Case Studies

Chula Unisearch and its Collaboration with the Social Security Office

In its effort to support the Universal Health Coverage goal, Chula Unisearch, a research arm of Chulalongkorn University, collaborated with the Thai Social Security Office to identify health financing and health service management models and potential areas of actions to improve the delivery of health care to the Social Security Fund’s beneficiaries and the overall health and social protection in the country.

The Social Security Office aims to improve the system management, benefit package, and payment mechanisms of the medical care system under the Social Security Scheme (SSS) to bring about the greatest benefits to the scheme and its beneficiaries. One of the models for health financing system management that has been proposed as a potential solution for the SSS is the “Health Maintenance Organization (HMO)” model. It was questioned whether HMO can be a useful model to develop SSS medical care system.

The project with Chula Uniseach aims to explore and analyze the HMO model and its potential application to improve the social security system in Thailand. It employs qualitative methods including literature review and in-depth interview, and focus group discussion to support this policy research.

The study shows that the HMO model has many similarities to the current policy and practice used in the SSS e.g. prospective payments, benefit package set-up, low cost sharing, and network service system. The main difference is that HMO emphasizes managed care with primary care focus while the current SSS model still does not emphasize those approaches.

Four potential models were identified where the findings from HMO model analysis can help contribute to the improvement of the current SSS system. Three main strategic approaches were proposed to benefit the existing SSS system through the knowledge from the HMO model.

View the full report here.