Abstract
Adverse events that occur in health service settings are resulting in more lawsuits than ever before.
The new patient compensation bill is expected to resolve patient-provider conflicts. It will be designed to
cover all groups of Thai people with acceptable claim process and amounts for compensations. This
communication reports the results of a study on the decision-making processes involved in compensating
injured patients under Article 41 of the National Health Security Act 2002.This was a descriptive study. The reasons used by committees in making decisions on whether to
“pay“ or “not pay“ the agrieved parties under the provisions of Article 41 were analyzed and compared
with the compensation criteria set out by the National Health Security Office. Altogether 1,276 claims
made during the period 2003 - 2008 were included in the study.
It was found that, of 1,276 claims, compensation was “paid out“ for 1,049 cases (82.2%) and 227 cases
(17.8%) were “not paid”. The main reason for paying compensation was that “it was an unavoidable
situation“ (76.5%). However, the reason above was not in accordance with the criteria for compensation.
Only 27.1 percent of the claims were made in accordance with the criteria, stating that the injuries were
related to medical errors or mistakes or substandard care. The main reason for not paying compensation
was that “the adverse events were the results of disease processes“ (61.6%). This was in accordance with
the criteria.
The conclusion was that inconsistency and unclear decision-making on patient compensations existed.
Of two cases with the same kind of injury, one might be paid and the other not. This type of
situation might motivate patients to bring cases to court.
