around thenational poverty line. Their income on average only 200.000 rupiahs per month ($24US). In
addition, employment growth has been slower than population growth. Such conditions
would result in public service for social security will be distorted.
2. Future plan
The government continues to strive to resolve the problems of poverty andunemployment, because both of these can interfere with the stability of social security inindonesia. The policies pursued must be able to reduce poverty and unemployment figures,
one of them with programs aid to the poor.
In order to increase community access to basic medical services, particularly for the poor
population, the provision of health care to the society guarantee which is already
implemented in previous years through the Jamkesmas and Jampersal program will be
continued and expanded in scope. In 2013, the Jamkesmas program is intended
approximately 86,4 million in the form of increased access of poor population and the
Jampersal program to about 2,7 million pregnant mothers.
Starting in 2014, the Government will implement the national programme of social
security systems (SJSN) which aimed to provide the assurance of protection and social
welfare for the whole people of Indonesia, especially the implementation of social security inthe health field in 2014.

Regards,
Agung Kurniawan P.P. (Fiscal Policy Office – Indonesia)-17-

The National Social Health Insurance Programe
In Indonesia(Country Report)

National Development Planning Agency/BAPPENASTOKYO, Japan
September 17 to Oktober 6, 2012-18-

I. Introduction

Maps of Indonesia

Indonesia is comprised of more than 17,500 islands and is home to more than 237
million people contained in more than 350 ethno-linguistic groups. It is not only the world’s
largest tropical archipelago nation but also the globe’s most varied tourist destination, with
distinctive beaches, mountains, lakes, forests, flora and fauna, rich and diverse in history,
traditions, culture and cuisine.
Indonesia extends from 6 degree of north latitude until 11 degree of south latitude,
and from 97 degree until 144 degree of longitude. It is situated between two continents-Asiaand Australia/Oceania. This strategic location has a significant influence towards its culture,social, politics and economy.
Indonesia’s territory extends along 3,977 mile between the Indian Ocean and thePacific Ocean. If the coastal area between the islands be connected, Indonesia’s area would
become 1.9 million square miles.

-19-

There are five large islands in Indonesia, they are: Sumatra with an area of 473,606
square km, Java with an area of 132,107 square km, Borneo/Kalimantan (the third biggest
island in the world) with an area of 539,460 square km, Sulawesi with an area of 189,216
square km, and Papua with an area of 421,981 square km.
Indonesia is a unitary state composed of 33 autonomous provinces. These provinces
are divided into 370 districts, 95 municipalities, 6,093 sub-districts and 73,067 villages.

II.

The National Social Health Insurance Program: Work in Progress

The Current Status of the System
The Indonesian healthcare delivery system consists of both public and private providers. Its
funding also draws from avariety of sources, both public and private.
The backbone of the system is a government line item budget aiming to fulfill theconstitutional mandate to provide statutory health services to all citizens. The state budget
is allocated for both public and personal healthcare. After the introduction of administrativeand government decentralization in 1999, local government is obliged to contribute
financially to development, including health.
The Indonesian Government installs and finances primary healthcare centers (Puskesmas)
and sub-centers (Puskesmas Pembantu and midwife/village clinics) at the sub-district andvillage level as points of healthcare delivery. The government also installs and finances
hospitals for referral to secondary care in all districts in Indonesia.
Currently, the government allows public providers to impose tariffs based on their costs, asmandated by Law No. 9/1968 jo Law No. 20/1997 on non-tax state revenues, Law No.
5/1974 jo Law No. 18/1997 on local taxes and retribution, and Law No. 32/2004 on regional
government. This policy also applies for members of existing health insurance schemes. The
difference between service charges levied by public providers and payment rates set up by
health insurance agencies must be born by the insurance members, so that cost sharing
occurs in the financing of health services. There are two reasons for the mismatch: on the
one hand, the insurers have fixed their rates based on what is taken for an acceptable rate
for the members, not strictly on cost-recovery mechanisms. Furthermore, there are no-20-

functional standards for service quality and matching costs under conditions of efficiency. As
this de facto cost sharing is regressive to members’ income, tariffs create an access barrier
particularly for people with a low income. On the other hand, user fees account for an
essential source of revenue for public healthcare providers.
Private health insurance only plays a role in a small segment of the market for affluent
individuals, and as a substitute for the health insurance scheme for formal sector employees
provided by state-owned JAMSOSTEK. By statute, formal employees must be insured either
by JAMSOSTEK or by any scheme that matches or exceeds the coverage provided by thiscompany. Many enterprises chose either private insurers, or they offer coverage from theirown resources.
The Indonesian government allows the private sector to install and provide healthcare
services for a wide spectrum of services. The private entities serve all levels of care, primary,secondary and tertiary. The major source of finance for private healthcare providers is user
fees. Private providers are mostly located in areas where people can afford their services.
In conclusion, the Indonesian personal healthcare system combines a government line item
budget, out-of-pocket fees for service, and health insurance. Out-of-pocket payments are amajor source of revenue for Indonesian healthcare providers. User fees have brought
inequity to the healthcare system both in terms of financial and geographical access.
The National Social Security System (NSSS) Law opens an avenue to restructure thepersonal healthcare system. The way forward requires careful design to assure that the
future system can significantly diminish inequity, and improve its performance and outcomes.
The design also needs to carefully integrate personal healthcare with overall health policy
with its important elements of public health, and with other programs within the nationalsocial security system.
The reform process has started with the ratification of Law No. 40/2004 on the National
Social Security System (NSSS Law). This law sets the basic principles for universal social
security, as well as a timeframe for the preparatory works necessary for the new system tobe implemented throughout Indonesia.

-21-

NSSS - the Law on the National Social Security System
Article 19 of Law No. 40/2004 on the National Social Security System, called the NSSS Law
below, dictates that personal healthcare is to be carried out through a national healthinsurance scheme that is based on the principles of social insurance and equity.
Health insurance as a national program is built within national structures and functions toensure social justice for all Indonesian citizens. The program’s structure and functions are to
be regulated by a new Presidential Regulation on the National Health Insurance Program(PresReg NHIP). Furthermore, there is a need for a comprehensive and integrated
regulatory framework spanning from the NSSS Law to implementation level regulations. The
comprehensiveness, alignment and concord of regulations on the health insurance program
will greatly influence the effectiveness of the PresReg NHIP as a regulatory instrument inensuring the attainment of benefits from health maintenance and protection for all the
population in meeting basic healthcare needs.
The fulfillment of the principles of social insurance depends on the financing system, and on
the implementation system framework that connects members, executing agencies of social
security and social (health) service facilities. This framework therefore includes both theflow of funding and that of benefits. In this context the following aspects need to becarefully
designed in order to ensure a functioning social health insurance scheme:
Allocation and flow of funding include the following functions: 1) determination ofcontributions and entitlements; 2) collection of contributions; 3) pooling of funds collected;4) purchasing of services; 5) provision of services.
The attainment of social insurance principles will also be influenced by the way the benefit
flow is ensured. These are theimportant elements of such a flow: 1) services received and fulfillment of basic healthcare
needs; 2) availability of quality healthcare and freedom for members to choose healthcare
facilities; 3) the level of direct co-payments from members for healthcare services coveredby insurance.

-22-

The equity principle stated in the NSSS Law postulates that members receive services
according to their medical needs, not according to their contributions. This includes equity offinancial and physical access to healthcare. It also means equal protection from financial
risks when in need of healthcare, standardized quality of healthcare, and relief of financial
burdens that may constrain members from benefiting from healthcare or even impoverish
them. The respective wording of Article 19 of the NSSS Law is as follows:(1) Health insurance shall be administered on a national scale based on the principles ofsocial insurance and equity.
(2) Health insurance shall be administered with the aim of ensuring that members receive
the benefits of healthcare and protection so as to fulfill basic health needs.
The NSSS Law dictates that four points are to be further regulated in the new PresReg
NHIP: 1) membership, 2) amount of contribution, 3) benefit package, and 4) provision ofservices by service facilities.
III.

Closure1. Problems
However, a continuous finetuning and further development of the Road Map for Universal
Health Coverage Reform in Indonesia are, naturally, very important issues.
2. Future plan
Last but not least, it needs to be emphasized that achieving universal coverage, as
intended by the Government of Indonesia, is a lengthy and incremental process, especiallyin a vast and heterogeneous population like that of Indonesia. With its longterm politicalcommitment to achieving social security for all, the Government of Indonesia has met an
essential pre-condition for success.

-23-

The Study Programme
for the Improvement of Social Insurance System- Health Security and Vulnerable people-

Kosova-24-

Improvement of Social Insurance System-Modernization of Health
Security Administration(September 17, – October 6, 2012, Japan)

Country Report
Map of your country

Republic Of Kosova-25-

Geographical and Political features ofRepublic of Kosovo•Government
Type: Republic•
Constitution: The Kosovo Assembly approved the constitution on April 9,
2008. It came into force on June 15, 2008.
•
Branches: Executive--president (head of state); prime minister (head ofgovernment).
•Legislative--unicameral Assembly (120 seats, 4-year terms; 100 seats
generally elected, 10 seats reserved for ethnic Serbs, 10 seats reserved forother ethnic minorities).
•Judicial--Supreme Court.
Subdivisions: 38 municipalities.

-26-

KOSOVO Population:

1,733,872
 Geography: Southeast Europe
 Area:10,887
 Climate:
Influenced by continental air
masses resulting in relatively
cold winters with heavy
snowfall and hot, dry summers andautumns-27-

Main Data of Health Statistics 2010

Total Population

1,733,872 million persons

Live Births

33751 - 27.645 in Health Institution（2010)

Total Fertility Rate

2.0

Infant Mortality Rate

19.1 per 1,000 Live Births

Maternal Mortality Ratio

7.2 per 100,000 Live Births

Life Expectancy at Birth[ 67 ] years old (Female)[ 71 ] years old (Male)-28-

Main Health Problems(National Level)●Lack of adequate health financing●Lack of Health Information System●Lack of sufficient financial resources●High mortality rate among mother and child●Lack of Health insurance found-29-

Main Health Problems(Local Level)●Insufficient financial resources●Lack of trained human resources●Inadequate access in health care facilities●Inadequate referral system● Lack of data for direct funding for services, medicines andmedical products-30-Social Security System•Health sector is struggling with insufficient funds for provision ofaccessible, quality health care services for entire population• Ensuring of the sufficient and sustainable financing of the developing
health sector is one of the main challenges of the Ministry of Health•Reforms have been initiated by drafting two very important draft-laws,
general Health Law and Health Insurance Law (HIL), which are expected tobe adopted by Parliament until December 2012
•Purchaser–provider split, commissioning of the health care services
through contracting, development of transparent payment mechanisms
and performance payments, requires sufficient number of humanresources with developed knowledge, skills and technical capacities toinitiate, develop and carry out these complex tasks, along with the processof establishing future Health Insurance Fund
-31-

Payment system of medical careexpenditures
 The public health system in Kosovo is currently funded through the statebudget and co-payments
 Revenues of health institutions are not keept in the health sector but paid to

the treasury in accordance with the Law on Public Financial Management andresponsibilities


According to the WB, out-of–pocket payment to the private sector amounts
approximately to the same amount than the public health expenditure.
There is no mandatory public health insurance

 PHC is directly funded by the Government through the Municipal Health

Grants allocated by the Ministry of Finance after a consultative process with
the MoH and relevant municipalities. The PHC budget for 2012 is 41 million
Euros (MF 2012).

-32-

Government calculation for health budget in
2013

-33-

Projection of financial resources basedon new law
Figure 3.1 Projectionof financial sorces
based on the
new law of MoH

100%
80%
60%
40%
20%
0%

Premium Payment

2012

2013

2014

2015

2016

28,945,519 37,105,810 38,362,214 38,362,214

Citizens Primiums 8,646,872 34,795,012 60,067,194 61,622,022 61,622,022
Budget transfer

115,970,98 84,123,383 80,888,231 84,765,955 84,765,955-34-

IMF Country Report-35-Organization Chart of
Future Health Insurance Fund-36- Thank you-37-

The Study Programme
for the Improvement of Social Insurance System- Health Security and Vulnerable people-

Laos

-38-



For the training and dialogue program course on“Improvement of Social Insurance System” (J1200718)
Japan, 17 September to 6 October, 2012

Prepared by:
Director of Social Security Management Scheme Division
Social Security Department
Ministry of Labour and Social Welfare
Tel: 856 20 55615569, Fax: 856 21 213287

-39-

-40-

I. General information on Lao PDR.
Lao People’s Democratic Republic is a landlocked country located in South East Asia
sharing borders with Thailand, Cambodia, Vietnam, China and Myanmar.
The population is estimated at 5. 874 million in 2007 with an average life expectancy
at birth of 62,5 years, an infant mortality rate of 64.4 per 1000 live births and a fertility
rate of 4,2% children per woman in 2002 (Population 2012 estimated at 6 million).
The Land area is 236.800 square km. The majority of the population is living in ruralarea (83%), and only 17% of population is living in the major cities.
The population is composed of 48 different ethnic groups of which the Laolum
located in the lowland areas close to the Mekong River is predominant (67%).
The official religion is Buddhist.
The GDP per capita is 701 US$ in 2007.
The Lao P D R’s terrain is mostly rugged mountain with some plain and plateaus.
The rainy season runs from May to November whereas the dry season is from December
to April.
74.37% of the Lao PDR population (10-year old and above) is active, from which
49.66% of male and 50.34% of female.
Lao PDR has rich water resource; the Mekong is the main water resource fornavigation as well as agriculture and hydropower development.
The official language in the Lao PDR is the Lao language as is spoken and written.
II. Social security system in Lao PDR
1. Social Security Scheme for the Public Sector.
The current decree for the social security scheme for the public sector
employees was approved in 2006. Its title is social security decree for government
employees No.70/PM. The pension benefit is one of social security benefits. This
scheme is managed by the State Authority of Social Security (SASS).
SASS is an autonomous organization that is under control of its board of
Directors. The board functions under the supervision of the Minister of Labor andSocial Welfare. The board is composed of 7 members.
This scheme is reform from the social security decree No. 178/PM. The
decree No. 178/PM is managed differently from the decree No. 70/PM. There are
four main departments performing under two ministries involved with the fundmanagement such as Social Security department, war veteran department andtreasury department. The first three are under ministry of labour and social
welfare. The last one is under ministry of finance. Most of operation or
management rules are lied with the social security department. The policy-age
pension department has duties to approve for awarding pension. The war veterandepartment has duties to approve invalidity pension applications. The treasury
depatment has the responsibility to control the social security fund. The system isoperational at three levels such as central level, provincial level and district level.
To be eligeble for old pension, insured men must attain the age of 60 years,
and 55 years for insured women. And both men and women have to fufil 25 yearsof service. For persons who used to participate in the revolution process before-41-the year 1975 and those who have performed duties close to poisonous substance,
their retirement age and duration of service can be reduced to 5 years.
A person who qualifies the above-mentioned conditions will receive
pension equal to 75% of his basic salary plus 1% for each additional year ofservice.
The social security fund for the pubblic sector comes from the monthly
contributions made by public employees 6% of their basic salary. This reflects asmall part of total expenditure. The government has to cover all the rest in order
to meet all requirements in the field of social security benefits. Nevertheless, theimprovement of the existing public sector social security system is being in theprocess. improvement of the existing public sector social security system
Currently, the number of old age pensioners are approximately 22,500
persons. As the Lao population is considered as young population the number is
expected to increase quite fast. The number of civil servants now is about 100,000
persons who are officially registered with the system. There is no figuere on
military and police who are also the member of the social security fund. It is
obvious that the fund is mainly finaced by the government.
Now aday the government of Lao PDR has received assistance from thegovernment of Luxembourg to develop social security system with a total periodof 4 year from the year 2002 to 2005. The Luxembourg assistance project has
been implemented through the International Labour Organization (ILO). The
project has tree main objectives as following:
1. To reform the public sector social security scheme.
2. To strenngthen the private social security scheme.
3. To find out the possibility to create the social security system for people
working in the informal sector.
Since Laos has independence in the year 1975 up to now, the government hasestablished two separate social security systems. One is the system for the public
sector employees and the other is for the private sector employees.
The social security scheme for employees of the public sector was established in
1993. This scheme is administered by the Ministry of Labour and Social Welfare(MOLSW). The fund is kept under the Treasury Department of MOF. The scheme
coverage includes civil servants, military and police. The scheme is funded bycontributions of employee and government. Employees pay 6% of their wages,
the government subsidises to expenditure for benefits.
Until 2006 reform for degree 178/PM to decree 70/PM was has accepted.
The contribution for this fund: insured person is contribution 8% their salaries andgovernment contributes 8.5% person salaries, but 0.5% for worked injury andoccupational deceases. Since the introduction of social security system for the
public sector the scheme now covers approximately 360,539 insured persons(583,457 beneficiaries).

-42-

2. Social Security System for the private sector.
The benefit for the private sector employee scheme is one of social
security benefits as stimulated in the decree 207/PM. The decree has been
implemented by Social Security Organization since June 01, 2001.
The decree regarding social security system for the private sector
employees was approved in 1999 and it was officially implemented in early 2001.
It’s a contributory and compulsory scheme. The scheme applies to all employers
who have 10 or more employees. The total contribution rate is 9.5% of
employee’s earnings in which 5% comes from employers and 4.5% from
employees.
Social Security Organization is an autonomous organization that is undercontrol of its board of Directors. The board functions under the supervision of the
Minister of Labour and Social Welfare. The board is composed of 11 members ofwhom there are three representatives from the government organization, four
from employees and four from employers. The management unit of SSO
comprises a director general and two deputes responsible for daily operation of
SSO.
Qualifying condition: an insured person has to complete at least five yearsof contribution to the social security fund and has to attain the age of 60 years. In
case of necessity 55 years of age will be allowed to retire, but the amount of his
retirement benefit (pension) will be reduced for 0.5% per month until he reaches
60 years old. In contrast, a person having 60 years of age but continuing to work
his pension will be increased 0.5% per month according to the period he works
after 60 years. For this case, the insured is allowed to work only up to 65 years
old.
Since the introduction of social security system for the private sector thescheme now covers approximately 59,905 insured persons (124,538 beneficiaries).

