Abstract
Health care system in Thailand has developed rapidly during a few decades ago. Thai citizen have enjoyed universal coverage for health care since 2002. Ministry of Pubic Health as a government body is responsible to oversee health service for people in Thailand. This ministry also has responsibility to enact many health laws.
At the same time, health care expenditure has continuously increases, and will increase rapidly in the future from maturation of ageing society, changing disease pattern to chronic diseases and the most significant one, fragmentation of health care system. For instance, patients from car accidents were victims of the game between social health protection schemes and private insurance companies. Anecdotage evident showed problems of adverse selection and moral hazard both from beneficiaries and health care facilities. These problems came from different payment mechanism and different payment rate in the same treatment from different social health protection schemes. It can be said that Thailand does not have system government on health care financing. Ministry of Public Health has loosed power to governance the system from time to time, Many financing agencies e.g. Social Security Scheme, Local governments and private health insurance companies, were established under authority of other Ministries.. Promotion of health export (Medical hub policy) is another example of conflict and no system governance of Thai health policy.
Objectives of this study aim to document and synthesis the current structure and function of institutes which play system governance role of health care financing in Thailand and developed countries which have already had universal coverage for health care. And assess how well the existing structures for system governance in Thailand measure up to the need. Finally, appropriate system governance structures for health care financing in Thailand are proposed. Analysis of this study used a framework of health system of the World Health Organisation, which health care financing is one of four missions of health system to provide universal financial risk protection, equity in finance, equity of access and use, transparency, effectiveness, and appropriate incentive for good quality providers.
The results of study founded, a common feature of the design of system governance of the 4 selected countries; England, Canada, Germany and japan, is a governance body which locates in administration structure of central government. This governance body is responsible to decide policy direction and to prepare amendment of related laws or new bills to shape the health care financing system of the country. These countries have different in revenue collection method, pooling, purchasing and payment. Therefore structures for system governance are also different. However, there are common features among these countries. Regarding revenue collection, contribution rates are regulated in counties which sickness funds or local governments are allowed to collect contribution by themselves. Equalisation fund or resource allocation formula has been implemented
