Questions/Answers

National Beneficiary Registration Center or NBRC is a registration hub of health insurance schemes of all Thai citizens. The NBRC has been found by the cabinet resolutions in 2015 to acknowledge the health insurance schemes of all Thai citizens. In the past, the NHSO had aggregated almost of the existing public health insurances and provided the eligibility via the portal (URL: http:eservices.nhso.go.th/eServices/mobile/login.xhtml) to verify the health insurance status. However, there were 128 government agencies that had not updated their members to the NHSO beneficiary database. Nowadays, the NBRC is the only concreted beneficiary registration which gather all Thai citizens including the 128 government agencies. The NBRC has been using the Government Agency Personnel Registration program (URL: http://govreg.nhso.go.th/AllGRegister/pages/login.xhtml ). The NBRC is thriving to acknowledge and document the beneficiary registration of the whole population and solve the redundancies of the public health insurance problems. Objective: 1. To promote government policy, the NBRC will integrate the beneficiary data of the 128 government agencies and expect around 67% of the integration by 2020. The NBRC wish to decrease duplicated enrollments and identify uninsured in order to increase the percentage of UHC and decrease the health insurance complains and the redundant budgetary. 2. To promote the innovation, the NBRC wish to create a data integration ecosystem with the government agencies according to the Sustainable Development Goals 3: ensure healthy lives and promote well-being for all ; target 3.8 achieve universal health coverage. It is an online government agency integration program with the NHSO database to help ensure their medical reimbursement services achieving medical accesses and protect them from financial hardships. 3.To sustain the development through collaborative public service agencies and maintain the program to be updated, the members of the 128 government agencies will carry on the collaboration and data integration with the NHSO database.

NHSO promotes an integration for sustainable development by selecting the committees from the 128 government agencies to facilitate the collaboration. NHSO developes the Government Agency Personnel Registration program as a central platform. The program reduces the duplication of programs and technology investment. Occasionally, the NHSO organize meetings to practice the program and reduce administrative budgetary. The results minimize redundancy medical budgetary. The policy is relevant to the linkage SDGs 10:reduces inequities among civil servants and SDGs 17:partnership for the goal by participatory positive atmosphere meetings and respecting to learn and share together towards collaboration in accelerating NBRC implementation.

The initiative supports the Sustainable Development Goals 3: Ensure healthy lives and promote well-being for all at all age.Target 3.8: Achieve universal health coverage ,including financial risk protection, access to quality essential health care services and access to safe, effective ,quality and affordable essential medicines and vaccines for all by giving the access to essential health services without financial risk and being equal to the civil servant rights of the Comptroller General's Department. NBRC implementation has contributed to the online government agency personnel registration program to record the rights of personnel and link to the National Beneficiary Registration Center (NBRC) which shown the health insurance schemes on the system of NHSO authentication program ensures medical reimbursement services achieving medical access and protect them from financial hardships . NBRC increases access to health services when medical service sector known who pay for them for all government officials, especially the 128 government agencies those whom the central agency does not take care of unlike civil servants by the comptroller. The disadvantage of those agencies to access the direct disbursement system without having to make a backup payment. The initiative is to support the principles of “Leave No One Behind”.

The program is continuously maintained using the manual for government personnel program on the website (URL: https://www.nhso.go.th/FrontEnd/page-information_detail.aspx?ContentID=NTkwMDAwMTM4) to update their members. Building the medical sector confidence in the current authentication system, therefore, the direct payment to hospitals could be set up and the advanced payment is not required . The high level executives of the national administrators monitor the work and provide integrated budget to support the system maintenance. Amendment to the law according people selects the health insurance schemes they want without redundancy and suffering.