-43-

Ministry of Laborand Social Welfare
MinisterVice Minister

Cabinet of the
Ministry

Labor Protection of
Department

Personnel of
Department

Labor Development
Skill and Employmentof Department

Inspection of
Department

Social Welfare of
Department

Labor and Social
Welfare Department ofProvince
Labor and Social
Welfare Office ofDistrict

Pension Elderly andHandicapped of
Department
State Authority ofSocial Security

Social Security of
Department

Social Security ofOrganization

Management Scheme
Social Security Division

Administration and
Planning Division

Development Social
Security Division-44-

ANNEX1-Form 1
The State of National
Area size ( 236,800 square Km )Population by aged group. Unit: thousandsYear

1991(1990)

1996

2001

2006

2011

Male
Female

373
388

368.9
375.4

426.91
419.5

370.8
366.2

476.00457.56

Male
Female10-19 Male
Female20-29 Male
Female30-39 Male
Female40-49 Male
Female50-59 Male
Female60-64 Male
Female65
MaleFemaleTotal Male
Female

279
292
481
464
332
284
238
227
154
142
121
113
45
45
83
79
2,106
2,034

353.6
367
544.2
552.2
387.3
342.3
285.7
280.3
177.4
172.8
133.5
117.4
48.3
44.7
92.4
84.7
2,391.3
2,336.8

417.39402.10627.99618.80389.28440.50318.81324.80196.46201.80133.51151.80
50.79
55.00
96.33
105.002,657.49
2,719.60

373.4
365.9
731.6
711.7
479.0
493.2
345.1
354.4
254.1
255.1
156.4
163.9
50.7
55.7
103.4
117.1
2,864.40
2,883.20

363.29358.74753.11
729.87571.90576.25371.84386.86291.61296.64193.83200.5157.60
62.50
109.51127.503,188.67
3,196.39

0-4
5-9

Source: National Statistic Center (NSC)-45-

ANNEX1-Form 2
Year
Population growth rate(%per annum)
Birth rate
(per1,000population
Mortarity rate
(per 1,000population)
Infant mortarity rate
(per1,000population)
The rate of the population of 65 years
and over to the total population(%)
Life expectancy
M
at birth
F
Life expectancy
60
at age 60 and 65
65
Unemployment rate
(per1,000population) average rate

1991

2.40

5.5

1996
2.84

2001

2.74

2006

2.40 2.22

40.30

38.10

33.70 28.00

14.70

13.90

9.40 7.70

162.2096.80

67.20 54.1

2011

3.9

-

53.70
55.90
-

56.40
59.70
-

-

-

5

Source: National Statistic Center (NSC)-46-

61.70 62.30
63.00 66.40
3 3-

ANNEX1-Form3
Year
National income (US$)
Average Wage (US$)
Average Wage of Male andM
FemaleF(US$)
Average income (US$)
Total GNP (US$)
GNP growth rate
GNP per carpita (US$)
Total GDP( US$) (Million US$)GDP growth rate
GDP per carpita(US$)
The rate of social insurance ofcontribution as % of salary for em-ee
Premium contribution
Of employee (Thaursand $)Premium contribution
Of employer (Thaursand $)Premium contribution
Of self-employer etc.

1991

1996

2001

2006

2011

13,495,315

3,334

8,181.21

4.50
211

5.90
344.9

6.20
450

7.90
580

8.50
1,281

Covernmemt
subsidied
6

Covernmemt
subsidied
6

Covernmemt
Subsidied
6

8.5%

8.5%

7,484

8

-

-

5

11,553

5

-

-

9.5

9.5

9.5

Source: Ministry of LSW-47-

ANNEX1-Form4
Number and percentage of workers engaged in industrial classification
Year
Primary industry
Secondary industry
Tertiary industry
Total

1991

1996

2001

2006

116
542
22,916
89,4052011

Source: Ministry of industry and commerce
Five leading causes of death(Year)

1st

2nd

3rd

4th

5th

1991

Malaria

-

-

-

-

1996

Malaria

-

-

-

-

2001

Malaria

Pneumonia

Accident

Meningitis

2006

Pneumonia

2011

Diarrfiouea

Cardiopadia

Accident

Brovacculaire

Acute Respica

Dengue fever

Source: Ministry of Public Health.

-48-

Traumatisme
Malaria

Crânien

Lao People’s Democratic Republic
Peace Independence Democracy Unity Prosperity

Country Report
The Training and Dialogue Program on“ Improvement of Social Insurance System” J12-00718/ID. 1280912
Japan, September 17, 2012 to October 6, 2012

-49-

I.

Geographical and Political Features

Lao people’ s Democratic Republic is a landlocked country in South East
Asia sharing borders with Thailand, Vietnam, Cambodia, China and Myanmar.
The country occupies an area of 236,800 Sq. Km, of which circa 75% ismountainous with forests. Lao PDR comprises 17 provinces including Vientiane
capital.
The Mekong River has Traditionally served as Lao PDR’s lifeline, andforms the country borders with Thailand as well as with Myanmar. The Mekong
flows over 1800 km along these borders. The Mekong River valley and its fertile
flood plains form the country’s main agricultural zones.
The population is estimated to 6,385,000 in 2011 with an average life
expectancy at birth of 64.7 years, an infant mortality rate of 54.1 per 1000 live
births. The majority of the population live in the fertile low lands near the
Mekong River and its tributaries. Roughly 83% of the population lives in rural
areas and 17% of population lives in the major cities.
The population is composed of 49 different ethnic groups of which the
Lao-lum located in the lowland areas close to the Mekong River ispredominant(67%).Buddhism was apparently in the late 13th or early 14th
centuries. Today about 62% of the population are Theravada Buddhists. Long
after the introduction of Buddhism, the people were reluctant to accept the newfaith and continued to worship different “phii” (earth spirit). It was not until themid 17th century, that Lao PDR maintained a continuous Theravadin tradition.
However still today in everyday life, different “phii” are feared and recognised,even if the “phii” worship has been officially banned. The Lao PDR’s terrain ismostly rugged mountain with some plain and plateaus, The Lao PDR is intropical climate, the rainy season runs from May to November whereas the dry
season is from December to April. The official language in the Lao PDR is theLao language as is spoken and written.The Lao PDR is divided into 17
provinces, which are divided into 139 districts and 9,113 villages, the village issmallest administrative unit.
II.
Social Security System in Lao PDR.
Since Laos has independence in the year 1975 up to now, the government
has established two separate social security systems. One is the system for the-50-

public sector employees and the other system is for the private sector
employees.
The social security scheme for employees of the public sector was
established in 1993. This scheme is jointly administered by the Ministry ofLabour and Social Welfare (MOLSW) and Ministry of finance (MOF). The fundis kept under the Treasury Department of MOF. The scheme coverage includes
civil servants, military and police. The scheme is funded by contributions of
employee and government. Employees pay 6% of their salaries, the government
pays all the rest of expenditure. Benefits covered by this scheme comprise oldage pension, disability benefit, survivor benefit, sickness benefit, maternity
benefit, work injury and medical care. Until the year 2006 the Lao government
decreed the new decree on Social Security for employees of the public sector to
replace the old decree which the contribution is 8% of employee’s salaries andgovernment pays 8.5% and the qualifying period for old-age pension benefit isreduced from 25 years to be 15 years. The scheme is administered by the State
Authority of Social Security (SASS) which is an autonomous body, under thesupervision of the Minister of MOLSW.
The decree regarding social security system for the private sector
employees was approved in 1999 and it was officially implemented in early
2001. It a contributory and compulsory scheme. The scheme applies to all
employers who have 10 or more employees. The total contribution rate is 9.5%of employee’s earnings in which 5% comes from employers and 4.5% from
employees. The insurable target groups are all employees who work for State,
private and partnership enterprises in the areas of industry, agriculture, services,
However, the system provides exception for those who are working
for:embassies, international organizations, companies that have a multinational
network located in Laos for the period not exceeding 12 months, companies thathave affiliates in other countries and who are sent to work abroad for 12 months
or more, who work for the government such as civil servants, military, police
and student. Benefits provided under this system from the beginning of its
introduction are composed of old age pension, invalidity benefit , survivor
benefit, sickness benefit, maternity benefit, medical care and work injury
benefits. The scheme is administered by the social security organisation(SSO)
which is an autonomous body, under the supervision of the minister of MOLSW.
III. Outline of Medical Insurance System (MIS).

-51-

The Medical Insurance System (MIS), which was implemented in 2001,
consists of two significant systems. The first is the Medical Insurance System
for Enterprises Employees and for Community Based Health Insurance (CBHI).
The medical insurance system for enterprise employees is administered andsupervised by the Social Security Organization. Social Security
Organizationdivides the supported capital that employers and employees
contribute to the SSO’s fund. 4 % of the 9.5% contribution will be deducted for
Medical Insurance.
The Community Based Health Insurance (CBHI) is supported by thegovernment of Japan through the UNHSF. Technical assistance is also provided
by the WHO. The CBHI is the system concerning the provision of healthcare topeople working as farmers, gardeners, retailers and other similar vocations.
There is a large percentage of the population engaged in such professions and itis hard for them to spend for medical treatment in the case of illness. The rate ofpayment is calculated based on the number of family members and there are twoalternative options to get access to the service or treatment as follows:
1. First option: the first option is the insurance for people who can accessprovincial hospitals or central hospitals directly:
 Families with 1 member: 37.25 US$ /insured person/year Families with 2-4 members: 62.08 US$ /insured person/year Families with 5-7 members: 80.71 US$ /insured person/year Families that have more than 8 members: 86.92 US$ /insured person/year Monks, religious practitioners and students who stay in dormitories: 14.9
US$ /insured person/year
2. Second option: the insured person has to be treated at the nearest district
hospital first. If the closestdistrict hospital cannot treat the insured person,them he/she must be sent to contracted hospitals. The rate of cover depends
on the contract. It might be 50%/ 50% , 60%/40% or 70%/30%
The rate of supported capital is indicated below
 Families with 1 member: 26 US$ /insured person/year Families with 2-4 members: 44.7 US$/ insured person/year Families with 5-7 members: 55.88 US$/ insured person/year Families that have more than 8 members: 62.08 US$/ insured person/year Monks, religious practitioners and students who stay in dormitories:
14.90 US$ /insured person/year-52-

The CBHI is administered and supervised by the Ministry of Health and isunder the inspection and supervision of minister of the Ministry of Health.
The Civil Servant Scheme was initially implemented in 2006. The system isunder the control and supervision of the State Authority Social Security (SASS).
It is also monitored by the Minister of the Ministry of Labor and Social Welfare.
The SASS divides the supported capital that civil servants and the government
contribute to the SASS’s fund. 4 % of the 16.5% contribution will be deductedfor Medical Insurance.
In the actual implementation of Medical Insurance System, the threeorganizations mentioned (SSO, SASS, CBHI) will be in the form of capitation
methods with state hospitals which covers 10.55 US$/insured person/year.
Insured person can receive treatment at a specified hospital regardless of
medical care costs or the number of treatments.
To make sure that the insurance is appropriate, the contract made with thethree organizations (SSO, SASS, and CBHI) has indicated the types of treatmentthat are not covered as follows:
1. Cardiac Surgery, Sexual changing surgery, Organ transplantation surgery.
2. Thalassemia
3. Hemodialysis
4. Tubal ligation (accept that it is medically required), In Vitro Fertilization.
5. Traffic accidents
6. Patients who have been in hospital more than 3 months due to the samedisease.
7. Esthetic dentistry, Operative dentistry.
8. Chemotherapy, Radiotherapy
9. Glass cost, Prothetic lens cost.
10. Yearly check ups
The expansion of the Medical Insurance System, specifically the Civil
servant Medical Insurance System and Enterprise employees Medical Insurance
System are now being set up in every province in the country. Interestingly, the
CBHI is now being operated in 25 districts throughout the country. There are asignificant number of insured persons as follows:
1. The Social Security Organization has 126,039 insured persons.
2. State Authority Social Security has 355,090 insured persons.
3. The CBHI has 140,000 insured persons.

-53-In order to allow the Medical Insurance System to cover the whole country,
to make the program sustainable, and to quarantine the benefits of insured
persons, the government of Lao PDR has issued decrees and regulations asfollows:
1. Decree No 207/PM, dated 23 December 1999 on the Social Security
System for enterprise employees.
2. Rule No 723/MOH, dated 13 April 2005 on the Community Based
Health Insurance.
3. Decree No 70/PM, dated 20 April 2006 on State Authority Social
Security.
The Law on the Social Security System is now being drafted
The problems of the Medical Insurance System- The Medical Insurance System was implemented in four central hospitals
in Vientiane capital in 2001. The program is now being operated in 17
provincial hospitals throughout the country. However, it is not
implemented at the district hospital level.
- All of three organizations (SSO, SASS, CBHI) implementing the contractof medical care are doing so in the capitation method with the statehospitals.
- The percentage of insured persons is only 9.72% of the total population- The rate of insurance does not balance with the rate of treatment.
- Regulations and laws about MIS are not fully managed, so it is difficult tocontrol.
To solve the problem mentioned, the Lao government has a policy
to integrate the three organizations into one as the SASS to average thecapital and to make sure that the capital fund available is sustainable.
.

-54-

State Authority of Social Security
Ministry of Labour
and Social Welfare
Board of Directors

Director General

Deputy Director 1

Administration
Fund Division

Deputy Director 2

Administration
Planning Division

Registration andInformationTechnology
Division
Province Brand

District Brand-55-

Health Insurance
Division

ANNEX1-Form 1
The State of the Nation
Area size (Area size Km2) Unit: thousands
Population by aged group

0-4
5-9
10 - 19Male
Female20 - 29
Female30 - 39
Female40 - 49
Female50 - 59
Female60 - 64
Female65 - Male
FemaleTotal
Female

Year

1990

1996

2001

2006

2011

Male
FemaleMale
Female

373
388
279
292
481
464
332
284
238
227
154
142
121
113
45
45
83
79

368.90375.40353.60367.00544.20552.20387.30342.30285.70280.30177.40172.80133.50117.40
48.30
44.70
92.40
84.70

426.91419.50417.39402.10627.99618.80389.28440.50318.81324.80196.46201.80133.51151.80
50.79
55.00
96.33
105.00370.80366.20373.40365.90731.60711.70479.00493.20345.10354.40254.10255.10156.40163.9050.70
55.70
103.40117.10476.00457.56363.29358.74753.11
729.87571.29576.25371.84386.86291.61296.64193.83200.5157.60
62.50
109.51127.50

2,106
2,034

2,391.30
2,336.80

2,657.49
2,719.60

2,864.40
2883.20

3,188.67
3,196.39

Male
Male
Male
Male
Male

Male

Data resource: Lao National Statistic Centre-56-

ANNEX1-Form 2
Year
Population growth rate(% per annum)

1991

1996

2001

2006

2011

2.40

2.84

2.74

2.40

2.22

40.30

38.10

33.70

28.00

14.70

13.90

9.40

7.70

162.20

96.80

67.20

54.10

Birth rate
(per 1,000 population)
Mortality rate
(per 1,000 population)

5.50

Infant mortality rate
(per 1,000 population)
The rate of the population of 65 years andOver to the total population (%)

3.9Life expectancy
at birth

M

53.70

56.40

61.70

62.30

F

55.90

59.70

63

66.40

Life expectancy at 60 and 65

60
65

Unemployment rate
(per 1,000 population)*average rate
Data resource: Lao National Statistic Centre-57-

ANNEX1-Form 3
Year
National Income (US$)
Average Wage (US$)
Average Wage of Male and Female
M
(US$)
F
Average Income (US$)
Total GNP (US$)
GNP growth rate
GNP per capita (US$)
Total GDP (US$) (MillionUS$)
GDP growth rate
GDP per capita (US$)
The rate of social insurance ofContribution as a percentage ofSalary for employer
The rate of social insurance ofContribution as a percentage ofSalary for employee
Premium
contributionof employee
Premium
contributionof employer
Premium
Contributionof self-employee etc.

1991

1996

2001

2006

2011

4.50
211

5.90
344.906.20
450Government
subsidized

Government
subsidized

3,334.00
7.90
580
8.5%

8,181.21
8.50
1,281
8.5%

6%

8%

6%

6%

Data resource: Lao National Statistic Centre-58-

Government
subsidized
6%

ANNEX1-Form 4
Number and percentage of workers engaged in industrial classification
Year

1991

1996

2001

2006

Primary industry

441

Secondary industry

2,055

Tertiary industry

86,909Total

89,40592,561

2011

Data resource: Ministry of Industry and Commerce
Five leading causes of death
Year

1st

2nd

3rd

4th

5th

1991

Malaria

Diarrhea

Pneumonia

Meningitis

Accident

1996

Malaria

Pneumonia

Diarrhea

Accident

Meningitis

2001

Malaria

Pneumonia

Cardiopathia

Accident

Meningitis

2006

Pneumonia

Accident

CerebrovascularTraumatism

2011

Diarrhea

Acute Respiratory
infection

DengueMalaria

CraniTraumatism
Pneumonia

Data resource: Ministry of Health-59-

Social Security Systems
and Health Insurancein Lao PDR
For the training and dialogue program course on“Improvement of Social Insurance System” (J1200718)
Japan, 17 September to 6 October, 2012
Ministry of Labor and Social Welfare
Department of Social Security
Presentation By :Head of Social Security Management Schemes Division
Email: nikonevongsavath@yahoo.com
Tel: 020 55615569, 021 213013-60-

-Small country, middle ofIndochina in South East
Asia.
-Area : 236,800 Square
Kilometers.
-Share border with : China,
Cambodia,
Vietnam,Thailand
and Myanmar.
-Population : 6.385.060
million(2011).
-Capital city : Vientiane.
-Consist of 16
provinces.
-GDP per capita : 1,281 US$.
(2011).
-61-

Structure and Organization of Ministryof Labor and Social Welfare
Ministry of Labor andSocial Welfare
MinisterVice Minister

Cabinet of the
Ministry

Labor Protection of
Department

Personnel of
Department

Labor Development Skill
and Employment of
Department

Inspection of
Department

Social Welfare of
Department

Labor and Social Welfare
Department of Province

Labor and Social Welfare
Office of District

Pension Elderly andHandicapped of Department

State Authority of Social
Security
Management Scheme Social
Security Division

Social Security of
Department
Administration and Planning-62Division

Social Security ofOrganization
Development Social
Security DivisionHealth Financing Schemes
Financing mechanisms

Health careservices

Financing sources

Tax-basedfinancing

1. General tax orother revenue

Social healthinsurance

2. Payroll tax

Otherprepayment
schemes

3. Contribution or
premium

Out-of-pocket
payments

4. Direct payment

Naturalresource
revenueHousehold-63-

External
resource

The Vision of Universal Coverage

Three Dimensions

Universal Coverage
 Everyone has access toneeded services without
the risk of financial
hardship linked to
paying for care.
 Universal Coverage isabout equal access toquality services andfinancial protection-64-Overview
Policy on Social Security and Health
Insurance Social Security Implementation(Social Health Insurance)• State Authority Social Security (SASS)• Social Security Organization (SSO)• Community Based Health Insurance (CBHI)• Health Equity Funds (HEF) Development Plan on Social Security
Challenges-65-

1. Policy on Social Security
in Laos Thegovernment of Lao PDR has issued
the social security policy in order toprovide services and to support people
and community in every economic sector
and profession with intention to allow
them having opportunity to join thescheme and receive the social security
benefits or services which are createdbased on the principle of solidarity,
helping each other and sharing risks.
-66-

1. Policy on Social Security(Contd.) Thedevelopment of social security
system in Lao PDR is necessary toextend its coverage to all employees
working at the city and rural area
including high aged group, low income
community in order for them having
appropriate assistance and efficient
benefits due to the development andtheir participation to the social security
system.

