Abstract
This report presents a study of managing the mechanism of providing the information of health insurance system that is suitable for consumers. The purpose of the study is about the organization’s mechanism and process in providing information regarding the health insurance system by considering efficiency, effectiveness of its mechanisms and management guidelines in providing the suitable information of health insurance system. The methods of the study includes both the quantitative and qualitative researches. The quantitative researches are conducted for 3,015 cases; the area of research is Bangkok and 11 provinces in 4 peripheral regions. While the qualitative researches are conducted the exclusively interviewing 59 persons. It also includes the public hearing and doing research of 5 case studies. The results of study are as follows.
Regarding the mechanism of providing information of health insurance system, it is found out that there obviously exists the agencies who are responsible for universal coverage health insurance and social insurance system. But the welfare system for civil servants, which is additionally attached to Comptroller General’s Department, Ministry of Finance who will be in charge, does not have a clear structural mechanism to handle the system. The process of providing information before the medical treatment (upstream) about the rights that one can receive according to rights of all three health insurance system is evaluated as fair, especially the rights of civil servants/state enterprise staff about their registration in order not to pay the medical bills in advance. For both in-patients and out patients, they are aware of more than two health insurance systems. From the opinions about the process of providing information of health insurance system in each stage of undergoing medical treatment (midstream) of health insurance system, It’s also found out that the simple groups agree at a high rate, especially the cases of receiving the medical treatment at medical centers, about the data of service users’ illness. And form information providing when finishing the medical treatment (downstream), regarding giving the clear information the sample groups also agree at a high rare, especially the case of being transferred to receive treatment at other places. Regarding the efficiency of mechanism and process of management of providing information of health insurance system, it is found out that the first two health insurance systems are not more efficient than the civil servants’ welfare system, is less efficient and lacks mechanism for systematic management. In terms of the effectiveness, the service users are quite satisfied, However, from the qualitative study it is found out that the study groups are satisfied to some extent and think that it needs to improve three systems continuously for their sustainment.
It is advised in the study that all three systems are to be improved to guarantee fairness and equality for the basic common rights of the three systems. In case of over the eligible rights, the service users should bear the expenses as well. It should be created the participation in sharing information earnestly and continuously. It should be developed the empowerment information process (EIP) to enable everyone to realize the importance of providing information and regard that it is the beginning of building the good relations between the parties concerned. It should be regulated the structure of management of providing information, that will comprise watching, following up, monitoring and learning from the best practice. There should be the organization, that will receive and deal with complaints, and be independent. It should be built the culture of reporting the mistakes occurring in the system. It should be fixed that providing information of health insurance system will be the index of evaluating the quality of organization (HA). It should be analysed about the nature / formats / channels / contents of information of health insurance system.