1. To minimize redundancy and budgetary: The government can reduce the redundant health expenses, increase the efficiency of the national budget management and have health expenses data to effectively estimate public health expenditures, that are 721 million baht from redundancies to 225,740 cases. 2. To minimize incorrect scheme complaints: People receive convenience health care services with confidence if the rights is correct. The number of incorrect scheme complaints has decreased from the number of complaints in 2016 (2,498 complaints). It was found decreasing by 73.78% in 2017 (655 complaints) and 84.20% in 2018( 394 complaints ). Moreover, the increasing of UHC: People is entitled to UC scheme immediately after the retirement from government agencies after the authorities release them from their rights and continuing when retirement from another scheme to UC scheme. This increases the percentage of universal health coverage. The result of the integration of the linking information on the medical welfare rights of the 128 government agencies with the NHSO databases makes it possible to know the medical rights, which have shown that the medical benefits scheme is comprehensive from 99.92% in 2016 and increased to 99.94% in 2018.

It is certain that the beneficiaries rights to be recorded and integrated with the 128 government agencies through the Government Agency Personnel Registration program integrating with the NHSO databases. The program shows the health scheme authentication of NHSO in order to identify the reimbursement prior health services and other health-related activities from the medical sector. The program does not give any special treatment regarding genders; therefore, the gender equality is applied.

The target groups were the 128 government agencies which have officer and their dependents up to issuing each welfare regulation and submitted their members rights to NBRC NBRC Improved outcomes : 1. To be more convenient and coverage increasing approximately 800,000 officers including their dependents of the 128 government agencies displaying the correct rights on the program encounter the convenience of receiving medical services when they are using medical services : before having NBRC, there are 33 agencies and 244,193 beneficiaries existing by chances of dynamic change scheme in NHSO database that have not updated their members. 2.To ensure hospital collecting medical fees directly from those agencies, such as the Provincial Waterworks Authority(PWA), one of the government enterprises desired to show the name PWA on the authentication screen resulting in the owner of the PWA employees do not have to pay the advance service fees in cash and to have a better quality of life with the confidence of health care services, and financial burdens 3. To increase coverage for access to health services for all ,without leaving government employees behind anymore.

The procedures after the training meeting are as follows: Coordinate the submission of data for the rights of each agency (Excel file) to check the rights before sending data into the system, Requesting the names of persons responsible for the data registration program (to create a Username / Password Before logging in) in order to send the agency welfare regulations and basic information of an organization, such as total number of personnel, address of the agencies , list of coordinators. There are 3 important steps of the operation, as follows: 1.) Prior sending the real data into the system, the government agency will send the information to the NHSO to check with the Bureau of Registration Administration to confirm the status of persons and check existing scheme, then return the information back to the government agency after inspections. 2.) Government agencies record and send real data into the system and have the registrar of government agencies approve; it can be sent to both groups and individuals. The channels of data transmission are as follows: 1) Send data in groups by sending ‘Batch’ in the format specified by the NHSO (Excel file) and then imported through the personnel registration program of the government agencies. This is suitable for agencies that have more than 100 employees' information. 2) Submit individual data by recording data through the personnel registration program of government agencies. This is suitable for agencies with less than 100 employees. 3.) The NHSO processed rights data and displays them in the authentication system. Government agencies began to record the actual data in November 2016, with the adjustment of the rights data on a daily basis. Data were processed twice a day at 14:01 PM and 01.45 AM.

1. Government agencies did not send information due to government employees concerns, Overcome by Building confidence and encourage partnership by participating problem solvings. 2. The unclear law issue, Overcome by Allowing government agencies to amend welfare regulations. Give the rights holders to be able to choose to receive / not receive the rights from government agencies . 3. Difficulty of coordination in technical program ,Overcome by Preparing the manual for the government agency personnel registration program, which can be downloaded from the NHSO website (URL: https://www.nhso.go.th/FrontEnd/page-information_detail.aspx?ContentID=NTkwMDAwMTM4) and create a group chat using Line application to communication.

There is no update beneficiary data system of the other 128 government agencies. The central agency has not taken care of. Therefore, they encounter the inconvenience of access to health services when they are using medical services. By the way, the 128 government agencies must reform the work integration together by participation on creating a transitional mechanism which is the program developed by the NHSO for recording and approval the rights of government officials and their dependents, and linked to the National Beneficiary Registration Center database for updating and learning how to use. These has never been implemented before.