-67-

2. Social Security
Implementation
 Almost

20 years, since 1993 thegovernmenthas
establishedanddeveloped the public sector social
security scheme which include also
military and police, the social security
system for private sector employees,
community based health insurance fund
(CBHI) and health equity funds (HEFs).
 The schemes for the public and private
sectors cover seven social security
benefits. The other two funds focus only
on health care.
-68-

-

State Social Security
SystemFormal Sector (compulsory shemes) In the 2006, The State Authority forSocialSecurity(SASS)
hasbeenestablished. The social security scheme
has
been
reformed.
The
total
contribution rate has increased to 16.5%
of which employees pay 8% and the rest
is made by the government.
 The Social Security Fund is divided in to 5
sub--funds such as: 1) Long term benefit
fund 2) Short term benefit fund 3)
Employment injury and occupational
disease compensation fund 4) Healthinsurance fund 5) Administration fund.
 Beneficiary Members 583.457 people.
-69-

State Authority Social Security
Funds
Contributions fromgovernment

Contributions from civil
servants (Military, police)

8,5%

8%

State Authority
Social Security
Funds
Total 16,5 %Long– term
benefit2%

HealthInsurance

Short– term
benefitLong– term
benefit(Maternity,
Sickness,(Retirement,

4%

Dearth) 2%

Invalidity,
Survivors) 8%-70-

Employment
injury andoccupational
diseasecompensation
0,5%

Admin
2%

Social Security for Interprises

Formal Sector (compulsory shemes) In the 2001 The Social Security Organization(SSO) has been established. This social
security scheme is compulsory forenterprises
employing
10
or
more
employees. SSO has Seven branches inprovinces now.
 The

sources of revenues of SSO is fromcontributions of employers 5% andemployees 4.5% and is divided to 5 sub
fund same as the SASS.
 Beneficiary Members 124.538 people.
-71-

Social Security Organization
Funds
Contributions from
Employers 5%

Long– term
benefitSocial Security Organization
Funds
Total 9,5 %2%HealthInsurance2,2%Contributions from
Employees 4,5%

Short– term
benefit(Maternity,
Sickness,

Dearth) 1,3%

Long– term benefit(Retirement,
Invalidity,
Survivors)
5,5%
-72-

Employment
injury andoccupational
diseasecompensation
0,5%

Admi
n

Community-Based Health
Insurance (CBHI)
For the Non Poor in Informal sector

1
4

-73-

CBHI Initiative inLaos
 1997 -to-2000 :- Situation analysis- Lessons gathering 2000- to 2002 : Legal framework 2002- to 2004 : CBHI pilot stage
 Since 2005: CBHI extension stage
 Since 2009: Develop NHI-74-

MOH-WHO Co-operation ProjectDesign of CBHI

(National regulations for CBHI in Laos) Voluntary membership Family coverage (extended family according to familybook) Monthly family premium payment (about 7 USD / year /p) Benefit package: free access to OPD and IPD +preventive services
 Health care providers: district and provincial/central
public hospitals with mandatory referral (HC whenfunctioning) Health provider payment: capitation
 Management framework: community based
management under MOH/DPB supervision at Provincial,
Regional and National levels (10% of contribution
allocated to district management)-75-

Result of CBHI

Sep 2012, CBHI schemes cover 1451 villages in
25 districts of 10 provinces with 2471--9 families
140,000 people.

 Hospitals received the amount of 6 billions kips

as capitation payment in 2010


Utilization of services: OPD 145,000 cases or 1.2
visit/p/year and IPD 12,000 cases or 0.1
time/p/y-76-

CBHI Coverage by district-77-

Health Equity Funds (HEF)

For the Poor in Lao PDR
HEF “History”

Piloted from 2004 by SRC/LRC
Extension with fund from bilateral
cooperation
Major increase in 2009 with WB/ADB funds
MOH Guidelines on HEF in 2011
(First initiated by projects, then in large-scale MOH
programs funded by grants)-78-

Management
Policy – Guidance - Oversight HEF committees Central, Province, District,
Village
Coordination-Consolidation-Evaluation:
 MOH Central HEF Unit
HEF Implementation
 HEF Management / Implementation Agency or PHO/DHO HEF Unit

Service delivery
 Public & Community Health facilities
-79-

20

Payment mechanisms
Several mechanisms in place

For curative & preventive services (user fees)
 Payment of bills
 Fixed fees by category of service
 Capitation & purchase of CBHI premium
For indirect costs
 Fixed fees for food allowance, transport,others Included in the capitation
-80-

21

HEF Coverage
Health Equity Fund Coverage
350, 00070HEF Beneficiaries (Poor)

64

300, 000

60

Districts
250, 00050

38

200, 000

100, 000

7,000
1

12
15,000

Y2005

Y2006

50, 000-

314,000

31

150, 000

13
24,00014
27,000128,000

40

30

20

175,000

10-

HEF Coverage in Lao PDRDistricts
HEF Beneficiaries (Poor)% of poor of covered districts% of total poor population (est.)% of total population% of total districts covered

Y2007

Y2005
1
7,000
11%
0%
0.1%
1%

Y2008

Y2006
12
15,000
4%
1%
0.3%
8%

Y2009

Y2007
13
24,000
5%
1%
0.4%
9%

Y2010

Y2011

Y2008
Y2009
Y2010 Y2011 (P)
14
31
38
64
27,000 128,000 175,000 314,000
5%
11%
12%
13%
2%
8%
11%
21%
0.4%
2.1%
2.8%
4.9%
10%
22%
27%
45%

Source: MOH September 2012 poor -81covered 713,944 people

Utilization of services
Utilization rate (2010)
83%

OPD
30%

IPD

27%

3%
All population of Lao PDR

5%

7%

Health Equity Fund members Health Insurance Members-82-

Towards universal coverage in
Laos
Civil servants
anddependents
Salaried

Total
PopulationMandatory coverage
under the Civil Servant
SchemeMandatory coverage
under the Social Security
Organization

workers anddependents
Population in
the informal
sectorVoluntary coverage under
the Community Based
Health Insurance (CBHI)

Pooresthouseholds

Specific instrument and budget
to be developed and allocated(Health Equity Fund as first
step)
-83-

Coverage by different scheme (2011-12)
2.5%
10%

CBHI

2%

SASS
5%

1%
79.5%

SSO
HEF
PHI
No

-84-

Coverage per target people
60.00%

50.00%

50%

40.00%

Cov

30.00%

Targ
20.00%

10%

19%

10%
9%

10.00%

5%

2.50%

2%

0.00%
CBHI

SASS

-85-

SSO

5%
1%

HEF

PHI

Compare Health Expenditure with Country's
Health expenditure as a share of GDP (2008)

Mongolia
Viet Nam
PNG
China
Cambodia
Philippines
Lao PDR
0%

1%

2%

3%

public%GDP

-86-

4%

5%

6%

7%

8%

private%GDP

Source: World Health Organization

GOVERNMENT PRIORITY TO HEALTH (general government health expenditure as % of total government expenditure)
FSM
Nauru
New ZealandAustralia
Japan
Palau
Marshall Islands
Samoa
Solomon Islands
Tonga
Vanuatu
Nieu
Republic of Korea
Cooks Island
Fiji
China
Vietnam
Cambodia
Kiribati
TuvaluMongolia
Philippines
Papau New Guinea
Malaysia
BruneiSingapore
Lao PDR
0%

1%

2%

3%

4%

5%

6%

7%

8%

9%
-87-

10%

11%

12%

13%

14%

15%

16%

17%

18%

19%

20%

Source: World Health Organization

3. Development Plan on Social Security
1) General DirectionSound development of social security
and social health insurance schemes forhighly effectiveness of service provision.
Improve the awareness of people for
their contribution to the social security
as well as health insurance systemdevelopment.

Expand coverage of social security and
Health Insurance to all target groups ofpeople.

-88-

3. Development Plan on Social
Security(Contd.)2) Target










Establish the National Social Security to provide
services or protect public servants and salary
workers.
Expand Health Insurance coverage to informal sector
employees(independent
workers)andpoorcommunity, with the goal to cover up to 50% of
population by the year 2015 .
Create and improve Social Security legislations inorder to promote and develop social security
incipiently.
Create coordination mechanism and sound andappropriate computer database to strengthen social
security services efficiently.
Improvesocialsecurity
administration
system in central and provincial levels,
develop efficient monitoring and evaluation-89systems.

3) Toward Universal Coverage
Universal Coverageand full sustainablefunding

2020

Cover 50% of total pop
NHI institution is set
and QA and HA

2015

Cover 30% of total pop
Full Merging with other
SHP

2013

Covered 20,5 %2011-2012

Capacity building and strategic
arrangement, pilot merging-90-4) Work plan on improvingsocialsecurity systemMerged project between the State Authority forSocial Security( SASS) and the Social Security
Organization (SSO) to become the National
Social Security;(Social Security Law)
Merged between health insurance SASS, SSO,
CBHI and HEF. (National Health Insurance
Funds).
Project on expansion of the health insurance
for independent workers and poor community
in informal sector.
Project on improvement of Social Security
administration and services.
-91-4. Challenges
1. Coherence of difference schemes- Merging of SHP schemes
2. Extension of coverage- Financial support for the extension- Institutional support and capacity
3. Provider on board
4. Professionalize
 Implementation challenge
•
•
•
•
•



extend from 5% (2010) to UC by 2020
Making the provider on board and improvement of quality of healthcare facilities
Capacity building for scaling up
System design ( IT, benefit, payment system)
Financial support for scaling up

Policy challenge• -Institutional design• Organizational arrangement• Health Financial sustainability-92-

Key Challenges
 Remove the key barriers (fees, transport, information,
uncertainty, cultural and language, indirect costs, quality ofservice) Develop a demand side pro-active, social andflexible HEF (not only a fund) Adequate targeting system Ensure accountability & transparency
 Ensure enough, reliable, predictable funding Choice of management body (policy, trade off)
 Keep management cost acceptable, avoid costinflation
 Adequate links with other schemes, free
MNCH/U5-93--¢º®Ã¥ Kobchai

Thanks For Your Attention-94-

Thank YouThe Study Programme
for the Improvement of Social Insurance System- Health Security and Vulnerable people-

Mongolia-95-

Improvement of Social Insurance System

Country:

Mongolia
Improvement of Social Insurance System

1. Geographical and Political features of Mongolia
Mongolia is the world's 19th-largest country Situated in the Central Asia andlandlocked country between the Russian Federation to the north and the People’s
Republic of China to the south. It is the fifth largest country in Asia with a total area of
1,565 million square kilometers. Overall population density was 1.7 persons per
square km, making it the least densely populated country in the world.

The country is also subject to occasional harsh climatic conditions known as zud.
The annual average temperature in Ulan Bator is 0°C, making it the world's coldest
capital city.] Mongolia is high, cold, and windy. It has an extreme continental climate
with long, cold winters and short summers, during which most of its annual
precipitation falls. The country averages 257 cloudless days a year, and it is usuallyat the center of a region of high atmospheric pressure. Precipitation is highest in thenorth (average of 200 to 350 millimeters (7.9 to 13.8 in) per year) and lowest in thesouth, which receives 100 to 200 millimeters (3.9 to 7.9 in) annually. The highest
annual precipitation of 622.297mm occurred in the forests of Bulgan province close
to the border with Russia and the lowest of 41.735mm occurred in the Gobi Desert(period 1961-1990). The sparsely populated far north of Bulgan Province averages
600mm in annual precipitation which means it receives more precipitation thanBeijing (571.8mm) or Berlin (571mm).

-96-

Socio-economic changes during the transition from a centrally planned to a market
economy were accompanied by increased rural-to-urban migration. As of 2007,
39.4% of the population of Mongolia resided in rural areas as compared to 42.8% in
2000.
Political situation
Mongolia is a democratic parliamentary country. The centralized governmental
structure is divided into three branches: the executive branch or the Government
chaired by the Prime Minister; the legislative branch or the Ikh Khural (theParliament); and the judicial branch led by the Supreme Court.
The President of Mongolia is a figurehead for the country and is elected for a fouryear term. Political parties that have seats in the Parliament are eligible to nominate
their candidates to the Presidential election. Although most political power is held by
the Prime Minister and the Parliament, the President of Mongolia is a commander-inchief of the armed forces and heads the National Security Council as well as appoints
all the judges, the Prosecutor General, the Deputy Prosecutor General andambassadors. The parliamentary and presidential elections take place once every 4
years and elections held in 2012 respectively.
2. Statistical Data
(Please fill in the attached FORM1-4 and go back to years as far as you can doresearch)-97-

3. Outline of the Social Security System
State Ikh Khural Parliament(approves legasliation)

Other ministries

Ministry of Social Security
and public development

Governmental implementing
agency for Children

Governmental implementing
agency State Social Insurance
General office

Governmental implementing
agency Social welfare/benefit/

Social Insurance department ofCapital city Ulaanbaatar

Aimag’s department of Social
insurance /21 province/

9 District sub divisions ofsocial insurance

Soum Sub divisions of Social
insurance

4. Outline of the Object Tax for Social Security Fund(If there is, please describe it's outline)
5. Outline of the Medical Insurance System (MIS)
Please describe MIS in your country including following items.

-98-5.1 Historical development of MIS
One of the many socio-economic changes and reforms that Mongolia implemented
during its transition in the 1990s from the centrally planned economic system into
market relations was establishment and development of the social health insurance(SHI).
Introduction of social health insurance created conditions to mobilize additional
funding sources as many other countries, increase individual’s responsibility for theirhealth, and to support stability of health financing.
The social health insurance was established in 1994 at “Mongol Daatgal” Company
which printed the certificates, collected premiums from individuals and entities andpooled them into a fund, and financed expenses of the hospitals on health careprovided to the insured.
Once the package law on social insurance started being implemented theGovernment issued a resolution No. 195 in 1995 whereby the health insurance
services were transferred from “Mongol Daatgal” Company to Social Insurance
Organization from 1st January 1996.
The transfer of the work to implement the Citizens’ Health Insurance Law to thesocial insurance organization enabled creation of integrated system of financial
resources, legal arrangements and organization. This transfer enabled one point
services for insurance fund income collection and premium transactions of employers
and insured, their registration and reporting. This reduced administrative costs andrelatively facilitated registration and transaction work. It also enabled integrated
electronic database and software at national, aimag and capital city level.

-99-

Because the social insurance organization has an independent registration,transaction and reporting system and experience in collecting premiums of
employers and insured, therefore, it facilitated collection of premiums from employers
and insured, finance health care, especially serving local herders.During this time
health insurance has become one source of reliable and stable financing of healthorganizations.
5.1.1 Types of the financial resources for the system, and current situation andoutlook for the revenue and expenses of the system.
Health Insurance fund revenue and Expenditure, by income sources, by type of
expenditure /mln, tog/

2000

2001

2005

2006

2010

2011

Total revenue of which :18156.9

19925.2

32574.2

40268

90131.9

121576.4

Contribution income

13259.5

14946.627398.5

34597.4

75264.4

105584.21

Contributions paid bygovernment

4856.64856.64856.64856.610906.1

10906

Fines and arrears imposed onlate payment of SI
contributions

6.5

34.5

44.7

58

75

115.92

Bank deposit returns of thefund surplus

1.7

19.1

195.2

667.5

3823.204849.5

Other income

32.7

68.4

79.2

88.5

63.1

120.67

Hospital expenditure

11772.014250.823118.2

25963.7

76075.8

84194.2

Discounts of pharmaceuticals

252.4

378.6

571.1

564.5

2045.42988.3

Total expenditure of which :-100-

5.2 Laws and regulations for MIS. A list of laws and regulations regarding MIS
in your country should be presented which gives the name/title, legislated year,
and description/purpose of each.
The Citizens’ Health Insurance Law of Mongolia was approved on 8 July 1993 andimplementing since 1 January 1994, which became the legal foundation to establish
the health insurance system.
The purpose of this law stands for set the types and scope of health insurance andarranging related matters with public, civil, entity, health organization and insuree
with related on paying contributions by insured, mobilizing and expending healthinsurance fund.
The Citizens’ Health Insurance Law was revised once and amended 9 times tostrengthen health insurance
insurance system and improve its operations in order to resolvepressing problems presented by changing circumstances.

Civil Health Insurance law has approved 1993 first time

Amendments
included on1994,
1997, 1998 , 2003,
2006.

Approved
modification on
2002

-101-

2 draft laws toparliament on 2010

5.3 Administration and management of MIS (Central level): An organizational
chart of the government should be provided that indicates the ministries/
departments/ divisions responsible for administrating MIS.

