Expanding population coverage (Beneficiary Enrollment) - Bureau of registration @ 20th August,2019
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Expanding population coverage
(Beneficiary Enrollment)
Bureau of registration @ 20th August,2019
Col .Panomwan Bunyamanop:Deputy Chairman of fund Management
cluster and director bureau of registration
1
Outline
• Overview and Right of people to access to
health services
• Beneficiary enrollment using national citizen
individuals identification system
• Data sharing on beneficiary across scheme
2
Core Business of UCS
CUSTOMER
Bureau of registration “Coverage “ 3
“Sustainable finance”
“CSG” 3 Goals “Good governance “
UHC coverage since FY2002-2018
Thai UHC, all Thai citizens covered
All Thais 66.25 millions, All Thai citizens target 99.95% in 2019
2018
100 99.94
99.90
98.75
Percent coverage
5.05 (7.6%) 95
47.8 (72.2%) 12.24 (18.5%)
UCS SHI CSMBS
92.47
90
2002 2007 2012 2018
1.15 (1.7%) FY 2002 - 2018
Others Source: Registration database, as 30 September 2018 ,
by Bureau of Health Information and Outcome Evaluation, NHSO
Eligibility: Right of people to access to health services
• According to the National Health Security Act, B.E. 2545 (A.D. 2002), all
Thai citizens are insured under government health insurance
schemes. (By section 5th)(by section 26(3)create record s of beneficiary
• There are currently three main government health insurance
schemes,and other states agencies,i.e,
• Civil Servant Medical Benefit Scheme (CSMBS) for government officers and
their dependents (including other small state enterprises schemes with the
same benefit package such as local government officers ),
• Social Security Scheme (SSS) for formal private employees, and
• Universal Coverage Scheme (UCS) for the rest of Thai citizens who do not
covered under other government schemes.
• Other states agencies,i.e., state enterprises employees,government
employees that not the same benefit packages as CSMBS
• Stateless People scheme under MOPH administration
5
Requirement
• Population database and health/medical benefit status of all
Thai citizens have been required to identify qualified people for the
UCS/NHS.
• Collaboration with other related government agencies who
manage these information is important.
• These government agencies include:
• The Bureau of Registration Administration (BORA), MOI Population
• Department of Provincial Administration (DOPA),MOI database
• Department of Consular Affairs, MOFA Thai citizens living aboard
• The Comptroller General’s Department (CGD), MOF
• The Social Security Office (SSO), MOL
• Department of Local Administration (DLA),MOI Health
• benefit
Others small group of states agencies e.g., Bangkok Metropolitan Administration
(BMA),NHSO,private teacher,government bank,...ect status
http://www.bora.dopa.go.th/callcenter1548 6
The transition of the Thai Civil Registration
System :Strength of UHC
• In 1909,Civil Registration began in Thailand, when the
first Royal Act proclaimed Thai citizens to register
households,births and deaths in their family.
• The civil registration system is managed and administered
by BORA(Bureau of registration administration)
• During 1984-1994,all Thais have 13digits by BORA.
• BORA serve as citizen data bank by providing a link to
other government agencies for other purposes such as
passport issuances,healthcare and social security system
as well as election voting system
• In 1995,The first national Thai smart card was introduced
toThai Society.
7
The transition of the Thai Civil Registration
System :Strength of UHC in expanding coverage
• In 2012,Beginning providing ID card services for Thai citizen
living abroad.
• Nowadays every Thai citizen in Thailand and Abroad carries
this smart card and it becomes the necessary official document
for Thai people in everyday’s business and social life.
• The use of civil information inside the smart card in business is
for person verifications,data security and data accuracy
• Using Thai national ID card in business private sector as
financial institute telephone service,automobile dealer,and
hospital namely a few take a great benefit of civil data stored
in the smart card
• To provide services rapidly and data accuracy as well as
• To protect the right of card’s holder information accessibility
and privacy for all Thai citizen in today business world.
