Abstract
This study explore grievance and compensation systems in the major public health insurance schemes, namely the Civil Servant Medical Benefit Scheme ( CSMBS ), the Social Security Scheme ( SSS ), the 30 Baht Scheme, and the Compulsory Car Accident Insurance Scheme. The Servant Medical Benefit Scheme ( CSMBS ) has practically no grievance or compensation systems. However, its fee-for-service payment scheme coupled with eligible member’s rights to choose their ( usually public ) providers help making the scheme less susceptible to substandard care experienced in other scheme that pay providers mainly on capitation basis. The Social Security Scheme ( SSS ) was the first public health insurance scheme that set up a formal grievance system. The grievances are usually sent to the SS’s medical committee. If the committee decides that the provider is at fault, it will also recommend the penalty. The penalty ranges from warning, probation, reducing the ceiling number of insured patients, to termination of contract. However, the vast majority of grievances were lifted on the ground that they were caused by miscommunications or patient’s misunderstandings. The 30 Baht Scheme although the intention of such a compensation scheme is to provide relief/settlement that would curb the increasing trend of medical malpractice suits, medical associations view it as a vehicle that would lead to more lawsuits ( or at least complaints ) and have fought vigorously against it. Thus far, there is no convincing evidence to disprove either claim. As a result of the fighting, the scheme is now equipped with regulations that, if strictly interpreted, would allow only compensation to substandard or malpractice cases. In practice, however, many ( provincial ) compensation subcommittees still use the regulation’s ambiguity to interpret it in such a way that they could provide compensation to some other cases based on humanitarian reasons. The Compulsory Car Accident Insurance Scheme is private insurance based and is therefore using the same grievance and arbitrator systems as present in other private insurance schemes.