The management structure of the SHI, carried out by the social insuranceorganization is as follows: DoHIIF is one department of the SIGO under its directsupervision and performs its legally specified mandate under direct and indirectsupervision of NSIC, HISC, MoH, MoSSPL and MoF. It does not have any direct
affiliates under it. In other words, HI functions are performed under numerous-102-instructors by departments and units with no power except professional technicalassistance and methodological supervision.
Health Insurance Inspecting and financing department of SIGO-14 officers/Order no B/19 in 2012/
The Governing Body of the Social Insurance Organization is Social Insurance
National Commission (SINC) consisting of 9 members. It is a tripartite body
representing the Government, Employer and Insured set up by the Parliament ofMongolia for a duration of 6 years. Health Insurance Sub Council under the SINC
oversees health insurance policies. Three seats representing Government include
representatives from the Ministry of Finance, Ministry of Justice and the Ministry ofSocial Security and public development . Mongolian Trade Union has also 3 seats
while the remaining 3 are represented by Mongolian Employer’s Confederation.
MLAC protects the rights of the social insurance organization, employers and insured
by determining the reason, percentage and length of loss of working capacity. MLAC
consists of members representing specialized doctors, organizations protecting therights of the SI, employers and insured.
5.4 Administration and management of MIS (Local level, private sector) : An
organizational chart of local government and/or private sector that specifies
organizations responsible for MIS at the local level and/or private sector should
be provided.
Capital City Social Insurance Department - Health insurance inspecting andfinancing division – 22 officers /Order no B/20 in 2012/
Aimag’s Social Insurance Department – Health Insurance division – 3 officers-103-

Aimag’s Social Insurance
Department

Health Insurance
division

Head of Health
Insurance branch andstate inspector doctor

Revenue inspectorof healthinsurance

Inspector in charge Healthinsurance fund payments
and fulling information
fund

Medical Accrediation
doctor

5.5 Structure of the systems.

/-Type, Insurer, number of the insured, recipient qualification and contents of thebenefits, etc./
The coverage since the establishment of SHI fluctuated between 73.4% and 95% in

1996-2010 whereas it reached 98.6% in 2011. This is a high level compared tosimilar countries. The reason behind the high coverage is that vulnerable groups
occupy 60% of the insured and these people are directly subsidized by the statebudget.
The employees of the public and official sectors are fully insured. However, a certain
group of people like people working in informal sector, herders and unemployed are

not insured. In 2011 Human Development Fund allowances were distributed in theform of health insurance premium, a work successfully organized by the social
insurance organization pushing the coverage towards 98 percent.

-104-

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%

86

1996

98.6
84.3

2000

76.5

73.4

79.8

2005

2006

2007

Insured

83.2

77.6

82.6

2008

2009

2010

2011

Uninsured

Contents of the benefits are below.

1. Inpatient service

6. Rehabilitative

7. Palliative

2. Day care

5. Traditional treatment

8. Drug discounts

3. Outpatient

4. Diagnosing

As a result of the Minister for Health resolution
resolution N 180 of 2010, starting from 2010,
health insurance covers 115 diagnoses by groups, an 8.1% increase of averagediagnosis net cost, an increase in the number of essential drugs at reduced cost from107 to 365, and a 35.0% increase in the average cost of drugs. All these have
impacted on the increase of the HIF expenditure The health care service's
expenditures as directly related to the number of people who received these
services. For outpatient services and care, expenses for health care and services
and the number of people who used these services have a reverse correlation. This
reverse correlation may be attributed, on one hand, to an increase of base tariffs of-105-

health care and inpatient services of one insurer with group diagnosis at similar cost,and on the other hand, to larger percentage of high cost of outpatient health careservices.
Total health insurance expenditure, 2011

PublicУлсынэмнэлэг
hospitals

Drug discountsЭмийнүнийн хөнгөлөлт
15.0%
3.5%

PrivateХувийн эмнэлэг
hospitals

SanatoriumРашаан
сувилал

2.7%

78.8%

Graph shows that most of the funding (78,8%) is received by the public hospitals.
The HIF funds over 700 health organizations and funds health care for 3.1 million(double count) insured.
Most of the HI funding (79.3%) is spent on hospitalization expenses of the insured
and insufficient funds are invested in conditions that prevent population from fallingsick or i.e. in prevention care .
The collection of premiums from employees of official sector is organizedeffectively together with all kinds of social insurance. However, the case is different
for coverage and premium collection among employees of unofficial sector.

-106-

Health Insurance Fund revenue and Expenditure /comparison/

Employee&employers
6.2
8.1
6.6
6.9

Citizen whose contribution are
subsidized by Government

12.6

Herders
83.5

Students
Unemployed

7.0
14.4
7.9
8.7

62.9

17.1

REVENUE

OthersEXPENDITURE

Though the financing process of health insurance funded health care is stabilized
which is good, but as a whole it does not aim at purchasing health care on behalf of

insured and is limited to passive financing of expenses incurred by healthorganizations.
5.6 Financial situation of MIS.

-Types of the financial resources for the system, and current situation and outlook forthe revenue and expenses of the system.
Revenue collection of thethe health insurance fund is done relatively well and its
sustainability is ensured. The HIF surplus in 2011 was 133.9 billion MNT whichequals to 105.4% of the annual revenue.

-107-

Revenue

87.1

90.1
78.1

72.3
56.9

60.4
50.8

50.3
29.7

38.3
26.5

32.3
23.7

28.1
20.9

24.3
19.3

22.0
16.9

19.8
14.6

18.1
12.0

14.4
11.4

14.1
13.1

11.4
9.7

9.1
9.9

7.5
6.4

127.0

Cost and Revenue of Health Insurance Fund /billions MNT/

Cost

The income of health insurance fund (HIF) comprises mostly of salary-based
premiums and state budget subsidies. A small group of the population, theemployees of the official sector, is accounting for the most of the HIF revenue and asof 2009 this group occupied 25.7% of total insured and paid 80.5% of the revenue.
The premium amount of employees working in informal sector was set too low and
was held constant without connection to increasing inflation level.

-108-

HIF revenue by the categories of insured

Employed

Vulnerable people

100%

Employees

Students

Herdersothers

86%

84%

85%

83%

85%

81%

81%

50%

78%

76%

72%

70%

66%

62%

54%

62%

60%

58%

70%

56%

80%

45%

90%

27%

24%

22%

20%

17%

15%

12%

10%

13%

11%

12%

9%

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

10%

2000

34%
1997

34%

37%
1996

43%

38%

20%

1995

30%

51%

40%

1999

1998

Years

1994

0%

5.7 MIS related policy within the National Development Plan : Indicate whether
MIS- related policy is included in your country's National Development Policy,
and if it is, give an explanation of its contents.
Midterm Strategy for Social Health Insurance 2012-2016 jointly with the German
International Development Cooperation (GIZ) to intensify the activities to implement
mandates provided by the Law on Citizen’s Health Insurance, strengthen the social
health insurance scheme and to achieve the goal to purchase quality health services
on behalf of the insured.
This strategy is specific as the first document to define the strategies to be
implemented in coming 5 years in order to develop the social insurance organization
as a purchaser of the health services subsequently to improve quality and-109-

accessibility of the health care provided to insured and to protect them from healthassociated financial risks.
The strategic plan was developed by the working group established by Order No.256
of 4 October 2011 with diverse compositions consisting of the deputy director of
SIGO, heads of the departments, relevant officials, teachers of the Management
Academy, consultants of the international organization and relevant officials of the
Ministry of Social Welfare and Labor using the participatory and capacity building
approaches.
5.8 List of aid projects of MIS with other donors : Indicate the title,
implementing organization, donor country, duration, budget, and purpose,
activities for each project.
''Mongolian Social Health Insurance Reform of the German International Cooperation
Agency'' (GIZ) project implementing on Social Insurance General Office.
This project implement and expected outcomes in 7 key areas such as improving thehealth insurance services, insurance funded care quality and its management,
information technology, organizational relations, culture and social dialogue, humanresource development, financial and organizational development management within
the wide range of important issues like to raise the reputation of the health insurance,
communicate its significance to the public, to purchase quality health care that meetsthe needs of the insured, to provide prompt and efficient insurance services to theinsured and to introduce e-services based on the current level attained in the healthinsurance activities.

-110-6. Please describe these points.
6.1 Problems to be solved in your current MIS.
1. Improving Health insurance services, widening benefit package
2. Inspection of quality of health insurance funded services and its management
3. Information technology
4. Organizational relations, culture and social consensus
5. Human resource development
6. Financial management
7. Organizational development, management

6.2 Contents of the reform to solve the problems.
1. Cover with HI the workers in unofficial sector, unemployed and herders,
improve registration of citizens subsidized by the Government, increase healthinsurance coverage by introducing family insurance system, improve premium
collection activities
2. Purchase health care that meets the needs of the insured by using payment
method or proper mix of methods that serve as a mechanism to improve thequality, effectiveness and efficiency, and by contracting that links financing
with satisfaction of the insured-111-

3. Get actively involved in improving quality of health care services throughcooperating with organizations that inspect and affirm quality of health careservices
4. Improve the process of contracting safe and quality health care services thatmeets the needs of the insured on their behalf
5. Integrated health insurance database is built real time
6. Introduce E-card system containing the main information of the insured
7. Provide technological possibilities to provide necessary evidence based
information to the insured and health insurance stakeholders and receive
feedback and complaint
8. Computerize inspection of health care providers
9. Improve perception of the insured on health insurance by providing healthinsurance information to the insured, and building an open information systemthat is insured-centered and regularly studies their needs and satisfaction byelectronic means
10. Continuously build relations and cooperation capacity of the health insurance
staff in accordance with the mission and vision of the organization throughcomprehensive management planning and performance evaluation
11. Improve capacity of social partners participating in health insurance relations(trade union, employers) on social consensus in health insurance
12. Create an open relations mechanism that delivers quality health care to theinsured according to the package jointly determined with health care services
providers and the contracts with health organizations and hospitals
13. Make client-friendly health insurance services provided to citizens who arepaying the premiums themselves-112-14. Develop and implement health insurance human resource development
program, continuously renew and improve human resource management
based on needs
15. Establish and operationalize a needs based continuous professional training
system
16. Improve social security of the staff working in health insurance sector andimprove incentive system
17. Set organizational operational costs at no less than 5 percent of the total
revenue collected in HIF in the particular year, strengthen effective andefficient independent expenditure of operational cost based on needs and its
accounting system, set up an open and responsible system of external audit
and proper internal inspection mechanism
18. Set realistically the amount of HI premiums based on needs and realities
taking into account the evidence, in particular, link the premium amount of
citizens subsidized by the Government with the minimum wages, and establish
an open mechanism that discuses and approves the premium amount by the
Health Insurance Sub-council
19. Establish conditions to purchase health care services from providers throughcontracts according to properly determined benefit package and payment
method, setting the tariff realistically
20. Create a proper mechanism to protect the health insurance fund from potential
risks, ensure sustainable and security of the fund, and establish legal
environment to dispose the free residual of the fund-113-

21. Create an integrated information management system including statistics,
relevant information of performance evaluation, and research information datecompleting each other
22. Set up an evidence-based planning system with joint and comprehensiveplanning approach that pays particular attention to implementation of theannual operational plan developed in accordance to the organization’s
development strategy and that widely involves stakeholders of HI relations
23. Use health insurance monitoring and evaluation based on proper set ofindicators as means of supportive supervision that aims at effectiveness andefficiency
24. Prepare, print and disseminate to the HI stakeholders social health insurance
yearbook that covers the pressing problems handled in the particular year,
their solutions, new development trends and best practices of foreigncountries
6.3 Problems for carrying out this reform.
Development of human resources in charge of health security system
Human resource policy for improvement of Skill and knowledge.
Making attitude and interest for good understanding of their work.
Systematically training program of developed countries for developing humanresource in charge health medical insurance.

-114-

ANNEX 1- Form 1
State of Nation: Mongolia
Area size /km2/: 1’564’116 km2

Population by aged group
Year

2010
146,3
141,8
112,6
109,6
250,1
248,6
290,3
305,7
227,3
246,5
171,2
190,3
98,2
113
23,2
29,2
45,5
62,2
1364,7
1446,90-4

MaleFemale5-9
MaleFemale10-19 Male
Female20-29 Male
Female30-39 Male
Female40-49 Male
Female50-59 Male
Female60-64 Male
Female65MaleFemaleTotal Male
FemaleANNEX 1- Form 2
Year
Population growth rate (% per annum)
Birth rate (per 1,000 population)
Mortality rate (per 1,000 population)
Infant mortality rate (per 1,000
population)
The rate of the population of 65 years
and over to the total population (%)
Life expectancy at birth
M
FLife expectancy at 60 and 65
M
F
Unemployment
rate
(per
1,000
population * average rate)

-115-

1991
2.7
35.3

1996

2001
1.5

2005
1.23
18.3
6.0

2011
1.74
25.1
6.9

63.4

31.2

20.8

16.5

0.19

0.15

3.8
62.11
68.61

64.68
73.76

7.7

ANNEX 1- Form 3
Year

2011*

National Income (US $)6’835’786’896.5

Average wage (US $)324.8

Average wage of male and female (US $)

M

324.2

F

267.8

Average income (US $)Total GNP (US $)GNP growth rate
GNP per capita (US $)Total GDP (US $)GDP Growth rate

17.3
3’886.7 /2’562 ATLAS

GDP per capita (US $)method of WB/

The rate of Social Insurance of contribution as a

7.62

percentage of National Income
Premium contribution of employee

163595.241

Premium contribution of employer

209’249’517.241

Premium contribution of self-employer etc

ANNEX 1- Form 4
Year

2011

Primary Industry

Agriculture 33%

Secondary Industry

Wholesale and retail trade 14.7%

Tertiary industry

Industry 12.3%-116-

Five leading causes of death
Year

1st

2nd

3rd

4th

5th

Injury,poisoning

Diseases of
2000

the
circulatory

and certain
Neoplasm

otherconsequencesystems of external

Diseases oftherespiratory
systemDiseases ofthe digestivesystemcausesInjury,poisoning

Diseases of
2005

the
circulatory

Neoplasm

systemand certain

Diseases ofotherthe digestive

consequencesystems of external

Diseases oftherespiratory
systemcauses
Diseases of

Diseases of
2010

the
circulatory

Neoplasm

systemInjury,thepoisoning

respiratory

and certain

Diseases ofsystem andotherthe digestivecertainconsequencesystemconditions

s of external

originating in

causesthe prenatal
period-117-

The Study Programme
for the Improvement of Social Insurance System- Health Security and Vulnerable people-

Myanmar-118-

COUNTRY REPORT ON
IMPROVEMENT OF SOCIAL INSURANCE SYSTEMCountry: Myanmar
Course:Improvement of Social Insurance System ~Modernization of Health Security Administration

1. Geographical and Political features of Myanmar
Myanmar is the largest country in South-East Asia. It has a total land area of 676,578 square
kilometers. The extent from North point to South point is 2200 kilometers and that from East
to West is 925 kilometers. It is bounded on the north and north-east by the People's Republicof China, on the east and south-east by the Lao People's Democratic Republic and theKingdom of Thailand, on the west and south by the Bay of Bengal and Andaman Sea,on the west by the People's Republic of Bangladesh and the Republic of India.
Myanmar is divided into 14 States and Regions but mainly three well marked areas i.e. thewestern hills, the central belt and the eastern Shan plateau continued to southern Tanintharyi
land. These hilly regions and high lands are hard to reach due to rugged topography but thecentral plain and delta region are very easy to travel due to smooth pathway because ofnumerous rivers and tributaries making networks or webs like communication.
Myanmar has abundant natural resources including land, water, forest, coal, mineraland marine resources, and natural gas and petroleum. In Myanmar, there are threeseasons named the summer, the rainy and the cold but mainly is tropical climate.
In Myanmar, Political features is changed since 2011 due to enormous changes within 63
years after attaining independence in 1948. It is led by Democracy Government performing‘Good governance and Clean government’. In line with the marked oriented Economy, ‘Open
door Economy Policy’ is set up and the Vision of our country is a modern and developed
democratic nation .
-119-

2. Statistical data (Form 1 – 4)
The population of Myanmar in 2009-2010 is estimated at 59.13 million with the growth rate of
1.29 %. About 70 % of the population resides in rural areas, whereas remaining are
urban dwellers. Myanmar is a large land area rich in natural and human resources. Mainly
agricultural sector can contribute to overall economic growth of the country. And there isliberal economic reforms to ensure participation of industrial sector and private sector using
modern machinery and technology. With expanding job opportunities, every citizen being
able to work, increasing individual income will contribute to the growth of GDP.

(Annex 1

Form 1-4)
3. Outline of Social Security System(a) Name and contents of each Social Security System
1) Health and Social Care Insurance System:
2) Family Assistance Insurance System:3) Invalidity Benefit, Superannuation Pension Benefit and Survivors’ Benefit Insurance
System:4) Employment Injury Benefit Insurance Systems:5) Unemployment Benefit Insurance System:6) Other Social Security Insurance Systems:(b) Supervisory Ministry of the system
Ministry of Labour is supervisory Ministry of system including 5 main departments;
1) Department of Labour
2) Social Security Board
3) Central Inland Freight handling Committee
4) Factories and General Labour Laws Inspection Deparment
5) Department of Labour Relation
Ministry of Labour acts in collaboration with Ministry of Health at implementation ofSocial Security Affairs for Insured Persons.
-120-

(c) Organization Chart of Social Security Board

Ministry of Labour

Minister

Deputy Minister

Chairman of Social Security Board

General Manager

Deputy General Manager

Manager (A.D)

Manager (A.D)

Manager (A.D)

Manager (A.D)

Manager (A.D)

Insurance

Finance

Administrative

Planning andMedicalDivision

Division

Division

Research Division

Division

80 Local Offices

3 Workers’ Hospitals-121-

92 Social Security Clinics

4. Outline of Object Tax for Social Security FundThe Social Security Scheme is financed by compulsory contribution from the employers andthe employees of the establishments applied to the Social Security System. They have to pay
their contributions in the ratio of 6.5 : 5.5 of the employees’ actual income for four insurance
systems named (a) Health and Social Care Insurance System (b) Family AssistanceInsurance System (c) Invalidity Benefit, Superannuation Pension Benefit and Survivor’s
Benefit Insurance System and (d) Unemployment Benefit Insurance System. Although theperson who works in establishments not applied to the Social Security System is cancontribute voluntarily for each insurance system which allowed systems. If the Social Security
Board’s Fund is not adequate to provide health care and medical treatment to insured
persons, the expenses may be borne under the capital sanctioned from the Union Budget, or
grant aid, or loan as Government Subsidies.