8
The transition of the Thai Civil Registration
System :Strength of UHC in expanding coverage
Thailand experience
Government Data Sharing
District Civil Registration Local Civil Registration Oversea Civil Registration
Office Office Office
878 1,555 95
National health care
CP• BORA CP
Passport O
O
Taxation Main Site Second Site
Central Registration
Database
Social
Driver license Election voting list welfare
The transition of the Thai Civil Registration
System :Strength of UHC
▪ Since 2002, NHSO has collaborated with Bureau of Registration
Administration (BORA), Ministry of Interior (MOI) to use a truncated version
of civil registration to serve as the baseline of eligible beneficiaries. BORA
and the managers of other insurance schemes exchange the data of vital
status and eligible members on a daily basis as the following;
▪ (a) insert the births data into national beneficiary database: every newborn
(approx. 800,000 per year) will be mandatory enrolled by one of health
insurance schemes providing the benefit for their dependents;
▪ (b) update deaths status (approx. 400,000 per year) in the national
beneficiary database;
▪ (c) update current membership across the insurance schemes. For example,
when social security scheme (SSS) members become unemployed and
beyond 180 days of grace period, CSMBS members with age beyond 60
years, CSMBS members’ dependents with age beyond 20 years. Their
entitlements from previous insurance scheme will expire and systematically
update in the national beneficiary database waiting for Enrollment into UC
members later.
▪ This facilitates a seamless transition from one to another national health
insurance schemes and decreases the redundant registration to UC schemes 10
which represents as a safety net for all Thais.The transition of the Thai Civil Registration
System :Strength of UHC
▪ In 2008, the government has initiated the policy of using smart
national identification card for any service with the government
officers. Hence, all the paper health insurance cards have been
terminated since then as the eligibility data have been updated
and embedded in the cards’ memory chip already.
▪ When accessing health services, the beneficiaries will show
their ID card for schemes verification. For children under 7 years
with no ID card, can apply their unique ID number given since
birth registration in the respective household registration
booklet. The service providers even the sub-district level can
validate and verify the eligibilities via smart card reader or
verify via NHSO website by using 13 digits.
▪ This can protect not only the health insurance right for all Thais,
but also strengthen the establishment of electronic medical
records in hospital information system effectively
11Dynamic of health insurance status
Dead in Thailand
Dead
Private formal sector Civil Servants and dependents
Social security Civil Servant Medical
Scheme Benefits Scheme
(SSS) (CSMBS)
New Depart/ Quit or Fired New
employment lay out / before employment
retired retired
Universal coverage
Scheme
(UCS) Dead
12Dynamics of health insurance status and
budgeting flow in Thailand
Thai citizens Budgeting Budget
Civil Service Medical
Benefits Scheme Tax
(CSMBS): gov. officers
and dependents
Social security scheme Tripartite
(SSS): contribution
private formal employees
Tax
Safety Net
Universal Coverage
Scheme(UCS):
the rest of Thai citizens
Beneficiary Population Financing 13 25Start Health Insurance
status confirmation
Provide “Personal ID, at service point
Service Date,
Hospital ID” UCS card
Retry
Invalid Valid
Search
“Health Insurance
Err message
done status”
End
Return result
1 2 3 4
CSMBS SSS UC Unregistered
Gov. employees, Formal Private The rest qualified citizens
14
dependents employeesReason why provider want to checking health
insurance rights.(health insurance status)
• 1.who is health insurance scheme that pay for the
beneficiary by NHSO checking insurance right
program.
• 2.what e-claim program that they choose to key in
for claim reimbursement, if non conformity that
record be denied to pay.
Before effective coverage to access to health services ,people must
access health insurance scheme Rights.
The first in real practice, by using the data from NBRC for eligibility
verification and submit the medical services for later reimbursement.
So that National Beneficiary Registration
centre(NBRC) is a Delivery System for
Universal Health Coverage 153 Chanels for checking what
right scheme for people.
other state
agencies
L L
o o
g g
i i
n n
By Provider
By other states agencies
http://ucsearch.go.th
By people By people through
By people
1330
http://eservices.nhso.go.th UCME in 2019
Press2 and press
National ID13
digitOutline
• Overview
• Right of people to access to health services
• Beneficiary enrollment using national citizen
individuals identification system
• Data sharing on beneficiary across scheme.
17In the past,at the UCS Enrollment
general process
beginning in 2002
UCS card
Sub-district
Health Centers
UCS card
Hospitals
WEB WEB
Provincial
Health Offices
File transfer File transfer
protocol(FTP) protocol(FTP)
Cardholder’s
database NHSO Online registrationBeneficiary Key Information
Primary Key : Personal ID Number
Personal Data : Name, date of birth, address
Scheme : Eligibility, subclass,
provider,
Provincial fund,
Card Number, date issued,
date of expiry
History & Reference Data
Transaction
…..
