Abstract
The Civil Servant Medical Benefit Scheme has expanded its benefit by poviding access to 77 elective
surgeries in contracted private hospitals since May 2011. This study aimed to assess institutional capacity
of the Civil Servant Medical Benefit Scheme (CSMBS) in regulating contracted private hospitals. Issues of
assessment included system design, factors influencing effectiveness of the regulation, and implementation
of the policy in regard to provider’s responses and medical record audit. We conducted in-depth
interviews with key stakeholders and analyzed medical record audit reports. Content analysis and descriptive
statistic were employed in the analysis.
Results show that the policy aims to increase choices of access and reduce waiting time for elective
surgeries among CSMBS beneficiaries. Moreover, the policy will increase level of patients’ satisfaction
while costs of the scheme remain contained. The policy was carefully designed in order to prevent fraud,
inappropriate care, and protect consumer’s right. Minimal standard regquirement of enrolled hospitals
was set including authorization process, and information needed for claim submission. However, limited
institutional capacity of the Comptroller General’s Department under the Ministry of Finance who manages
the scheme remained a major constraint in policy implementation; moreover, errors coding of diagnosis
and procedure was urgently needed for improvement before scaling up the program.
