Abstract
Payment Systems, Mechanisms and Approaches for Health Service for Equity, Efficiency and Quality Various payment mechanisms for health care and their impact on equity, efficiency and care quality were reviewed in this study. Recommendation for appropriate mechanisms for Thailand was also proposed to put in National Health Bill. Development of health insurance in Thailand and experiences of using various payment mechanisms in other countries were reviewed. A number of well experienced people, health care users and providers in both public and private sectors were interviewed. The study found diverse mechanisms in Thailand which could be grouped as following; out-of-pocket payment was directly made to providers, fee-for-services was remunerated to the insured under the Civil Service Medical Benefit Scheme and private insurance (some schemes having ceiling level per year),payment was made under fee schedule for example the Social Security Scheme and the Substitution Fund, capitation payment was used under the Social Security Scheme in order to contain medical costs and expenditures but was problematic to care quality, per-case payment on the basis of DRGs (Diagnosis-related groups) was made, budgeting by capitation was solely implemented in public sector, line item budgeting was used for allocating salary, operating and capital expenditure in public sector.