The development for local government officers integrating with UC scheme databases increase the coverage from 101,351 persons in 2013 to 625,823 persons in 2018 and decrease duplicate enrollment with UC scheme in 350,000 persons. Therefore, the initiative decreases redundant budgetary in 1,000 million bath. Successfully displaying local government officers health insurance scheme in the authentic system and improving access to health care and quality of life. It’s the same problems as no update for their members with populations UC databases , might encounter serious financial risk, and having 7,850 local government organizations likes the 128 small groups of government agencies.

On the 35th ASSA (Asian Social Security Association ) board meeting 2018 at Vietnam.NHSO Obtains Health Insurance Recognition Award in the title “ National Beneficiary Registration centre(NBRC) : a Delivery System for Universal Health Coverage” On Annual International Training Course on Universal Health Coverage,2019 “Thai Universal Health Coverage in Action” On 19th-30th August 2919 managed by International Health Policy Program (IHPP) for 21 countries in the 5th session : Expanding population coverage (Beneficiary Enrollment) at 13:00-14:00 PM on 20 August 2019 at TK palace Hotel Thailand. Since 2002, the NHSO has aggregated all the existing public health insurance beneficiary registration data and provided the eligibility verification for all Thais implying act as NBRC .This operation not only decreases the duplicate enrollment and redundant reimbursement among health insurance schemes but also effectively identify the uninsured persons accurately. In fact, small groups of government agencies, local authorities and non-Thai residents still have redundant eligibilities with UC scheme, and no update their members to NHSO database. This brings to the duplicated enrollments and the redundant budgetary. Many universal health coverage policies cannot be implemented successfully as the lack of concrete and complete beneficiary registration of whole population.

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To implement the initiative the resources were used in 1.Budget about 7,819,650 bath ($260,655) categories in 1.1 administration meeting budget for 3 years about 379,650 bath(13,655$) 1.2. project manager salary about 480,000 bath per year for 3 years totaling 1,440,000 bath($48,000) 1.3.Information technology for developing government agency personnel registration program and maintain by outsourcing 2 programmer, 1 System analyst, totaling 6 millions bath ($200,000) 2.Human resources in collaboration and coordination with the other 128 government agencies officers for knowledge management (can’t be estimate).

Embedding program as a tool continuously maintained by having the manual on the NHSO website. Build hospitals confidence in the update authentication system and wildly charge directly to the agencies. Amend the law in order to meet the needs with rights without personnel redundancy bring. People get benefit without financial suffering. In term of institutional, acceleration to show the rights update real-time everyday, not 15days around, specify agencies and strengthen the policy to be implemented all 128 agencies and all schemes increasing coverage for access to health services for all citizens sustainable and consistent with the “Leave No One Behind”.

Yes

1. Internal assessment by the Bureau of Information and Health Outcomes Assessment and the Bureau of the Budget affiliate with the Prime Minister issued by performance indicators based on the success level of the implementation and number of the submission agencies. The success level of setting the personal government agencies program. 2. External assessment by 2.1 The committee consider budgeting through strategic integration, the first on 10 January 2018 with document report. 2.2 The office of the Auditor General of Thailand found redundancies of state enterprises and NHSO. Order NHSO to make measures for the government agencies follow the cabinet’s resolution.

1.The first indicator is the success level of implementation as: 1) Appoint a working group. 2) Design database and implementation. 3) Set a program. 4) Set the program training 5) record and send the data that not less than 67 percent in the fiscal year 2020. 2.The second indicator is The success level of setting the program as 1) Set the scopes. 2) Get IT requirement from relevant parties. 3) Design system. 4) Conduct system and testing. 5) Able to use the system.