5. Outline of the Medical Insurance System (MIS)
5.1 . Historical development of MIS
5.1.1 . Types of financial resource for the system
Medical Insurance System was established since implementation of the Social Security Act(1954). The Social Security Board collected contributions from establishments covered by the
Act in the ratio of 2.5:1.5 which was 4 % of the insured wages according to 15 wage classes.
(minimum wage class is 3000 kyats and maximum wage class is 31000 kyats and above).
And The Social Security Board provided benefits for insured employees especially free
medical care and cash benefit for their social contingencies. Therefore this social insurance-122-system is also called health insurance or medical insurance system. All of the contributions
collected from employers and employees were kept into three main separate accounts of theSocial Security Fund:
1)

General Insurance (sickness, maternity and death) Account2)

Employment Injury Insurance Account3)

Administrative Expenditure Account

The State supported nearly 250 million kyats annually for capital expenditure to be utilized inbuilding hospitals, clinics, medical centers, offices and purchasing medical equipments,
vehicles, furniture and office equipments up to 1988. After these period, the State stopped
supporting the fund.
Now, the new Social Security Law (2012) is currently enacted on 31st August 2012 and will be
implemented in accordance with renewed Rules and Regulation.
There are five Social Security Fund as following;
1)

Health and Social Fund including Family Assistance Fund

2)

Invalidity Benefit, Superannuation Pension Benefit and Survivor’s Benefit Fund

3)

Unemployment Benefit Fund

4)

Employment Injury Benefit Fund

5)

Fund for Social Security Housing Plan

Current situation and outlook for the revenue and expenses of the system
In current situation, upto 2011-2012 Fiscal year, the collected contribution is (6821.81) kyat in
millions and expenditure for Social Security Scheme is (3646.14) kyat in millions. But the-123-Social Security Board has authority to utilize owned budget for insurance system after
starting time of application of New Social Security Law (2012).
5.1.2 Payment system of medical care expenditures
From Health and Social Fund, the cost effective medicines are purchased and distributed toWorkers’ hospitals, social security clinics and enterprise clinics by arrangement of Social
Security Board. The medical instruments and equipments are also installed.
The insured persons can be enjoy free primary health care at Social Security Clinics andEnterprise Clinics and free hospitalization at Workers’ Hospitals and Government Hospitals.
The investigation fees and any cost paid by patients as out of pocket are reimbursed within
one month. There are no health care provider fees and incentives because all health persons
are government staffs and their salaries are paid by Government.
5.2 Laws and regulations for MIS
Laws and regulations regarding MIS are Social Security Act (1954) and Social Security Law(2012) and related Regulations.
5.2.1. The Social Security Act (1954)
The Government requested technical assistance from the ILO to draw up a social security
plan. The expert mission from ILO came to Myanmar and drew up a plan for introducing a
number of social security measures and drafted the Social Security Act. The Social Security
Act was enacted in 1954 and came into force in Yangon area on 1st January 1956. Then the
Scheme was gradually extended to other areas of the country.
The objectives of the Social Security Scheme are(a)to improve the health of the insured workers,
-124-

(b)

to enhance their working ability and to boost productivity;(c)

to provide effective benefits in times of social contingencies such as sickness,maternity, employment injury, unemployment, old age and death etc;(d)to support the insured workers and their family members for living when the former
are unable to work;(e)

to make the Social Security Scheme concern the entire people.

5.2.2. The Social Security Law (2012)
This Law is enacted by the Union Parliament and very recently signed by the President on
31.8.2012.
The purpose of this Law are as follows:(a)to make collective insurance of employer, employee and the State to provide
workers’ health and social need so that the workers who are major productive forceof the State may enjoy more social security for social life and health care so that
production may increase and be of support to the development of State’s economy;(b)

to allow the public may insure voluntarily that they may enjoy more security forsocial life and medical care;(c)to make the public have more faith upon the social security scheme by providing
benefits correspond to realities;(d)to have the opportunity to draw back some of the contributions paid by theemployer and the employee as saving, in line with specifications;(e)to make the workers have health care and cash benefits relating to sickness,maternity, employment injury, and moreover, the right to continued medical-125-

treatment

after

retirement,

familyassistancebenefit,invalidity

benefit,superannuation benefit, survivors’ benefit, unemployment benefit, and also the rightto residency and ownership of housing.

5.3 . Administration and management of MIS (Central levels)
An organizational chart of the government(ministries/ departments/ divisions responsible for administrating MIS)

Ministry of Labour

Social Security Board

Chairman

General Manager

Deputy General Manager

Manager (A.D)
Insurance
DivisionManager (A.D)
Finance

Manager (A.D)

Manager (A.D)

Manager (A.D)

Administrative

Planning andMedicalDivision

Research Division

Division

Division-126-

The brochure and the annual report giving an outline of governmental measure in MIS
will be submitted later.

5.4 Administration and management of MIS (Local levels)
An organizational chart of local government and private sector that specific organizations
responsible for MIS at the local level and private sector should be provided.
SSB Head Office

13 State/ Regional Office

80 Local Offices

Township Officer

Contribution Section

92 SSB Clinics

3 Workers’ Hospitals

Medical Officer

Benefit Section

Medical Team

Clerical Team

5.5 Structure of the systems-type/ insurer/ number of the insured/ recipient qualification/ contents of the benefits
The Social Security Act (1954) has two types of insurance system;(a) General Insurance System(b) Employment Injury Insurance System-127-

All persons employed in the establishment to which the Social Security Act applies arecovered by the Act. The number of insured workers covered by the social Security Scheme inAugust 2012 was 58600 in public, cooperative and private sectors.
Contents of the Benefits are as follows;(a) Free medical care; Outpatient health care, Hospital care, Specialist consultation,
Investigation, Medical certification, Health education, Preventive measure andRehabilitation(b) Cash benefit; benefits for sickness, maternity, employment injury and death
The Social Security Law (2012) has five types of insurance system;(a) Health and Social Insurance system(b) Invalidity Benefit, Superannuation Pension Insurance system(c) Unemployment Insurance system(d) Employment Injury Benefit Insurance system(e) Social Security Housing Insurance system
The Law has already been enacted on 31.8.2012. The Rules and Regulation corresponding
to this new law are still drawing and the new law will be implemented approximately next year.
In this new law, there are two types of insured person. One group, compulsory contribution is
all formal sectors of public and private enterprise which work with five and above employees
and another group, voluntary contribution is informal sectors of self employees, vendors andpublic. The Social Security Housing system is also voluntary.

-128-

5.6 Financial situation of MIS
The financial resources for new Social Security System are mainly two sources;
Type of Insurance

Employer

Employee

Totala) Health & Social

1.5 %

1.5 %

3%

b) Invalidity

3%

3%

6%

c) Unemployment

1%

1%

2%

d) Employment

1%

0%

1%

6.5 %

5.5 %

12 %

0%

20 %

20 %

Superannuation Pension
Survivors’ Pension

Totale) Housing plan

Under previous Social Security Act (1954), the financial status was budget allotment by
Government and with the new Social Security Law (2012), the Social Security Board has
opportunity to manage owned budget.
The current Revenue and Expenses are as following;
Description

2007-2008

2008-20092009-20102010-20112011-2012

Contribution

40699164404047

491184458235226821815

Total Expenditure

1793385

2257080259501735345813646136

Balance

22765312146967

231682722889413175679-129-

5.7 MIS related policy within the National development Plan
MIS related policy within the National Development Plan indicates the country’s National
Development Policy. The health activities are in accordance with the National Health Policy
to achieve one of the social objectives namely, “Uplift of health, fitness and education
standard of the entire nation” in developing MIS,

Ministry of Labour and other related

ministries, Social and non-governmental organizations perform to undertake plan formulating
activities in a coordinated way. There is necessary to establish a system for financing healththat will protect people from financial burden in seeking health care. The State supports indevelopment of the Health professionals, equipments and technology. MIS related policy i.e.
implementation of Social Security Act has been developed with the leadership of the State,guidance and supervision of the Social Security Board, support of the organizations andenterprises and collaboration of the whole community. The Ministry of Labour will keep inraising the health status of employees and to expand the coverage of scheme up to entire
Nation. The priority will be given to low income employees and vulnerable persons

Four Objectives of Social Security Scheme;
1)

To improve the health condition of workers and to improve working power & production

2)

To obtain the comprehensive benefit when the employees are facing with social
difficulties like illness, delivery, employment injury, unemployment, old age and death
etc.

3)

To support employee and his family when he cannot work

4)

To cover the whole nation under the social security scheme-130-5.8 List of aid projects of MIS with other donors
There is no foreign support and aid for Social Security Program, but this year 2012, theworkshop named ‘ Future Medical Care of Social Security Scheme’ on 25th May 2012 inYangon and the Conference named ‘Social Protection Conference’ on 25th June to 26th June2012 in Nay Pyi Taw are sponsored by UNICEF Myanmar. At recent time, the State arranges
for foreign aids, supports and loans for the development plan all over the country.

6. Problems with MIS
6.1 Problems to be solved in current MIS
6.1.1. In the Social Security Act (1954), according to 15 wage classes i.e. 3000 kyat to 31000
kyat, the contribution rate 4 % is un-modernized withcurrent situation of country. The

amount of cash benefits and funeral grant are poor attractable for the employees andemployers. Therefore, some employers avoid to contribute in real number of employees andtheir real salary. Within 56 years, the number of insured persons covered by Social Security
Scheme is nearly 600000 only. It is just less than 1 % of total population of Myanmar.

6.1.2. There are 3 Workers’ Hospitals and 92 Social Security clinics under Social Security
Scheme. The comparison with 324 townships in country is shortage in implementation ofhealth insurance system. And the distribution of health care centers especially industrial
zones is required.
6.1.3. At recent condition, all funds collected from contribution of the employers and theemployees are given to the State’s Budget and all expenses are allotted by Government.
-131-

Therefore limited budget allotment makes the insufficient for medical expenditure for healthcare of insured persons.
6.1.4. According to old Law (1954), in case of sickness, free medical care is provided toinsured persons up to 26 weeks for one spell of sickness. In case of diseases considered
as a special importance from the point of view of public health, it is prolonged until the
insured person is totally cured or till his death. Therefore, the high cost medical expenses forsevere diseases are unlimitedly reimbursed as regardless of their contribution class, duration
and amount. The cardio-valvular diseases are repaid up to 2 million kyat and the renal failure
up to 8 million kyat.
6.2 Contents of the reform to solve the problems
6.2.1. Under the new Social Security Law (2012), the contribution will be collected withactual income of employee and the contribution rate will be changed according to extended
Insurance systems. i.e. 6.5 % by employer and 5.5 % by employee. Similarly, the cash
benefits will be increased in line with contribution rate. Therefore, the coverage will be
expected to expand more.
6.2.2. According to New Law (2012), the contract hospitals and clinics will be put into service
with Social Security Board so that the health care and health insurance system can beprovided all required areas including out reached areas and industrial zones.
6.2.3. Nowadays the Social Security Board has an authority to utilize the owned budget ofcontributory funds. As a result, the medical expenditure for health care of insured persons will
be adequately offered.

-132-

6.2.4. The high cost treatment for severe and life threatened conditions are limited inaccordance with ceiling cost of medical care and treatment regime recommended by Medical
Advisory Committee reformed in this new Social Security Law.
Problems for carrying out this reform
6.3.1. Public awareness for New Social Security Law (2012) is required because of themodernized and internationalized insurance system is unfamiliar to public within 56 years.
And preparation of Regulations and Rules appropriate to new Law need enough time tooperate practically among community.
6.3.2. The establishment of contract hospitals and clinics also require advocacy meeting
because the agreement may be difficult between the Social Security Board and these
medical centers. The Government Hospitals have no will to contract because of limited
budget allotment for their performances and the Private Hospitals are practicing via highmedical care costs. Therefore higher authority to contract with the Hospitals and Clinics.
6.3.3. The Social Security Board shall stand on the Social Security Fund and Employment
Injury Benefit Fund. If it is not sufficient to give benefits from that fund, the Board may submit
and request for government subsidy.
6.3.4. The Medical Advisory Committee is only one authorized committee to set up ceilingcost of medical treatment according to Diagnosis Related Group (DRG) and requires toprovide advocacy meeting with expertise from various aspects.

-133-

ANNEX 1 – Form 1
The State of the Nation
Area size (676,578 Km2 ) Unit: thousands
Population by aged group
Year

1990

1995

2000

2003

2004

2005

2006

2007

2008

2009

Male

2652

2769

3050

3193

3235

3278

3323

3364

3418

3283

Female

2586

2736

3016

3115

3172

3235

3285

3344

3397

3263

Male

2398

2501

2759

2925

2974

3020

3075

3119

3169

3233

Female

2401

2304

2735

2927

2959

2993

3040

3074

3122

3184

Male

4550

4724

4987

5157

5227

5306

5397

5537

5624

5736

Female

4619

4511

4655

4873

4979

3093

5224

5378

5462

5570

Male

3754

3996

4422

4633

4694

4748

4802

4795

4872

4968

Female

3836

4031

4357

4505

4544

4572

4596

4650

4722

4816

Male

2654

3078

3569

3823

3904

3983

4066

4059

4121

4203

Female

2709

3210

3700

3926

5675

4056

4122

4987

4117

4197

Male

1691

2157

2589

2853

2944

3036

3130

3169

3215

3279

Female

1739

2280

2733

3009

3120

3195

3292

3294

3340

3407

Male

1264

1465

1717

1907

1979

2054

2129

2218

2250

2295

Female

1322

1606

1857

2055

2132

2211

2290

2385

2418

3501

Male

478

538

623

676

698

721

741

1534

154

1585

Female

509

615

709

760

780

803

823

1857

1881

1918

65 and

Male

776

999

1191

1300

1345

1394

1434

1534

1554

1585

above

Female

850

1224

1456

1587

1640

1698

1743

1857

1881

1918

Total

Male

20215

22227

24907

26467

27000

27540

28097

28586

29026

29400

Female

20571

22517

25218

26757

27299

27856

28418

28918

29351

29730

0-4
5-9
10-19
20-29
30-39
40-49
50-59
60-64

Source: Department of Population.
-134-

.

ANNEX 1 – Form 2
Year

1990

1995

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

1.88

1.87

2.02

2.02

2.02

2.02

2.02

2.02

2.02

1.75

1.52

1.29

Birth rate (per 1,000 population)

27.2

26.8

26.2

25.7

23.8

21.8

21.1

20.4

20.2

19.8

15.4

16.2

Mortality rate

7.5

7.4

7.1

6.9

6.8

6.3

6.1

5.9

5.8

5.6

8.4

5.6

50.9

50.4

50.2

49.3

50.0

46.5

46.5

46.5

46.3

45.5

29.5

27.2

6.4

7.56

7.94

7.99

8.05

8.12

8.22

8.33

8.39

8.80

8.79

8.85

Population growth rate(% per annum)(per 1,000 population)
Infant mortality rate
(per 1,000 opulation)
The rate of the population of 65
years and over to the total
population (%)
Life expectancy

Male

59.0

60.4

61.1

61.5

61.8

62.1

62.4

62.5

62.9

64.0

65.1

65.5

at birth

Female

63.2

64.3

65.1

65.6

66.0

66.2

66.5

66.6

67.3

69.0

70.5

70.7

Life expectancy

Male

15.9

16.0

16.2

16.2

16.3

16.4

16.4

16.5

16.6

17.2

18.1

17.8

at 60 and 65year

Female

18.0

18.1

18.1

18.2

18.0

18.0

18.1

18.1

18.3

20.4

18.7

21.0

36.2

36.1

36.0

35.7

36

36.2

36.4

36.4

36.1

36.4

36.3

36.5

Unemployment rate
(per 1,000 population)*average rate

Source: Central Statistical Organization.
-135-

ANNEX 1 – Form 3
Year

1991

1995

National income (Kyat)

2000

2003

2004

252172476326975

2005

2006

2007

2008

2009

2010

8975280 1215139

Average wage (Kyat)

Not Available

Net Output per Worker

34385

127509547807

Total GNP (Kyat)

Not Available

GNP growth rate

Not Available

GNP per capita (Kyat)

Not Available

Total GDP (Kyat)

50259.5

66742

1002753624926

4116635467522013893395

15559413

17155078

18970327

20946337

GDP growth rate

2.8

6.9

13.7

13.8

13.6

13.6

13.0

12.2

10.2

10.5

10.3

GDP per capita (Percent)

0.9

5.0

11.5

11.6

11.3

11.3

10.8

10.1

8.6

9.2

9.2

GDP per capita (Kyat)

1232

1492

2000

68107

75814

84396

245836270580293867320824350390

9.46

47.51

86.61

273.7

295.78535.26

1386.701517.811640.82

1830.192170.48

28.37

79.69

144.35456.2

826.30892.102311.212529.462734.873050.823617.47

-

-

-

-

-

-

-

-

-

-

The rate of social insuranceof contribution as apercentage of National
IncomePremium contribution of
employee(Kyat Million)
Premium contribution of
employer(Kyat Million)
Premium contribution ofself-employer etc.

Source: Planning Department, Social Security Board.
Myanmar National Health Accounts (2010-2011) WHO-136-

ANNEX 1 – Form 4
Number and percentage of workers engaged in industrial classification

Year

1990

1995

2000

2005

2010

Primary industry
Secondary industry

Not Available

Tertiary industry

Insured persons and Establishment

Year
Registered Insured
Persons
Actively Insured
Persons
Establishment

1990

1995

2000

2005

2006

2007

2008

2009

2010

504885434418648809967350965705972580965349966383978576329890340320508877502263500618507493500262501296516072

13129

13305

23010

31009

31994

33011

34116

35717

36938

-137-

Five leading causes of death

1st

2nd

3rd

Disease of the heart

Pneumonia

Disease of the heart

Pneumonia

Disease of the heart

Pneumonia

Infectious & parasitic

Injury, Poisoning andCertain condition in the

diseases

External causes

peri-natal period(Year)
1990
1995
2000
2005
2010

Senility without
mention of psychosis
Senility without
mention of psychosis
Senility without
mention of psychosis

Infectious & parasitic

Disease of the heartdiseases

4th

5th

Certain condition in theIntestinal infectious

peri-natal period

diseaseCertain condition in theIntestinal infectious

peri-natal period

diseaseCertain condition in theIntestinal infectious

peri-natal period

diseasePneumonia

Tuberculosis(all forms)

Injury, Poisoning andCertain condition in the

Disease of theExternal causes

peri-natal period

Digestive system

Source: Central Statistical Organization.
Benefit from Social Security Board(Kyat in millions)Type of benefit

1990

1995

2000

2005

2010

Sickness Benefit

2.95

9.58

6.93

30.52

137.69Maternity Benefit

1.07

2.81

3.58

19.47

10.94

Death Grant

0.94

1.25

1.19

33.06

6.51

Temporary Disability Benefit

0.29

0.82

0.65

3.62

1.61

Permanent Disability Benefit

0.96

1.79

2.52

4.66

12.99

Survivor Pension

0.69

1.29

1.45

2.23

11.87

Medical Expenditure

21.35

23.27

151.05380.13846.24

Total Benefit in Cash

28.25

40.81

167.37473.691027.85

Source: Annual Statistical Report of Social Security Board-138-

The Study Programme
for the Improvement of Social Insurance System- Health Security and Vulnerable people-

Thailand-139-

COUNTRY REPORT(THAILAND)
Improvement of Social Insurance System~ Modernization of Health Security
Administration ~(J 1200718)

JICA Tokyo, Japan
17 September – 6 October 2012

Ministry of Public Health,Thailand.