…Concurrent retrieved data from 2 remote database sites:
BORA of the MOI and NHSO
(สปส
ช.)Concurrent retrieved data from 2 remote database sites:
BORA of the MOI and NHSO
Information from Ministry of Interior : first name, last name,
birth date, home address
(สปส
ช.)
Information of UCS Scheme
from NHSO head office :
eligibility data ,providerfrom UCS card to National ID card in
2010:response to one smart card policy.
since Oct. 1, 2010
❑ Thais above15 years old
were required to carry
national ID cards.
❑ Since Jul.10, 2011,
children above 7 years old
can issue the national ID
card.Unique ID card:13 digits represents
And content of Smart Card
smart card
Explicit Data
IC Chip
Card ID , Purchase province Name
Main_inscl, Sub_inscl ID number
Hmain_op, Hsub_op Date of birth
Hmain_ip Hometown address
Start_date, Expired_date Photograph
transdate
Health insurance status 23What’s 13digits represents ? 1st digit:types code 1-8 Thai or alien or immmigrant 2nd-3digit: province 4th-5th digit: amphor 6th-10th digit:number of certificate booklets 11st-12nd digit:number of certificate 13rd digit:check 12digit correct 24
History of Registration System
Referenced Data NHSO Provincial office Hospital
Health office
2001 - 2002
Web search for eligibility
SSS Population
DB DB
UCS Offline Offline
Hospital DB
DB
▪ Since2002,The National Health Security Office (NHSO)
has successfully harmonized the 3 main public health
insurance schemes in Thailand by using unique
national identification and automatically linking
eligibility data to the civil registration .
Since 2003 CSMBS DBImproving in quality of registration data, FY2002-
FY2005
Offline Provincial registration office
14 Duplicated
12.360 Develop Online Registration
11.920
11.710
MIS for Registration Data: 11.9 %
11 9.730
8.740 Revocation( offline ) system
7 registration error
Hospital Registration
4 Duplicated data:
1.420
1.340 0.003 %
0.520 0.820
0.490
0.340 0.180 0.180 0.450 0.290
0.130 0.100 0.060
0.060 0.130
0.080 0.100
0.098
0.070
0.047
0.043
0.030
0
Feb_02 Jun_02 oct-02 Feb_03 Aug_03 Feb_04 Feb_05
Decrease in errors of registration data
Source: , Bureau of Registration NHSOHistory of Registration system.
▪ Since 2002,NHSO has aggregated all the existing public
health insurance beneficiary registration data and provided
the eligibility verification for all Thais . This operation not
only decreases the duplicate enrollment and redundant
reimbursement among schemes but also effectively
identify the uninsured persons accurately
▪ .Moreover, the NHSO also facilitates a seamless
transition from one to another national health
insurance schemes automatically. As a result,
improved access and experiences on Health
Insurance and Benefits Programs.
•
27How to expand coverage :
1.Attention to target groups
• 1.Enrollment in Retire group from two main scheme (CSMBS,SSO) and other states
agencies and Local governments organizations (LGO) using electronic Program
• 2.Vulnerable group:Homeless people ,prisoner,Monks
• 3.Thais who have no document.
• 4.Stateless people Enrollment (Thais who’s in waiting list of cabinet )
• 5.Foreigner labor group in MOU with MOL,and SSS.
• 6.Neonatal Enrollment in Birth registrations program.
▪
▪ Seamless transition of the eligibility status in UHC:
The policy of automatically and seamlessly
enrollment for any Thai with uninsured and left
out from the previous schemes according to the
law and regulation has become the right protection
for all. 28Flow chart for Birth certificates
Birth
Document
Civil hospital BORA.
database
Birth document
program
BORA databa
Birth Birth certificates se
certificates program
Oracle
Golden Gate
private NHSO
Birth
hospital
certificates Birth Data
document Databas base
program e
Birth
DocumentBirth registration program for birth document
Birth registration program links to birth
certificate program
30Birth certificates registration
▪ In 2011, with the collaboration of the Ministry of Interior (MOI), Ministry of
Public Health (MOPH), UNICEF and NHSO was initiated in developing an online
birth registration program by linking the information on each child born from
the delivery room to BORA’s birth registration system. Hence, the birth
certification are prefilled and parents therefore spend minimal time at the
district office to complete the legal process. In case that parents do not
inform the district within 15 days after birth, the officials will follow up and
alert the family with unregistered newborn by watching through MOI’s report.
