Abstract
Consumer protection in health insurance system intends not only to facilitate the benefiaciries to efficiently utilize their health benefits but also to indirectly expedite the quality of care. The study aimed to summarize the existing situations and make the policy recommendation to improve the consumer protection system in health insurance system in Thailand that comprises three main health insurance schemes including National Health Security, Social Security and Civil Servant Medical Benefit Scheme. The scope of consumer protection system in the study has covered on five issues of people’s rights as follows: the right to access to needed care through health insurance, the right to access to quality care, the right to access to complete benefit package, the right to participate in health insurance management and the right to access to necessary information. Focus group discussion, questionnaire survey and documental review were used for data collections. Focus group discussions were employed to collect the current situation of consumer protection in target groups as wll as to suggest policy recommendation. The people’s opinions toward health services quality under the National Health Security were collected by using questionnaire survey. The documental review was performed to gather the information needed for people to efficiently utilize health services in their health insurance schemes. Preliminary data was also sent to community representatives in Provincial Health Security Sub-committee to make comments before finalizing the report. The results show that there still have been several problems regarding the people’s rights such as the problems of uninsured groups due to no ID Card, low people’s confidence in quality of care and medications especially for high cost care and medications, the problems of specific groups of people who could not access to health benefit package such as the disability, patients living with HIV and AIDS and the informal sector workers, lack of or inadequate information database for general people, and low level of people participation in health insurance system. The crucial policy recommendations to strengthen the consumer protection system covered in the report are: 1) actively searching for uninsured groups by cooperating with civil groups or not for profit non-governmental organizations, and financial supporting to hospitals that are responsible for these uninsured; 2) accelerate the process of external accreditation in all levels of, and both public and private health facilities, 3) people have to participate in all levels including policy formulation, health insurance management by acting as local purchasers and hospital committee, service providers especially health promotion, monitoring service quality and the completeness of benefit package provided, managing complaint, and disseminating the essential information to people especially in the remote areas by getting financial support from the government to help people in communities to set up “Community Health Insurance Center”; 4) the essential information that needs to be widely distributed are composed of the information for selecting the hospital, the information for deciding whether or not to receive some controversial health services or second opinion and the information to increase basic knowledge about health insurance and health service utilization.