-140-

Contents
1. Geographical and Political features of Thailand
2. Statistical Data (Attached Form 1- 4) / Page 43
3. The Social Security System in Thailand
4. The Object Tax for Social Security Fund.
5. Medical Insurance System (MIS) in Thailand
5.1 Historical Development of MIS
5.1.1 Types of the financial resources
5.1.2 Payment system of medical care expenditures.
5.2 Laws and regulations for MIS
5.3 Administration and management of MIS
5.4 Administration and management of MIS
5.5 Structure of the systems
5.6 Financial situation of MIS
5.7 MIS related policy within the National Development Plan
6. Please describe these points
6.1. Problems to be solved in your current MIS
6.2. Contents of the reform to solve the problems
6.3. Problems for carrying out this reform
References........................................................................................................
List of figures and tables
Figure 1: Organization structure of the SSO
Figure 2 : CHART OF SOCIAL SECURITY OPERATION
Figure 3: Chronological development of the health insurance system
Figure 4: Scope of the UCS assessment, 2001-2010
Figure 5: Organization structure of the NHSO
Figure 6: UCS institutional arrangements
Table 1: Characteristics of three public and private health insurance
Table 2: Percent distribution of five sources of finance, 1994-2007
Table 3: Paying for health services
Table 4: Characteristics of Thailand’s three public health insurance
Table 5: Structure of government revenue, 1994 and 2007
Table 6: Financing Sources for healthcare and their progressivity
Table 7: Cause and effect of health policy in Thailand-141-

List of abbreviations and acronyms
BoB
CGD
CPI
CUP
CSMBS
DRG
GFMIS
GDP
GGHE
GNI
HCS
HSRI
IHPP
IMF
LIS
MoPH
MoF
MWS
NESDB
NHSB
NHSO
NSO
PCU
PID
PHC
PHO
P&P
SES
SHI
SQCB
SSO
SSS
UC
UCS

Bureau of Budget, Thailand
Comptroller General’s Department, Ministry of Finance, Thailand
Consumer Price Index
Contracted Unit for Primary Care
Civil Servants Medical Benefit Scheme, Thailand
Diagnosis-Related Group
Government Financial Management Information System
Gross Domestic Product
General Government health Expenditure
Gross National Income
Health Card Scheme
Health Systems Research Institute, Thailand
International Health Policy Program
International Monetary Fund
Low Income Scheme
Ministry of Public Health, Thailand
Ministry of Finance, Thailand
Medical Welfare Scheme
National Economic and Social Development Board, Thailand
National Health Security Board
National Health Security Office, Thailand
National Statistics OfficePrimary Care Unit
Personal Identification Number
Primary Health Care
Provincial Health Office
Preventive and health Promotion
Socio-economic Survey
Social Health InsuranceStandard and Quality Control Board
Social Security Office, Ministry of Labour, Thailand
Social Security Scheme, Thailand
Universal Coverage
Universal Coverage Scheme, Thailand-142-1. Geographical and Political features of Thailand

The kingdom of Thailand islocated in the center of the
Indo-Chinese Peninsula, andcovers

an

area

of

about

514,000 square kilometers. It is
the third largest country among
the

South

Asian

nations,

compared to Indonesia and
Myanmar. It is bordered by the
Lao

Peoples’

Democratic

Republic on the North, KingdomofCambodia

on

the

East,

Malaysia and gulf of Thailand
on the South, and Myanmar on
the West.

Geographically, Thailand is divided into four regions: Central, North, Notheast,and South, and is administratively divided into provinces. Each province is divided into
district and each district is also divided into sub-district. Currently there are 77
provinces; one of which Bangkok Metropolis, the capital of Thailand, 877 district and
7,255 sub-districts.
The central region (including Bangkok Metropolitan Region) comprising thebasin of the Chao Phrya River which runs from north to south and after crossing
Bangkok flows to the Gulf of Thailand. The central region is often called the "rice bowl"of Thailand being the most fertile area of the country. After the Bangkok Metropolitan
Region, it enjoys the highest per capita income in the country.

-143-

The northern region is mountainous and was traditionally the most heavily
forested area of the country. In the recent years, however, overcutting has
considerably reduced its forest resources. The main centres of population are in the
narrow alluvial valleys along the four north-south flowing rivers which unite in thenorthern central plain to form the Chao Phraya.
The north-eastern region (Isarn) constitutes approximately one third of the areaof the Kingdom and comprises the Korat Plateau which is bounded on the north andeast by the Mekong River and the south by the Dongrek escarpment. The region isdrained by the Mun and Chi rivers, both tributaries of the Mekong. Largely owing tolower and erratic rainfall and poorer soils than in other parts of the country, the northeastern provinces have the lowest per capita income in the country.
Approximately one third of the population of Thailand lives in the north-east. The
south-eastern region: the south-east, which comprises the hilly countryside from
Bangkok to the Cambodian border, is characterized by higher rainfall and poorer soils
than the adjoining central region. It is an important fruit, maize and cassava-growing
area and its coastline offers extensive opportunities for fisheries and tourism. The highrainfall also permits some rubber to be grown.
The southern region: the southern peninsula has the highest rainfall in the
country. It is the principal rubber-growing area and contains extensive alluvial depositsof tin. The forests of the south have been seriously overcut as elsewhere in theKingdom. In recent years, the region has suffered from severe floodings which are
believed to have been amplified by deforestation and subsequent soil erosion.

ClimateLocated outside the typhoon belt, Thailand can be divided into two climatic
zones. The north, north-east, south-east and central regions including Bangkok have a
climate with three distinct seasons: rainy, from June to October; cool, from November
to February; and hot of highest temperatures and sunny weathers from March to May.
Temperatures in Bangkok vary between 20 C in December and 38 C in April
with an average humidity of 82 percent. Winter temperatures in the north can fall to 10
C or lower. The average rainfall in these regions is 1,250 cms per year.

-144-

The southern region has a characteristic tropical rainforest climate. Rainfall
occurs virtually throughout the year, although a number of micro-climates can be found.
There is little variation in temperature, which is on average 28 C throughout the year.
March and April are normally the driest months in the south. The periods of maximum
rainfall in these areas vary according to climatic sub-regions.

Population
The estimated population is 64 million of which approximately 9.3 million live in
Bangkok and its vicinities. Ninety-four percent of the population are Thai-speaking
Buddhists; Thai is also the official language of the country. Four distinct dialects of theThai language are spoken, in the central, northern, southern and in the north-easternregions, the latter being closely related to the Lao language. In the four southern
provinces of Pattani, Satun, Yala and Naratiwat near the Malaysian border, themajority of the population is Muslim and speaks "Pattani" Malay. In the mountains of
the northern region there are approximately 525,000 highland people who speak
distinct languages.
From about 1850 until the Second World War there was a steady flow ofimmigrants from China who established themselves in commerce and as artisansthroughout the country. The population of Chinese origin now comprises 10-15 percentof the total population. The Thai Government has successfully encouraged theassimilation of the Chinese, and the younger generations are Thai citizens and speak
Thai.
Bangkok (Krung Thep) has been the capital since 1782. Bangkok metropolitan
area is by far the most significant urban area in the country. The per capita income in
Bangkok is almost triple the national average of US$ 8,135 per year (2009). The next
largest city, Nakhon Ratchasima in the northeast, has a population of 2.5 million.Largeprovinces, apart from Bangkok and Nakhon Ratchasiama, are Khon Kaen, Ubon
Ratchathani and Udon Thani in the north-east, Nakhon Si Thammarat and Songkla(where Hat Yai city is located) in the south, and Chiang Mai, Chiang Rai in the North.

-145-

Religion
The Theravada or Hinayana Buddhism is the state religion of Thailand. Aboutfive percent of the population is Muslim residing mainly in the south along the
Malaysian border. Other religious groups include Taoists, Christians, Hindu and Sikhs.

The Politics of Thailand
The politics of Thailand are conducted within the framework of a constitutional
democratic monarchy, whereby the Prime Minister is the head of government and ahereditary monarch is head of state. The judiciary is independent of the executive
and the legislative branches.
Thai kingdoms and late Kingdom of Siam were under the absolute rule of thekings. However, after the 'democratic revolution' in 1932, the country officiallybecame under a constitutional democratic monarchy with a prime minister as thehead of government. The first written constitution was issued.
Politics of Constitutions
All of Thailand's charters and constitutions have recognized an undivided
kingdom with the constitutional monarchy, but with widely differing balances of power
between the branches of government. Most of them have stipulated parliamentary
systems. Both unicameral and bicameral parliaments have been used, and membersof parliament have been both elected and appointed. The direct powers of themonarch have also varied considerably.
The current monarch of Thailand is His Majesty King Bhumibol Adulyadej.
The king has reigned since 9 June 1946, making him the world's longest reigningcurrent monarch and the world’s longest serving head of state. Most of the king's
powers are exercised by his elected government in accordance with the current postcoup constitution. The king still retains many powers such as: being head of theRoyal Thai Armed Forces, the prerogative of royal assent and the power of pardon.
He is also the defender of the Buddhist faith, commands enormous popular respectand moral authority in Thailand.

-146-

Government of Thailand
According to the constitution, the three major independent authorities holding
the balance of power are executive, legislative, and judicial.
The head of government is the Prime Minister. Under the present constitution,
the Prime Minister must be a Member of Parliament. Cabinet members do not haveto be Members of Parliament. The legislature can hold a vote of no-confidence
against the Premier and members of his Cabinet if it has sufficient votes. The cabinet
is responsible for the administration of thirteen ministries and the Office of the Prime
Minister. Each ministry is headed by a politically appointed minister with one or more
deputy ministers. The Prime Minister is assisted by Deputy Prime Ministers as well
as a number of ministers holding the portfolio of "Minister to the Prime Minister's
Office."2. Statistical Data (Attached Form 1- 4)-147-

3. The Social Security System in Thailand
In 1954, the Social Security Act was enacted. However, the then Government
considered that the economic condition of the country at that time was not favorable for
enforcement of the Social Security Act 1954. As a result, the ROYAL DECREE wasenacted in lieu of the said Act. (Social Security Office : http://www.sso.go.th)
In 1972, the Government by the Revolutionary Party decided that employees
who sustained injuries or illness or who died as a result of working for the employer
should be secured that they would receive compensation money. The Compensation
Fund has started its management of the fund since 1 January 1974 under thesupervision of the Department of Labor. This was the first step of actual social
security. Efforts to push for full realization of social security have been madecontinually consistently through the appointment of several committees to review thematter. Until 1981, the Committee charged with the preparation of social security
scheme under the chairmanship of the Permanent-secretary of Interior, finallycompleted the draft of the Social Security Act A.D ....... in which the operation of theAct, the establishment of an administrative organization and the Contributions Fund;but unfortunately, this draft of the Social Security Act was not successful.
Until 1990, the Draft of the Social Security Act 1990 was approved by the
National Assembly and went into force on 2 September 1990. Under this Social
Security Act, the employees would receive protection in the capacity as the insured
under a total of 7 circumstances, namely: illness or accident; physical disability; death
not related to performance of work; child delivery; old age, child assistance andunemployment. In the initial stage tentative protection coverage shall be provided toplaces of business with over 20 employees and afterwards in 1993, it was extended
to places of business with over 10 employees; and provides protection particularly inthe case of illness, disability, and death which is not resulted from work performanceand to child delivery on tentative basis. For this purpose, the employer, andemployee and the Government have made contributions at equal rate: at 1.5 percent
for old age and child assistance was covered in 1996 and the coverage of
unemployment shall be provided protection coverage by means of enacting a Royal
Decree when the operation was ready.

-148-

The Office of Social Security is attached to the Ministry of Interior and wasestablished on 3 September 1990. The work related to social security was transferredfrom the Department of Public Welfare; and the work of the Office of Compensation
Fund, the Department of Labor, was then transferred to be under the management of
the Office of Social Security. The Office of Social Security was transferred to be under
the Ministry of Labor and Social Welfare on 23 September 1993.
Figure 1 Organization structure of the SSO-149-

Figure 2 : CHART OF SOCIAL SECURITY OPE

TION IN CASE OF UNEMPLOYMENT(For Example)
CHART OF SOCIAL SECURITY OPERATIONIN CASE OF UNEMPLOYMENTOffice of Social Security
Collection of Contributions

Reporting

Department of Skill
UNEMPLOYMENTREGISTRATIONTHE UNEMPLOYEDInterview/Examination of
Qualification; Working Record

Job training (as required)

Job Vacancy

Department ofLabor Protection & Welfare

Department of
Waiting
Reporting

Job Placement

Employment
Registration Data

Labor Complaints,
Termination of Employment
and Labor Dispute Data

UNEMPLOYMENT SECURITY BENEFIT DATA

Verification of
Entitlements
OFFICE OF THE SOCIALSECURITY

Payment of Contributions Qualification of the Unemployed
Be entitledPayment of the compensation
benefit

Source : Social Security Office : http://www.sso.go.th

-150-

SKILL
TRAINING
DATA

Record of Contribution Payment Data
Registration of the Insured and Employment Data
Record of Compensation Benefit Payment Data
Financial Information and Accounts of the Fund D
Record of Reporting Registration Data
Job Waiting Record Data
Job Seeking Record Data
Record of Labor Skill Development Data
Termination of Employment Record Data

4. The Object Tax for Social Security Fund.
(Exchange rate: US$1.00 ~ 31.36 baht. at 9/9/12)

The Social Security Fund was established under the Social Security 1990 to
institute security and stability of livelihood for Thai citizens.
The Social Security Office, established by virtue of the Act, has duty to manage
the SSF for the best interest of all members. The coverage is divided into seven types:
sickness, maternity, disability, death, child allowance, old age and unemployment.
Categorized under the Defined Benefit System, the SSF regulates member
benefits at the very outset regardless of the amounts of contributions or returns on
investment of any parties. Every employer with at least one employee and all workers
except those exempted by the Act such as civil servants, state enterprise employees
and private school teachers are required to make equal contributions while thegovernment subsidizes additional levy to the fund.
As long as wages are paid, employers are duty bound to submit the contributed
sums to the Social Security Office within 15 days of the month following the monthwhen the contribution is deducted.
Contribution Rate
Conditions

Government

Employers

Employees

1. Sickness
2. Maternity
3. Disability

Every party made a contribution of 1.5% of wage.

4. Death
5. Child allowance
6. Old-age
7. Unemployment

1% of wage

3% of wage

3% of wage

0.25% of wage

0.5% of wage

0.5% of wage

Note: Base wages for calculation range from 1,650 to 15,000 baht per month.

-151-

Sickness and Maternity
Regulatory Framework
First and current laws: 1990 (social security), implemented in 1991 and 1998; and1990 (sickness and medical benefits).
Type of program: Social insurance system.
Coverage
Employees aged 15 to 60.
Voluntary coverage for self-employed persons and for persons who cease to becovered after at least 12 months of compulsory coverage.
Exclusions: Employees of foreign governments or international organizations;agricultural, forestry, and fishery employees; temporary and seasonal workers; andThai citizens working abroad.
Special systems for judges, civil servants, employees of state enterprises, andemployees of private schools.
Source of Funds
Insured person: 1.5% of gross monthly earnings (1.06% finances sickness andmaternity benefits; 0.44% finances disability and survivor benefits). For voluntary
contributors, see source of funds under Old Age, Disability, and Survivors.
The minimum monthly earnings used to calculate contributions are 1,650 baht.
The maximum monthly earnings used to calculate contributions are 15,000 baht.
Self-employed person: See source of funds under Old Age, Disability, and Survivors.
Employer: 1.5% of monthly payroll (1.06% finances sickness and maternity benefits;
0.44% finances disability and survivor benefits).
The minimum monthly earnings used to calculate contributions are 1,650 baht.
-152-

The maximum monthly earnings used to calculate contributions are 15,000 baht.
Government: 1.5% of gross monthly earnings (1.06% finances sickness and maternity
benefits; 0.44% finances disability and survivor benefits).
The minimum monthly earnings used to calculate contributions are 1,650 baht.
The maximum monthly used to calculate contributions are 15,000 baht.
Qualifying Conditions
Cash sickness and medical benefits: Must have at least 3 months of contributions in
the 15 months before the incapacity began or the date of treatment.
The insured must provide medical certification of the incapacity.
Cash maternity, childbirth grant, and medical benefits: Must have at least
7 months of contributions in the 15 months before the expected date of childbirth.
Cash maternity benefits are paid to an insured woman. The childbirth grant is paid toan insured woman or to the wife of, or a woman who cohabits with, an insured man.
The childbirth grant is paid to cover the cost of medical expenses related to childbirth.
Maternity benefits are paid for two childbirths only.

Sickness and Maternity Benefits
Sickness benefit: The benefit is 50% of the insured's average daily wage in thehighest paid 3 months of the 9 months before the incapacity began. The benefit is paid
from the first day of certified absence from work (after the end of entitlement tostatutory sick pay, usually 30 days, under the labor law) for up to 90 days for each
illness and for up to 180 days in any calendar year; may be extended up to 365 days
for a chronic condition.
The minimum monthly earnings used to calculate benefits are 1,650 baht.
The maximum monthly earnings used to calculate benefits are 15,000 baht.
There is no minimum benefit.

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Maternity benefit: The benefit is 50% of the insured's average daily wage in thehighest paid 3 months of the 9 months before maternity leave and is paid for up to
90 days for each childbirth.
The minimum monthly earnings used to calculate benefits are 1,650 baht.
The maximum monthly earnings used to calculate benefits are 15,000 baht.
There is no minimum benefit.
Childbirth grant: A lump sum of 12,000 baht is paid.
Workers' Medical Benefits
Medical examination and treatment, hospitalization, medicine, ambulance fees,
rehabilitation, and other necessary expenses are provided under the healthcare
system.
The insured must register with a hospital under contract with the healthcare system toreceive benefits from the hospital. Medical care outside this hospital is provided incase of emergency and accident only, in which case costs are reimbursed according to
fixed rates.
There are no provisions for cost sharing.
Disability pensioners are entitled to receive subsidized medical care and rehabilitation.
Dependents' Medical Benefits
Necessary medical care related to childbirth for the wife of, or a woman who cohabits
with, an insured man.
Administrative Organization
Ministry of Labor (http://www.mol.go.th) provides general supervision.
Social Security Office (http://www.sso.go.th) collects contributions and pays cash
benefits.
Hospitals under contract to the Social Security Office deliver medical benefits.
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Work Injury
Regulatory Framework
First law: 1972 (announcement of the revolutionary party), implemented in 1974.
Current law: 1994 (workmen's compensation).
Type of program: Employer-liability system, involving compulsory insurance with apublic carrier.
Coverage
Employees of industrial and commercial firms.
Exclusions: Agricultural, forestry, fishery employees; and self-employed persons.
Special systems for government employees, employees of state enterprises, andemployees of private schools.
Source of Funds
Insured person: None.
Self-employed person: Not applicable.
Employer: 0.2% to 1% of annual payroll, according to the degree of risk.
The contribution is made annually. Beginning with the 5th year of contributions, thecompany's accident rate is taken into account when assessing the degree of risk.
There are no minimum earnings used to calculate contributions.
The maximum annual earnings used to calculate contributions are 240,000 baht.
Government: None.
Qualifying Conditions
Work injury benefits: There is no minimum qualifying period.