▪ In order to make birth registration accessible to the families of migrant
workers typically from neighboring Myanmar, Cambodia, or Lao PDR. BORA
with non-governmental organizations (NGOs) has provided a legal advice and
translation in hospitals where the births of their children most often take
place. This initiative allowed BORA to issue the national identification for all
newborns in Thailand even with non-Thai nationality in order to comply with
the Universal Declaration of Human Rights.
▪ The linkage between the health sectors and BORA combined with the fact that
99 percent of births in Thailand occur in hospitals have contributed to high
birth registration rates for children under five (99 percent) and high birth
registration rates (approximately 95 percent) (NSO & UNICEF 2016).
31Non Birth certificates rate
3.30
3.11 3.13 3.15 3.11 3.13 3.07
3.13
2.95 2.86 2.86 2.84
2.8 2.8 2.81
2.78
2.60Jun-2017 Aug-2017 Oct-2017. Dec-17. Feb-17. Apr-2018
Jun-64 Aug-64 Oct-64 Dec-64 Feb-65 Apr-65
Source: , Bureau of Registration NHSOHow to expand coverage :
2.Empowerment to another state agencies i.e KTC bank ,local
government and people
▪ Encourage self-access services: The policy of facilitating every people and
services providers and local government and people themselves to access the
eligibility data from NBRC with the privacy security concern has brought a big
conveniences to the patients and health workers. This policy can assure the
correct right verification with little time consuming for the health workers
and also facilitate the patients not to carry more cards whenever visit the
health care providers,just only one SMC using in e-form enrollment.
▪ As a result, the achievement of NBRC has successfully
facilitated the seamless transition of health insurance eligibility
for all Thais which brought the coverage to 99.9% and
strengthened the right protection and also reduced the
redundant budgetary among health insurances schemes and
prevent the financial hardship for the households.
Furthermore, the extended coverage to non-Thai residents has
been considered and finally subsidized by the government in
order to achieve the ultimate goal of universal health care
coverage in the long run 33Enrollment process for changing primary care unit by
using Smart Card and e-form system in 2019
Beneficiary have chance to change 4 times Beneficiary
per year regarding to the new address.
Attached file : in case primary care
unit where people want non conformity
with SMC/address in BORA database
Eg. receipt of electric or water
using ,certified documents of community
leaders
printing garuntee
document
Fingerprints
reading
Digital
signature
database
Enrollment system by using SMC
Printing request
form
signature
Scan
requested
SMC reader formIn 2020:Develop UCME mobile phones for
Focus 4 : REGISTRATION – DIGITAL ENROLLMENT
Consent Form 2. Authentication
People 1. UCMe Mobile
& Register User 1.ID card 3. Login 3.1
2.Name - Family name
(Consent Form 3.Date of Birth
4.Laser No. On ID Card Mobile PIN
&
Register User ) 5.Telephone number
6.OTP : One time password
7.E-mail
ONLINE
ENROLLMENT 5. 4. 4.1
E-mail/App Notify/
sms Select / Change CUP Searching Hospital
request API for
Contracting
11. 8. Provider Profile
Inform : Showing address
Start date Inform : for NHSO 6.
Result of receiving Database
the request MASTERCUP
Confor Non- DATABASE
Comparing address
m Conform
with 7.
DOPA Database CPP For
People
Insert petition Attach file (daily) AMI
NHSO region
10. Update
sent data to
auditing
NCH (National DOPA
Approve/ ONLINE ENROLLMENT address with 9. clearing house)
DATABASE
submit data DOPA CARDBASEOutline
• Over view
• Right of people to access to health services
• Beneficiary enrollment using national citizen individuals
identification system
• Data sharing on beneficiary across scheme
by NBRC policy
▪ Not only expanding coverage but also Another
aim :To serve the policy of Universal coverage for
critical health services in case of serious accident or
emergency illness, any schemes’ beneficiaries will
be protected from financial hardship and receive the
necessary health services within first 72 hours from
any nearest hospital.
36National Beneficiary Registration Center(NBRC)
. Government policy at 3rd November, 2015
▪To make every life count and ensure that no
one is left behind , according government policy
▪The NHSO has been nominated and
appointed by the cabinet to take
responsibility as National Beneficiary
Registration centre (NBRC) for whole
population in Thailand since 3 November
2015.