1. At the end of November 2016, there were 64 agencies that have started to send information (50%), with 490,748 eligible persons registered. Due to technical IT problems in using the program, organizing the meetings were divided into several subgroups, meeting to create a database of government agencies that have not yet submitted data , meeting to discuss the ranking of medical welfare benefits government agencies. As a result , there was progress in data transfer. At the end of December 2017, there were 86 agencies that submitted information (67.1%) from 128 government agencies, be totaling 730,058 people, and issued a letter to track and accelerate to the submission of eligible information for the agencies, continuing in currently 50 agencies using the program actively every month, 3 in every 3 month, 21 more than 3month and 17 more than 6 month depending on entry or resign. 2. The rest of the government agencies decided to amend welfare regulation due to their members concerns in rights selection receiving and not to send the data government officers and their dependents through the program waiting for the solution in reforming the regulation guidelines from the Royal Decree. 3. These are used to inform the committee for recommendations.

From the collaboration among the Bureau of Registration Administration(BORA), 3 main schemes of Thailand as CSMBS by the comptroller , SSS by social security office and UCS by the NHSO through memorandum of understanding (MOU), refarding the cabinet resolution on 3 November 2016 granted the NHSO to be the National Beneficiary Registration Center(NBRC). Therefore, there is a linked data of the medical welfare benefits as follows: 1. BORA is responsible for Birth data, Death data, Letter of Birth Certification data, Medical rights data, Disabled data, and Smart Card Authentication system users. 2. The Comptroller General's Department and NHSO has developed the data connection of civil servant rights by File Transfer Protocol (FTP). 3. Social Security Office and NHSO has developed the data linkage of worker for Social Security right by FTP. 4. Government agencies have record and transmitted data through online government agency personnel registration program developed by NHSO since November 2016. Data will be processed daily and show the rights of new registered cases in 2 times daily. 5. NHSO will process the data for universal health insurance coverage (UC) after receiving another scheme data on a per-round basis every 15 days and show the rights of new registered UCS cases.

1. organizing for communication meetings, the benefits of integrating medical rights of all schemes and NBRC institutions resolution. 2. organizing for seminar meetings for participating respecting, trusting atmosphere and selecting representatives to working groups and committee settlement. 3. developing the program by central platform formation and training the program and capable skills to save and send information to the system when there are changes in rights, such as re-entry, resign or die. 4. setting Line application chat group of 88 members to involve and collaborate in technical programs sharing and other problems. 5. organizing knowledge management meeting for participating respecting and trusting atmosphere by empowering the state enterprises: the Provincial Waterworks Authority (PWA) be advocacy speaker in the topic of how to work successfully objectives for modeling apply for the other government organizations. 6. organizing problem solving meeting by empowering the public organization: Thailand Greenhouse Gas Management Organization (TGO ) be advocacy speaker in the tropic of effects of sending or not sending data and what’s next . 7. organizing problem solving meeting between NHSO board and executive committee of states enterprises: the government savings bank in the tropic of how to amend medical registrations relevant with the Royal Decree.

The key lessons learned are trust and participatory problem solving 1.Trust in the authentication system that comes from having a single central database as NBRC through embedding the government agency personnel registration program. Adjusting mindset with commitment of people centric to see big convenient benefit by promoting health care sector confidence through credible real-time right scheme following collecting disbursements direct to their affiliate agencies. Reduce the redundancy of the scheme is another critical factor that promote progressive accountability and willingness to send data. 2. Participatory problem solving, their expressed problems should be proposed to relevant organizations such as the amendment regulation. This strengthens the empathy and eases following activities and collaboration. Plan to improve the initiative : 1.Displaying the 128 other government agencies on screen of authentication system purposes for e-claim reimbursement to their agencies. 2.collaborating all agencies through linkage centers for dynamic change from scheme to another scheme by web services eg.resign, dead, and disability 3.Further integrating of all databases such as Stateless people fund for whom in waiting cabinet’s list and non-Thai residents that administered by MoPH. 4.accelerating collaborate integrating real-time with 2 main schemes (CSMBS/SSS) for dynamic change of schemes shown every day automatically.