Abstract
The characteristics of problems on health service utilization under different health insurance schemesThis research aims at analyzing conditions and problems of health service consumers under current five insurance programs and of a group of consumers who are not covered by the systemproblems of health service delivery affecting the consumermode of health service utilization of the consumers who are not insured problems caused by weaknesses of the five schemes and the quality of service andproposing guidelines and machinery leading to the development a national health service system. The research in both quantitative and qualitative. The quantitative study involves the interviews of 2,400 consumers consisting of 400 each from the five different schemes and another 400 from non insured group in 4 provinces namely Samutprakarn, Chiengmai, Pattani, and Srisaket. The qualitative study involves the administration of 9 focus groups, 12 case studies and interviews with 9 resource persons. The objectives of the research are hereby responed: Problem encountered by all groups of consumers in clouding the non-insured are the lack of promptness on part of public providers; the long waiting for the doctors, the limited time spent for the examination and diagnosis with no explanation on symptoms of the illness; difficulty to commute to and from the designated health centers.Problems relating to the implementation which affect the consumers are lacks of sufficient information on benefits under the schemes by the insurers and lack of good coordination among them; inappropriate subsidization for the free medical care consumers; moral hazard and adverse selection; refusal to receive reffered patients due to reimbursement difficulty; and inefficient service due to unreasonable financial incentives managed by central administration. 3) Only the non-insured minority are capable to pay for their own medical expenses. In case of minor illness, the non-insured would go to the drug stores or private clinics. Their utilization of hospital service is less compared to all of the insured groups. Most of them can depend on themselves for out-patient charges. Most of them can depend on themselves for out-patient charges. Non-insured patients with high cost of expenditures are sometimes advised by the nurse to buy health card or to consult with hospital social workers for appropriate assistance. The number of the non-insured could be much decreased upon efficient health campaigns. Each of the health insurance schemes has its strengths and weaknesses. Collectively speaking, the duplication as well as the discontinuation of rights undermine the reliability of the data used for effective planning. Insufficient subsidization has and impact on the important factors determining provider's behavior. Good accessibility to free service enhances the beneficiaries to overuse the service. 5) The researchers have some reservations over adopting one single insurance system for the "health for all" policy. We might not be able to adopt the system that has been proved successful in many developed countries due to our people's limited ability to pay tax on the one side, and the eddiciency of tax collection on the other. The authorities should timely consider the introduction of pay mechanism by which all consumers receive free essential service and pay only for non-essential service.