▪ Nevertheless, groups of state agencies, local authorities and non-Thai
residents still have redundant eligibilities with UC scheme as there is
no system for update their members with NHSO beneficiary database.
37National Beneficiary Registration
Center(NBRC)
. Government policy at 3rd November, 2015
Smart Card reader for authentication
other state Program for checking Provider
agency fund what right scheme
NHSO
Beneficia
ry data
base
program for Central All
other state Beneficiary
agency Database
Processing
▪ groups of state agenciesData sharing beneficiary across scheme by NBRC.
Government policy at 3rd November,2005
shown daily
shown at Shown at(1st,16th)) (STP)
(4th,19th)
Social Security 2019
Civil MOPH
Servant
Daily sending Sending weekly
sending
(every Tuesday )
at(1st,16th)
shown daily in
shown daily personal
status:dead/birth
LGO
BORA:MOI
Daily sending
NHSO Centralized
database
shown daily shown at(5th,28th) UC
JMS/web services/
Other
web application
states NHSO
agencies
Daily sending ) Daily sending ) 39
HospitalData Integration
Year Organization Methods at present
2002 BORA (ministry of Intreior) AMI (application message
Interchange)
Oracle golden gate
2003 Civil Servant Medical FTP (File Transfer Protocol)
Services Scheme (CSMBS)
2003 Social Security Office FTP (File Transfer Protocol)
2009 Hospital Web services
2012 Hospitals :NHSO data integrator
program
2014 Other states agencies /Local key in LGO program
Governments organizations
(LGO)
2016 Other state agencies key in other state agencies
program
2019 Division of health economics Access Authorize Data From
and health security (MoPH) Table
FStateless People Fund
2019 Department of Corrections Web services /GIN
40
2019 National Office of Buddism Transfer by diskettes in exelNBRC save government budget from redundancy :721million bath
Dynamic of health insurance status @July 2018
Number
UCS change to other state agencies 225,740
SSS change to other states agencies 40,580
No health insurance change to other state agencies 4,132
LGO change to other states agencies 3,614
CSMBS change to other states agencies 48,488
Other states agencies ( private teachers)change to other states agencies -
Other states agencies ( BKK LGO)change to other states agencies 1,311
Other states agencies ()change to other states agencies 416
From BORA change to other states agencies (That NHSO have no) 1,243
From BORA change to other states agencies (Central house 44,79) 7
Total 325,531
Source: , Bureau of Registration NHSO
Year July 2018 Capitation (UC) Budget (bath)
2018 225,740 3,197.32 721,000,000 41Summary
• 1. Right of people to access to health services by Law NHS Act.A.D 2002
(session 5).Many universal health coverage policies can’t be implemented
successfully as the lack of concrete and complete beneficiary registration of
whole population.So National Beneficiary Registration centre(NBRC) is a
Delivery System for Universal Health Coverage.
• 2.Beneficiary enrollment using national citizen individuals identification system
by BORA in MOI,in the first step and the next step processing declaration
health insurance status by NHSO to UCS Enrollment , as a safety net for all
Thais.
• 3.Data sharing on beneficiary across scheme by government policy in National
Beneficiary Registration Center(NBRC ) in 2015, and participating strategy,and
seamless national health insurance scheme automatically integration make
progressive population coverage and decreases duplication .
• 4. More Expanding population coverage by attention to vulnerable groups ,Thais
who have no document and empowerment to other states agencies and to
people Enrollment by themselves using mobile phones or websites for people.
42Challenges ahead
• 1.Daily shown in UC beneficiaries and every scheme as
single national beneficiary registration center actually
checking at only one place.
• 2.Expanding Enrollment stations to Local government
and government banks for counter services in record
request form and e-form registration through SMC.
• 3.Encourage People Enrollment by Themselves through
mobile phones ,website.
• 4.Some problems in develop national digital ID by
Ministry of Digital Economy and Society(MDES),for
identify and higher authentication assurance level by
biometric and personal data protection legislative law.
43Example: website for people : for right scheme checking Thank you for your attention
Example: website for people : checking what right scheme program
By national ID 13 digits and date/
month/year of birth
And alphabetical 5 digits then click ok
Shown 1st right:other state
agency
2nd right: dependence
Thank you for your attentionExample: website for hospital for checking what
right scheme program
Authentication by SMC
Shown 1st right: UCS
Shown the name of primarily care unit
Thank you for your attention 46History of Registration System
2001 - 2002
Beneficiary Enrollment linkages
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