Abstract
The study on “The mechanism and process of handling complaining and extending primary assistance in the health insurance system” employed the quantitative and qualitative methodologies. Its purpose is to study the mechanism and process of handing complaints and extending assistance regarding the health insurance system; efficiency and effectiveness of its mechanisms and process; the impacts of failure of providing health services giving effect to the service providers, the complaints, and society; including the implementation and constraints of Health Insmance Coordination Centers of People Sector concerning of participation in health insurance development and the independence of people sector in working with the local administration organizations in long term of community health management. The sample size of quantitative study composed of 3,015 respondents based in Bangkok Metropolitan and peripheral areas, including 11 provinces in 4 regions. While qualitative study used the in-depth interview of 59 key-performants, organizing a public hearing, and case study of 5 cases. The finding of study are as follows.
The mechanism and process of handing complaints and extending primary assistance in the health insurance systems show different standard among the universal coverage health insurance system, the social insurance system, and the medical welfare system of civil servants and employees of state enterprises, The universal coverage health insurance system has more mechanism of central, regional, provincial, and medical center level to manage the complaints. On one hand, the social insurance system has its mechanism of central, provincial, and medical center level, on the other hand, the Comptroller-General’s Department, Ministry of Finance is the main agency managing the medical welfare of civil servants and employees of state enterprises and controlling the budget disbursement for their medical expenses.
Regarding the efficiency and effectiveness of the mechanisms and proves of handling complaints and extending primary assistance in the health insurance systems, it is found out that the universal coverage health insurance system and the social insurance system are more efficient and effective than the medical welfare of civil servants and employees of state enterprises. However, each system has some weaknesses that needs to be improved in the process of handling the complaining and extending primary assistance.
The impacts of failure of providing health services in the past has often caused the complaining and also caused the negative impacts to the complaints, e.g. wasting time, increasing their own and theirs family expenses. On the other hand, the service providers also suffered from stress, anxiety, losing credibility, and losing good relationship with patients and their families. In the mean time, the society as a whole has both positive and negative impacts. The positive impact is enhancing the public awareness to improve the health insurance system especially in terms of providing the quality of health insurance services to ensure public confidence. On the contrary, it dampened the public confidence in integrity and moral ethics of medical doctors.
With regard to the performance of Health Insurance Coordination Centers of People Sector, most of the people have satisfied with the performance of health Insurance Coordination Centers Sector at the medium level. Its activities are effective to some extent. The main factor of less effectiveness is budget constraint due to source of budget come from government.
According to the findings, an independent agency for handing the complaining should be set up, as well as the single standard of all three health insurance systems should also be assigned. The mechanism of handing complaining at medical center level should be empowered. Clients and the health service providers should having positive attitude towards the complaining. The creative conflict management should be promoted to create harmonization between health service provider and clients. Professional ethics. Should be conducted. The effectiveness of handing complaining should be improved. The restoration is used in dealing with conflict management. The equilibrium of medical doctor and population should be adjusted to each area, and also the local administration organizations should participate to strengthen health insurance system in each district. The effectiveness of three health insurance systems should be improved. Also Health Insurance Coordination Centers of People Sector’s potential have to be also improved.
The further study should be focus on 3 topics as follow: (1) the role and function, committee members, process of undertaking the mission, and sources of financial support of the independent health insurance agency, and (2) the participation guidelines of civil servants and employees of state enterprises in the policy and implementation of theirs medical welfare services.
