Project News

In July 2022, the Project organized a study visit to Japan on claim review and audit system for 12 officials; 9 from National Health Security Office (NHSO) who manages Universal Coverage Scheme and 3 from responsible agencies of the other 2 public insurance schemes and the Bureau of the Budget.

Especially since NHSO expanded the fee schedule items in recent years, the claim review and audit has got to play more crucial role to secure and sustain effective payment mechanism. However, in 2020, a number of incorrect or suspicious claims by private health facilities were revealed. As a response, NHSO address the urgent task of strengthening claim review and audit system.

On the other hand, the Project has been supporting other countries to achieve UHC, some of which ask for technical cooperation on claim review and audit.

To further improve claim review and audit system in Thailand as well as to promote collaborative activities with the third countries, the course aims to learn how Japan strengthens the claim review and audit system to detect inappropriate and fraudulent cases.

Thanks to the experience sharing by various actors under the Japanese health insurance system including a supervising agency, a claim review agency, an insurer, and medical institutions, through comprehensive presentations, active Q&A and furthermore, demonstrations of billing practice at- and guidance and audit to a medical institution, Thai participants gained a lot of practical lessons about medical billing, claim review, guidance and audit, and optimization of medical expenses.

Thai participants had a heated discussion every night on how to adopt the Japanese system for improvement of the Thai system in light of the difference between the two, and reported on it on the last day of the program. NHSO and each agency will consider improvement of the system based on their reports. The GLO+UHC Project will continue to support their efforts.

Last but not least, we would like to express our deep gratitude to Kanto-Shinetsu Regional Bureau of Health and Welfare (Medical Economics Division), Health Insurance Claim Review and Reimbursement Service, Medical Insurance and Pension Division, Health Department, Shinjuku-city, National Center for Global Health and Medicine, Medical Innovation, Health -MIH Clinic, and Hoppe Pharmacy for their kind cooperation despite the COVID-19 pandemics.

An example of active Q&A sessions

With lecturers from Health Insurance Claim Review and Reimbursement Service

Group discussion at a daily meeting among the Thai participants

Lecture by Medical Insurance and Pension Division, Shinjuku-city

Demonstrations of guidance and audit to a medical institution by Kanto-Shinetsu Regional Bureau of Health and Welfare @ NCGM

Visit to a dispensing pharmacy

Demonstration of preparing medical fee statements (receipts) @ MIH clinic

Wrap-up session: Presentation by Thai participants