Contracting the Private Health Sector in Thailand’s Universal Health Coverage

Background Private sector plays an import role in health service provision, therefore the engagement of private health facilities is important for ensuring access to health services. In Thailand, two of the three public health insurance schemes, Universal Coverage Scheme and Social Health Insurance, contract with private health facilities to fill gaps of public providers for the provision of health services under Universal Health Coverage. The National Health Security Office (NHSO) and Social Security Office (SSO), which manage the schemes respectively, have designed their own contractual agreements for private facilities. Methods This qualitative descriptive case study was conducted through document review and in-depth interviews with key informants to better understand the current situation of contracting private health facilities within UHC by comparing the two purchasing agencies on how they contract private primary care facilities, service types, duration of contract, standard and quality requirement and renewal and termination of contracts. Results Social Security Office (SSO) have adopted capitation-based contract model since 1991. The National Health Security Office (NHSO) applies capitation payments for outpatient services and Diagnostic Related Group systems payment for inpatient services. NHSO classified contractor providers in 3 categories for seamless referral services: main contracting units, primary care units, and referral units. External evaluations and certifications from the Healthcare Accreditation Institute are required for standardization of care. Both purchasing agencies conduct auditing to monitor quality of care while NHSO additionally provides incentives to private facilities for continuous quality improvement. Conclusion Contracting of private healthcare facilities is needed to fill the gap of public healthcare facilities, especially in urban settings. To ensure access to quality of care, in contracting with private-for-profit providers strong regulatory enforcement and auditing measures with financial incentives in necessary.