-155-Temporary Disability Benefits
Temporary disability benefit: The benefit is 60% of the insured's monthly wage
before the disability began, according to a schedule in law. The benefit is paid after
a 3-day waiting period for up to 1 year; the benefit is paid retroactively if the incapacity
lasts more than 3 days. The insured must be unable to work.
There are no minimum earnings used to calculate benefits.
The maximum annual earnings used to calculate benefits are 240,000 baht.
The minimum monthly benefit is 60% of the minimum daily wage multiplied by 26 andmust not exceed 60% of the monthly average wage.
The maximum monthly benefit is 12,000 baht.
Permanent Disability Benefits
Permanent disability benefit: For a total disability, the pension is 60% of theinsured's monthly wage before the disability began and is paid for up to 15 years.
Permanent disability benefits are paid according to a schedule in law.
The minimum monthly benefit is 60% of the minimum daily wage multiplied by 26 andmust not exceed 60% of the average monthly wage.
The maximum monthly benefit is 12,000 baht.
Permanent partial disability benefit: The pension is 60% of the insured's monthly wage
before the disability began. The benefit is paid from 2 months to 10 years, according toa schedule in law. In certain cases, the benefit may be paid as a lump sum.
The degree of disability is assessed annually by medical officers assigned by theSocial Security Office.
Benefit adjustment: Benefits are adjusted on an ad hoc basis.
Workers' Medical Benefits
All necessary medical, surgical, and hospital services.

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Up to 45,000 baht is paid for each incident of work injury or occupational disease; up to
300,000 baht in certain specified cases, depending on the decision of the medical
committee of the Office of Workmen's Compensation Fund.
Rehabilitation services are provided for a cost of up to 20,000 baht.
Survivor Benefits
Survivor benefit: The pension is 60% of the deceased's last monthly wage and ispaid for up to 8 years. (A reduced benefit may be paid as a lump sum.)
Eligible survivors include parents, the spouse, and children younger than age 18 (nolimit if a student or disabled). The pension is split equally among all eligible survivors.
In the absence of eligible survivors, any other dependent persons may qualify.
The minimum monthly benefit is 60% of the minimum daily wage multiplied by 26 andmust not exceed 60% of the average monthly wage.
The maximum monthly benefit is 12,000 baht.
Benefit adjustment: Benefits are adjusted on an ad hoc basis.
Funeral grant: A lump sum of 100 times the highest minimum daily wage is paid. The
benefit is paid to the person who paid for the funeral.
Administrative Organization
Ministry of Labor (http://www.mol.go.th) provides general supervision.
Social Security Office (http://www.sso.go.th) administers the program through the
Office of Workmen's Compensation Fund, which collects contributions and pays cash
benefits.
Hospitals under contract with the Social Security Office and meeting the standards of
the Office of Workmen's Compensation Fund provide medical benefits.

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Old Age, Disability, and Survivors
Regulatory Framework
First and current law: 1990 (social security), implemented in 1991 and 1998.
Type of program: Social insurance system.
Coverage
Employees aged 15 to 60.
Voluntary coverage for self-employed persons and for persons who cease to becovered after at least 12 months of compulsory coverage.
Exclusions: Employees of foreign governments or international organizations;agricultural, forestry, and fishery employees; temporary and seasonal workers; andThai citizens working abroad.
Special systems for judges, civil servants, employees of state enterprises, andemployees of private schools.
Source of Funds
Insured person: 3% of gross monthly earnings for old-age and family benefits.
Disability and survivor benefits are financed under Sickness and Maternity.
Voluntary contributors pay an annual flat-rate contribution of 3,360 baht. Voluntary
contributions finance disability, survivor, and maternity benefits.
The minimum monthly earnings used to calculate contributions are 1,650 baht.
The maximum monthly earnings used to calculate contributions are 15,000 baht.

Self-employed person: An annual flat-rate contribution of 3,360 baht.
The self-employed person's contributions finance disability, survivor, and maternity
benefits.

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Employer: 3% of monthly payroll for old-age and family benefits. Disability andsurvivor benefits are financed under Sickness and Maternity.
The minimum monthly earnings used to calculate contributions are 1,650 baht.
The maximum monthly earnings used to calculate contributions are 15,000 baht.
Government: 1% of gross monthly earnings for old-age and family benefits only.
Disability and survivor benefits are financed under Sickness and Maternity.
The minimum monthly earnings used to calculate contributions are 1,650 baht.
The maximum monthly earnings used to calculate contributions are 15,000 baht.
Qualifying Conditions
Old-age pension: Age 55 with at least 180 months of contributions. Employment mustcease. If a pensioner starts a new job, the pension is suspended until the end of
employment.
Old-age pension increment: Paid if the insured had more than 180 months ofcontributions at the pensionable age.
Deferred pension: The pension may be deferred.
Old-age settlement: Age 55 with at least 1 month, but less than 180 months ofcontributions. Employment must cease.
Disability pension: Must be incapable of work and have at least 3 months ofcontributions in the 15 months before the total physical or mental disability began. The
benefit is paid after entitlement to the cash sickness benefit ceases.
Medical officers assigned by the Social Security Office assess the degree of disability
annually. The benefit may be suspended if the medical committee of the Social
Security Office determines that the disability pensioner is rehabilitated.
Survivor benefit: Paid if a pensioner dies within 60 months after becoming entitled tothe old-age pension.

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Eligible survivors include the surviving spouse, legitimate children, and a surviving
father or mother.
Death benefit: Paid if the deceased had at least 1 month of contributions in the
6 months before death or was a disability pensioner. The death must be the result of anonwork-related injury or illness.
The eligible survivor is the deceased's named beneficiary; in the absence of a named
beneficiary, the surviving spouse, children, and parents are eligible.
Funeral grant: Paid if the deceased had at least 1 month of contributions in the
6 months before death or was a disability pensioner. The death must be the result of anonwork injury or illness.

Old-Age Benefits
Old-age pension: The pension is 20% of the insured's average monthly wage in thelast 60 months before retirement.
The minimum monthly earnings used to calculate benefits are 1,650 baht.
The maximum monthly earnings used to calculate benefits are 15,000 baht.
Old-age pension increment: The old-age pension is increased by 1.5% of the insured's
average monthly wage in the last 60 months for each12-month period of contributions
exceeding 180 months.
There is no minimum pension.
Deferred pension: The old-age pension is increased by 1.5% of the insured's averagemonthly wage in the last 60 months for each 12-monthperiod of contributions
exceeding 180 months.

Permanent Disability Benefits
Disability pension: 50% of the insured's average daily wage in the highest paid
3 months of the 9 months before the disability began. The benefit is paid until death.

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The minimum monthly earnings used to calculate benefits are 1,650 baht.
The maximum monthly earnings used to calculate are 15,000 baht.
There is no minimum pension.
Benefit adjustment: Benefits are adjusted on an ad hoc basis according to changes in
the cost of living.

Survivor Benefits
Survivor benefit: A lump sum of 10 times the deceased's monthly old-age pension is
paid.
The amount is split among eligible survivors, according to the number and category ofsurvivors.
Death benefit: With between 36 months and 10 years of contributions, a lump sum is
paid of 50% of the deceased's average monthly wage in the highest paid 3 months of
the 9 months before death multiplied by 3. With at least 10 years of contributions, alump sum is paid of 50% of the deceased's average monthly wage in the highest paid
3 months of the 9 months before death multiplied by 10.
In the absence of a named beneficiary, the amount is split equally among the eligible
survivors.
Funeral grant: 40,000 baht is paid to the person who paid for the funeral.
Administrative Organization
Ministry of Labor (http://www.mol.go.th) provides general supervision.
Social Security Office (http://www.sso.go.th) collects contributions and pays benefits.
Unemployment
Regulatory Framework
First and current law: 1990 (social security), implemented in 2004.
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Type of program: Social insurance system.
Coverage
Employees aged 15 to 60.
There is no voluntary coverage.
Exclusions: Judges; employees of foreign governments or international organizations;employees of state enterprises; agricultural, forestry, and fishery employees;
temporary and seasonal workers; Thai citizens working abroad; and self-employedpersons.
Source of Funds
Insured person: 0.5% of gross monthly earnings.
The minimum monthly earnings used to calculate contributions are 1,650 baht.
The maximum monthly earnings used to calculate contributions are 15,000 baht.
Self-employed person: Not applicable.
Employer: 0.5% of monthly payroll.
The minimum monthly earnings used to calculate contributions are 1,650 baht.
The maximum monthly earnings used to calculate contributions are 15,000 baht.
Government: 0.25% of gross monthly earnings.
The minimum monthly earnings used to calculate contributions are 1,650 baht.
The maximum monthly earnings used to calculate contributions are 15,000 baht.
Qualifying Conditions
Unemployment benefit: The insured must have at least 6 months of contributions in
the 15 months before unemployment.

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The insured must be registered with the Government Employment Service Office, beready and able to accept any suitable job offer, and report at least once a month to theGovernment Employment Service.
Unemployment must not be due to performing duties dishonestly; intentionallycommitting a criminal offense against the employer; seriously violating work
regulations, rules, or lawful order of the employer; neglecting duty for 7 consecutive
days without reasonable cause; or causing serious damage to the workplace as aresult of personal negligence.
The Social Security Office may suspend benefit payments for failure to comply withconditions.
Unemployment Benefits
If involuntarily unemployed, the benefit is 50% of the insured's average daily wage inthe highest paid 3 months in the 9 months before unemployment and is paid for up to
180 days in any 1 year; if voluntarily unemployed, the benefit is 30% of the insured's
average daily wage and is paid for up to 90 days in any 1 year.
The benefit is paid from the 8th day of unemployment.
The maximum daily benefit is 250 baht.
Administrative Organization
Ministry of Labor (http://www.mol.go.th) provides general supervision.
Social Security Office (http://www.sso.go.th) collects contributions and pays benefits.
Department of Employment (http://www.doe.go.th), under the Ministry of Labor(http://www.mol.go.th), registers the unemployed insured persons for job placement
and training through the Government Employment Service Office.
Department of Skill Development (http://www.dsd.go.th), under the Ministry of Labor,trains unemployed insured persons for new jobs.

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Family Allowances
Regulatory Framework
First and current law: 1990 (social security), implemented in 1998.
Type of program: Social insurance system.
Coverage
Employees aged 15 to 60.
Voluntary coverage for persons who cease to be covered after at least 12 months ofcompulsory coverage.
Exclusions: Employees of foreign governments or international organizations;agricultural, forestry, and fishery employees; temporary and seasonal workers; Thai
citizens working abroad; and self-employed persons.
Special systems for judges, civil servants, employees of state enterprises, andemployees of private schools.
Source of Funds
Insured person: See source of funds under Old Age, Disability, and Survivors.
Self-employed person: Not applicable.
Employer: See source of funds under Old Age, Disability, and Survivors.
Government: See source of funds under Old Age, Disability, and Survivors.
Qualifying Conditions
Child allowance: The insured must have at least 12 months of contributions in the
36 months before the month of entitlement.
The benefit is paid for legitimate children younger than age 6, but for no more than twochildren at a time. If the insured becomes disabled or dies while the child is younger
than age 6, the allowance is paid until the child is age 6.
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Family Allowance Benefits
Child allowance: A monthly allowance of 350 baht is paid for each child.
Administrative Organization
Ministry of Labor (http://www.mol.go.th) provides general supervision.

-165-5. Medical Insurance System (MIS) in Thailand
5.1 Historical Development of MIS
The timeline for expansion of MIS in Thailand is:
1975: Free Medical Care for the poor (Medical Welfare Scheme), drawing lessons,gradual expansion and amendments in the health systems;
1980: Royal Decree for CSMBS;
1983: Voluntary health insurance (Voluntary Health Card) scheme: transitional
measures, building up the social capital and institutional capacity to manage
insurance fund;1990: Social Security Act: Introduction of SHI for employed sector, capitation, andpredecessor of the current universal coverage (UC) design;
1992: Reform of CSMBS - not very successful;
1996: Reform of health systems including financing (drafting national healthinsurance act), and2001: Political will to adopt universal coverage of health care – financed
from general revenue.
Thailand reaches the universal coverage for health care in 2002. It started fromuser fee with exemption, and gradually moved from this out-of-pocket payment to
prepayment system (Figure 3). Various forms of prepayment systems were introduced
and tested in Thailand. These implementations are huge differences in terms ofcontribution, public subsidy, benefits and quality of services. Anyway, Thailand could
reach the coverage of social protection in health around 70% with these pluralistic
approaches, and there were weakness in terms of efficiency, quality and equity. Figure
3: chronological development of the health insurance system in Thailand-166-

Figure 3: Chronological development of the health insurance system in Thailand

Regarding movement of technocrats and civil societies, then Universal
coverage for health care was stated as a national strategic policy. In 2001, regarding
the commitment to rapidly raise the coverage of health care to all Thai citizens under
the slogan “30 Baht to cure every disease” as one of key campaign promises, thegovernment at that time provide Thai citizen the universal coverage for health care . Asa matter of fact, the design to reach the universal coverage for health care is morecomprehensive than the slogan. For the Transition State, there are two action plans.
First is the expansion of the coverage with the Social Security Scheme. Second is thereform of the existing welfare scheme for indigent people and voluntary healthinsurance for self-employed people to the new compulsory scheme, “the 30 Baht
scheme”. After the Universal Coverage Policy was totally introduced in April 2002, thesocial health protection can be divided in to three groups, schemes for public
employees, schemes for private employees and scheme for the rest of Thai (informal
sector). Currently, Public health protection schemes Cover all Thai citizen, 7% of
population are covered by public employee benefit schemes, The SSS covers 16% of-167-

population, and the rest (75%) are in the UCS. It should be noted that private healthinsurance companies play very limited additional role in Thailand due to their highpremium rate and very strict under-write policies.
5.1.1 Types of the financial resources for the system, and current situation andoutlook for the revenue and expenses of the system
After the UC scheme was launched in 2002, Thailand had three public healthinsurance schemes covered the whole population. The CSMBS provides health care
free at point of service for 5.2 million government employees and their dependants[including parents, spouse and not more than two children less than 20 years old, andthe pensioners. The SHI protects 9 million private sector employees in any firm having
more than one employee, for non-work related conditions, while Workmen’sCompensation Fund covers work related injuries, illnesses or deaths. Note that SHI
covers individual worker, excluding their dependants except maternity benefit which
covers spouse of male beneficiaries. Finally, the UC scheme covers the residual
population who are neither CSMBS nor SHI beneficiaries. UC replaces all previous
government subsidized health insurance schemes prior to 2001, namely the Low
Income Card (LIC) scheme for the poor, the Voluntary Health Card (VHC), the disabled,
the elderly, and children aged less than 12 years. However, private health insurance
covers the affluent groups, 2.2% of total population.

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Table 1: Characteristics of three public and private health insurance schemes

Source: Modify from Prakongsai et al

Refer to Thai National Health Account, there are five main funds of finance:
general government health expenditures (GGHE), social health insurance (SHI),
private health insurance, out-of-pocket (OOP) and the rest of world (ROW).
In 1994, the share of health care spending by GGHE was less than the private
spending (private health insurance and OOP). However, the proportion of GGHE
gradually increased and overtook the private spending, and became the dominantfinancing source after the 1997 Asian economic crisis and the emergence of the UC
scheme in 2002 (Table 2). SHI was not a major contributor in health expenditure. SHI
accounts for 2.9% of THE in 1994 and gradually increased to about 7% in 2007.
Household OOP had a lion share in 1994, 44.5% of THE, until the 1997 Asian
economic crisis and then slowly and steadily dropped to 19.2% in 2007. Funding size
from the rest of the world is negligible.

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Table 2: Percent distribution of five sources of finance, 1994-2007

Source: NHA Working Group 2009
Note:
1 General Government Health Expenditures (GGHE) comprised of health expenditure spent by the ministry of
publichealth and other ministries, local government agencies, CSMBS, state enterprise and universal coverage scheme
since 2002.
2 Social Health Insurance (SHI) comprised of health expenditures through social health insurance fund andworkmen compensation fund.
3 Majority of private health insurances were voluntary basis (about 57% of all private insurances) while the rest
(43%) were compulsory traffic accident protection fund managed by private insurance companies.
4 Out-of-Pocket (OOP) were paid by household at point of services.
5 Rest of the World (ROW) means grants from bilateral and multilateral donors.

5.1.2 Payment system of medical care expenditures.
Table 3 describes how different health services were paid for by three public
insurances schemes as well as the voluntary health insurance schemes. We observethat there are harmonization of payment for health services by NHSO and SSO as they
applied the close ended provider payment contract mode while the CGD applied fee
for service opened ended provider payment for outpatient services and conventional
DRG for inpatient services.

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Table 3: Paying for health services-171-

* There are increasing numbers of local government officials and employees of independent public organizations.
The provider payment mechanism often applies
the CSMBS reimbursement model. Any reform in the CSMBS may have effects to these groups.

5.2 Laws and regulations for MIS: A list of laws and regulations regarding MIS
in your country should be presented which gives the name/title, legislated year,
and description/purpose of each.
National Health Security Act B.E. 2545 (A.D. 2002) Given on the 11th Day of
November 2002 The reasons for the promulgation of this Act are as follows: Whereas
Section 48 of the Constitution of the Kingdom of Thailand provides that the Thai
population shall enjoy an equal right to receive standard Health service and theindigent shall have the right to receive free medical treatment from Health centers of
the State, as provided by law. Health service by the State shall be provided thoroughly
and efficiently and, for this purpose, participation by local government organizations
and the private sector shall be promoted insofar as it is possible.
5. 3 Administration and management of MIS (Central Level): An organizational
chart of the government should be provided that indicates theministries/departments/divisions responsible for administrating MIS.
A brochure or annual report that gives an outline of governmental measurein MIS, if any, these materials would be appreciated.
The comprehensive assessment of the UCS’s first 10 years (2001-2010)
focused on five areas of inquiry: policy formulation, contextual environment, policy
implementation, governance and impacts. The scope of the study is shown in Figure 3.

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Figure 4: Scope of the UCS assessment, 2001-2010

Source : Thailand’s Universal Coverage Scheme: Achievements and Challenges (2010)

The National Health Security Act B.E. 2545 (2002) is the legal basis for the UCS.
The Act stipulates the establishment of the National Health Security Office (NHSO)
and the National Health Security Fund. Actually, this act stipulates that every Thai
citizen has entitlement to medical care under a public health protection scheme.
However, Thai citizens who already have entitlement to use any existing social healthprotection scheme have to use those schemes-173-

Figure 5: Organization structure of the NHSO

Source : National Health Security Office (NHSO) Thailand : http://www.nhso.go.th-174-Responsibilities
The National Health Security Act. 2002 Section 26 authorizes the National Health
Security Office (NHSO) with the following responsibilities
1. Responsible for administrative work of the National Health Security Committee,
and the National Committee for Quality Accreditation.
2. Compile and analyze data on health services.
3. Organize systems for registration of beneficiaries service provider and their
networks.
4. Administer the fund according to the regulations.
5. Pay service expenses to health providers and their network under regulation
determined by the National Health Security Committee.
6. Carry out claiming process for medical services provided by the service
providing units.
7. Make service registration for people and aloe them to change their registration
as required.
8. Monitor and control service quality to be at standard level and makeconvenience to people when complaining.
9. Process authority, ownership and assets.
10. Organize rights and legal procedures concerning with its assets.
11. Able to collect fees and services fees.
12. Authorize other organizations to carry out activities under the responsibility ofthe office.
13. Dan an annual report of the National Health Security committee and the
National Committee for quality Accreditation.
14. Carry out other duties.
5.4 Administration and management of MIS (Local level, Private Sector):
An organizational chart of local government and/or private sector thatspecifics organizations responsible for MIS at the local level and/or private
sector should be provided.
The original vision for the UCS was that the NHSO, rather than the MOPH,
would act as the fund manager and that the MOPH would relinquish its authority over-175-

MOPH health-care facilities, which would come under the devolved control of local
government or “area health boards”. However, the plan to establish autonomous
hospitals did not progress beyond a single pilot institution and the MOPH continued
functioning as the major provider (see Figure 6). With financial authority transferred to
the NHSO, it is understandable that the MOPH did not favour the devolution of its
health facilities.
As the following chapter elaborates, the purchaser-provider split proved to be
the biggest challenge faced by the UCS during its first decade, far more difficult, forexample, than registering 47 million people in the new scheme and finding the publicresources to cover 18 million previously uninsured people. The latter was done in thefirst year; the former has yet to be completed and may be further delayed by ongoingpower struggles and institutional conflicts between the MOPH and the NHSO.

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Figure 6: UCS institutional arrangements

Source : Thailand’s Universal Coverage Scheme: Achievements and Challenges (2010)

5.5 Structure of the systems-

Type, Insurer, Number of the insured, Recipient qualification and contentsof the benefits, etc.
Table 4 summarizes the characteristics of the three health insurance schemesthat have covered all Thai citizens since 2002. The UCS and SSS capitation rates
are similar but the UCS rate should be higher as it draws members from all age
groups, including children under 5 and adults over 60, while the SSS covers only
adults aged 15-60 years. CSMBS expenditure is thought by most analysts to be
more than four times higher than the other two schemes because fee-for-service
payment creates incentives for providers to prescribe more diagnostics andedicines. Research evidence shows large practice variations between the UCS andCSMBS17. For instance, the CSMBS spends more on branded drugs and less on-177-generics, has a higher caesarean section rate and has longer hospital stays formost DRGs.
Table 4: Characteristics of Thailand’s three public health insurance schemes after
achieving universal coverage in 2002

Source : Thailand’s Universal Coverage Scheme: Achievements and Challenges (2010)-178-

5.6 Financial situation of MIS (Types of the financial resources for the system,
and current situation and outlook for the revenue and expenses of thesystem)Taxation is the main source of Thai government's revenue. A large part of tax
collection is responsible by three Department of the Ministry of Finance—The Revenue
Department, the Excise Department, and Customs Department - which collectively
account for about 85-90% of the government's revenue collected. The Revenue
Department responsible for personal and corporate income tax collection, contributes
more than half of the total tax collected. Liability of tax payers are prescribed by rules
and regulations stipulated in the Revenue Code.
In the tax revenue structure, the direct tax (personal income and corporate tax)
is the largest portion, follows by consumption tax (including value added tax—VAT anda very small role of business tax for small enterprises), excise tax and import andexport duties respectively. However, indirect tax combining all items has a large sharethan direct tax. This tax profile has not changed between 1994 and 2007, except in theyear 1998 and 1999, two years after the 1997 Asian economic crisis; the consumption
tax was larger than direct tax. The main source of direct tax is from personal income
tax which applies very progressive tax rates (Table 5).
Revenue Department had demonstrated an improved effectiveness of tax collection,
now totally in electronic submissions by March every year for personal income tax.
However the tax base is still narrow. There is no political will to introduce property andinheritance tax though this was discussed by the Parliament in 2009.
There is only one earmark tax to healthcare, 2% levies on tobacco and alcohol
consumption was transferred by the Excise Department on a daily basis to the Thai
Health Fund. The Fund is governed by a Board chaired by the Prime Minister, aiming
to campaign against tobacco, alcohol and active health promotion activities by funding
NGO and civil society and government agencies to strengthen healthy enabling
environment (Tangcharoensathien V., Prakongsai P., Patcharanarumol W., 2008).

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Table 5: Structure of government revenue, 1994 and 2007

Source: Fiscal Policy Office, Ministry of Finance http://www.fpo.go.th/fiscaldata/Revweb.xls,
access 20 December 2009

An EU funded EQUITAP study and subsequent studies conducted (O’Donnell, O., vanDoorslaer, E., 2007), estimates a Concentration Index of various sources of healthcare
finance in Thailand, using NSO SES data and National Health Account in its estimates,
see Table 10.
Table 6: Financing Sources for healthcare and their progressivity

Source : Thailand. Bulletin of the World Health Organization 85, 8(2007)

Note: * Concentration Index (CI) based on Socio-Economic Survey (SES: 2002, 2004 and 2006). CI ranges from– 1 to +1
1, the closer to 1 the more progressive of financial contribution.
** Fraction of health expenditures by source was derived from Thailand National Health Account (figures in 2006
were estimated from 2005 data)

CI, an index of the distribution of payments, ranges (-1 to 1), a positive (negative) value
indicates the rich (poor) contributes a larger share than the poor (rich), a value of zero iseveryone pays the same irrespective of ability to pay.
Between 2002 and 2006, the proportion of total expenditure made up from direct tax
payments increased from 20% to 23% while the share from indirect tax payments fell from
38% to 33%. The proportion from household direct payments remained unchanged, at 2728%. Direct tax was the most progressive funding source, where the rich paid
proportionally more than the poor, followed by indirect tax, and SHI contribution. Private-180-

insurance premiums and household OOP payment were both regressive. General tax finance(direct, indirect tax and other government revenues) was therefore progressive. As
indicated in Table 10, the dominant share of general tax as a source of total healthexpenditure in Thailand resulted in an overall progressive system. The overall CI remained
virtually unchanged over the three observations: 0.5719 in 2002, 0.5822 in 2004 and0.5593 in 2006.
The main reason why the SHI contribution was less progressive was the 15,000 Baht
(approximately US$428) per month ceiling placed for the assessed contribution. This ceilinghas never indexed or revised since the 1990 SHI inception, resulting in consistent
movements towards less progressivity as workers’ wages have increased.

5.7 MIS related policy within the National Development Plan: Indicate whether
MIS-related polity is included in your country’s National Development Policy,
and if it is, give an explanation of its contents.
It can be said that one of the main reasons, which Thailand can reach universal
coverage for health care, comes from continuous and strong commitment of public
policy. This public policy for population health care had history of evolution. From theideology of using health care to strengthen State power in 19 century toward
considering health care as an important part of long-term investment for economic
growth. Finally, health is considered as an entitlement of Thai citizens. Every steps
pushed the Thai health system forward to universal access to care and to protect therights of the people.
Table 7: Cause and effect of health policy in Thailand-181-

6. Please describe these points
6.1. Problems to be solved in your current MIS.
 Reduce inequities in benefits and level of expenditure, and address
inefficiencies across the schemes.
 Continue building institutional capacity for health technology assessment to
inform the purchase of cost-effective interventions and thereby improve value
for money.
6.2. Contents of the reform to solve the problems.
 Explore whether more local commissioning of health services would be more
efficient than provincial purchasing, especially for primary health care.
 Identify innovative ways to minimize the reliance on high-cost tertiary carethrough greater investments in disease prevention and health promotion and byaddressing the social determinants of health outside of clinical settings. In
addition, appropriate long-term care models need to be developed, which will
require adapting the character and range of health facilities and services.
 Improving care system or local activities on effective health promotion.
6.3. Problems for carrying out this reform.
 Generate evidence on the strengths and weaknesses of each scheme to informongoing and future scheme harmonization.
 Develop methods to use routinely collected data to monitor, assess and improve
quality of care, including clinical outcome assessment. At present this is an
unexploited opportunity in Thailand.

-182-

References
Limwattananon S., Tangcharoensathien V., and Prakongsai P. Catastrophic andpoverty impacts of health payments: results from national household surveys in
Thailand. Bulletin of the World Health Organization 85, 8(2007): 600–606.
National Health Security Act B.E. 2545 (A.D. 2002) National Health Security Office.
2002.
National Statistical Office of Thailand. The 2006 Health and Welfare Survey. Ministry ofInformation and Communication Technology. 2006.
National Health Security Office. (NHSO) Thailand, NHSO Annual Report, 2009. :http://www.nhso.go.th
NHA Working Group. Report of Thailand National Health Accounts 2006-2007.
International HealthPolicy Program, Nonthaburi. 2009.
O’Donnell, O., van Doorslaer, E., Rannan-Eliya, R.P., Somanathan, A., Adhikarim,
S.R., Harbianto, D.,Garg, C.C., Hanvoravongchai, P., Huq, M.N., Karan, A.,
Leungm G.M., Ng, C.W., Pande, B.R., Tin,K., Tisayaticom, K., Trisnantoro, L.,
Zhang, Y. & Zhao, Y. 2007. “The incidence of public spending on healthcare:
Comparative evidence from Asia”. The World Bank Economic Review.
Prakongsai P., Limwattananon S., and Tangcharoensathien V. The Equity impact of
the universal coverage policy : lessons from Thailand. In Dov Chernichovsky,
and Kara Hanson, eds.
Social Security Office of Thailand. The 2009 Annual Report. Ministry of Labour andSocial Welfare.: http://www.mol.go.th/
Tangcharoensathien V., Prakongsai P., Patcharanarumol W., Limwattananon S., andBuasai S. Innovative financing of health promotion. In Kris Heggenhougen, andStella Quah, eds.International encyclopedia public health, 624-638.
San Diego : Academic Press, 2008.
Tangcharoensathien, V. 2009. “The Current Capacity and Future Development of
Economic Evaluation for Policy Decision Making: A Survey Among Researchersand Decision Makers in Thailand”. Value in Health 12, Suppl. 3.
Tangcharoensathien, V. & Kamolratanakul, P. 2008. “Making sensible rationing:
the use of economic evidence and the need for methodological standards”.
Journal of the Medical Association of Thailand. 91, Suppl 2: S 4-7
Thai National Health Account 1994-2008 :http://www.ihppthaigov.net/nha/thai_nha_1994-2008.xls
Viroj Tangcharoensathien, Samrit, Srithamrongsawat, and Siriwan Pitayarangsarit,“Health Insurance Systemsin Thailand”, Chapter 2, German Foundation forInternational Development, Health Insurance Office, Thailand, and-183-

Health Systems Research Institute, Thailand. 2002.
Viroj Tangcharoensathien, Pongpisut Jongudomsuk;Samrit, Srithamrongsawat“Thailand’s Universal Coverage Scheme: Achievements and ChallengesAn
independent assessment of the first 10 years (2001-2010)” International Health Policy
Program, Thailand. 2010.
Viroj Tangcharoensathien, IHPP. Walaiporn Patcharanarumol, IHPP. (2010)
Chitpranee Vasavid, IHPP. “Thailand Health Financing Review 2010”
International Health Policy Program, Thailand
World Health Organization (2009). Health Financing Strategy for 2010 - 2015 in Asiaand the Pacific.Manila, WHO Western Pacific Region and South East Asia
Region.
Bureau of Policy and Strategy, Ministry of Public Health : http://bps.ops.moph.go.th/
National Economic Development Board (NEDB), Thailand : http://www.nesdb.go.th/
National Health Security Office (NHSO) Thailand : http://www.nhso.go.th
Office of Insurance Commission. :http://www.oic.or.th/upload/insurranceact/download/362-5141.pdf ,Social Security Office : http://www.sso.go.th
United Nations hailand : http://www.un.or.th/thailand/geography.html
World Health Organization, WHO Thailand : http://www.whothailand.org-184-

ANNEX1- Form 1
The State of the Nation : Thailand
Area size (Area size 510,890 K m2)
Population by aged group

Year

0–4

Male

Unit : thousands

1991

5,872

Female
5–9

Male

6,096

Female10 – 19

Male

12,420Female20 – 29Male

11,454

Female30 – 39

Male

8,415

Female40 -49

Male

5,316

Female50 -59

Male

3,775

Female60 – 64

Male

1,343

Female
65 -

Male

2,262

FemaleTotal

Male
Female56,923

1996

2001

2006

2011

2,726

2,585

2,052

2,027

2,674

2,540

1,930

1,905

2,740

2,660

2,307

2,091

2,687

2,632

2,177

1,972

5,811

5,515

4,934

4,934

5,639

5,416

4,685

4,672

5,663

5,711

5,289

4,967

5,465

5,544

5,184

4,846

4,806

5,050

5,505

5,412

4,777

5,028

5,644

5,479

3,492

4,065

4,749

5,064

3,583

4,186

5,024

5,384

2,311

2,595

3,047

3,563

2,479

2,776

3,338

3,934

867

952

952

1,105

963

1,079

1,067

1,262

1,406

1,685

1,768

2,208

1,697

2,072

2,643

2,875

29,82630,81930,91331,372

29,962

31,27531,71032,329Source: Bureau of Policy and Strategy, Ministry of Public Health ( http://bps.ops.moph.go.th/)-185-

ANNEX1- Form 2
Year

1991

1996

2001

2006

2011

Population growth rate(% per annum)

1.1

1.0

1.2

0.9

0.6 (2010)

Birth rate
(per 1,000 population)

17.0

15.8

12.7

12.7

12.0

Mortality rate
(per 1,000 population)

4.7

5.7

6.0

6.2

N/A

Infant mortality rate
(per 1,000 population)

8.3

5.5

6.5

7.4

7.0

4.6

5.2

6.1

7.0

7.9

M

65.85

67.35

68.51

70.59

71.93

F

70.55

71.80

75.82

77.54

78.82

60
65

N/A
N/A

N/A
N/A

N/A
N/A

N/A
N/A

2.1

1.5

3.3

1.5

Source: World Development Indicators (WDI) &Global Development Finance (GDF), April 2012

The rate of the population of 65
years and over to the total
population (%)
Life expectancy
at birth
Life expectancy at 60
and 65
Unemployment rate
(per 1,000 population*average rate
Source: World Economic Outlook, April 2012

-186-

M 19.4
M 16.1

F 21.9F 18.1
0.7

ANNEX1- Form 3
Year

1991

1996

2001

2006

2011

1,912,873 (Baht)

3,727,690 (Baht)

3,689,512 (Baht)

5,644,699 (Baht)

7,440 US

NA

NA

8,326

NA

NA

NA

7,554

NA

NA

NA

NA

7,978

NA

Total GNP (US$)

2,540,178 (Baht)

4,514,260 (Baht)

5,184,655 (Baht)

8,053,052 (Baht)

NA

GNP growth rate

1.0

1.6

0.8

1.3

1.1

56,574 (Baht)

60,000 (Baht)

62,836 (Baht)

65,574 (Baht)

NA

96.2

181.9

115.5

207.1

345.6

8.1

5.9

2.2

5.1

0.1

1688.73026.6

1854.33296.15394.4

National Income (US$)
Average Wage of Maleand Female (US$)

NA
NA

Average income (US$)

GNP per capita (US$)
Total GDP (US$) / (current
price billion (US$)
GDP growth rate
GDP per capita (US$)
The rate of social insurance ofcontribution as a percentage of
National Income
Premium
contributionof employee
Premium
contribution
employer
Premium
contribution ofself-employer etc.

-187-

ANNEX1- Form 4
Number and percentage of workers engaged in industrial classification
Year
1991
1996
2001
Primary industry
Secondary industry
Tertiary industry
Five leading causes of death (rate per 1,000 population)(Year)
1st
2nd
1991

Heart disease (54.7)

1996

Heart disease (77.4)

2001
2006
2011

Accidents andincidents(45.6)

Accidents andincidents(62.0)
Malignant neoplasm, Accidents andall forms(68.4) incidents(50.9)
Malignant neoplasm,
Accidents andall forms
incidents(83.1)(59.8)
Malignant neoplasm, Accidents andall forms(91.1) incidents(51.6)

3rd

2006

4th

2011

5th

Malignant neoplasm, Hypertension andall forms(41.2) Cerebrovascular
Suicide and murderdisease(15.9)(14.8)
Malignant neoplasm, Hypertension andall forms(50.0) Cerebrovasculardisease(15.6)
Hypertension andHeart disease (30.3)
Cerebrovasculardisease(24.5)
Hypertension andHeart disease (28.4)
Cerebrovasculardisease(24.4)
Hypertension andCerebrovascularHeart disease (28.9)
disease(31.4)-188-

Suicide and murder(13.8)
Pneumonia and otherdiseases of lung
(18.0)
Nephritis, nephritis
syndrome andnephrosis(20.6)
Pneumonia and otherdiseases of lung(25.7)

-189-

-190-

-191-

-192-

-193-

-194-

-195-

-196-

-197-

出典：平成 24 年度 JICA 集団研修カントリーレポート

平成 24 年度 JICA 集団研修「社会保険行政」

Japan International Corporation of Welfare Services (JICWELS) was established with the sanction of
the Minister for Health, Labour and Welfare in July 1983 and implements international technicalcooperation programmes with purpose of contributiing to the promotion of health and social welfare
activities in the friendly nations.
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Phone: +81-(0)3-6206-1137
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