Abstract
Unwanted outcomes of health services, either unavoidable occurrences or due to negligence, can
lead to damages and conflicts between health-care providers and patients. Consequently, this can have an
impact on the health service delivery system, in which the faith and credibility of the people has been
deteriorating. The current compensation mechanism implemented through the judicial system cannot
enhance good relationships between the providers and patients. The “no-fault” basic compensation system,
under which the affected patients are entitled to damages, according to article 41 of the National
Health Security Act of B.E. 2545, can alleviate their distress to a degree but the law covers only patients in
the Universal Coverage Scheme. This has led to the idea of drafting new laws to extend this protection to
all Thai patients. As a result, the authors have summarized the policy options and the pros and cons of
each option in order to inform the public, create symmetry of information between different groups of
stakeholders, and empower the society to assess by themselves the feasibility and long-term impact of the
policy options. This study found that non-judicial no-fault compensation for affected patients is widely
accepted and adopted in several countries (such as the Scandinavian countries and New Zealand) under
the principle which emphasizes the responsibility of the party who afflicts the damage before proving
who is right or wrong. There are two different sources of funds for no-fault compensation: (a) funds
collected from providers, public hospitals through health funds which are mainly from taxation, and
private hospitals which pay directly; and (b) contributions from people proportionate to their income
(with a certain income ceiling) and (c) from the government for low-income or unemployed people. Also,
the providers may need to contribute (as in New Zealand). It is the authors’ opinion that Thailand should
adopt a no-fault liability policy which could help in reducing conflicts between patients and providers. A
non-judicial mechanism should be developed for provision of full compensation, which if the patient
accepts, would mean that no further lawsuit could be filed. This would allow the affected patients to be
compensated in a timely manner. Regarding the funding source, we propose the use of the health funds
model through which the government contributes to public hospitals while private hospitals contribute
themselves. The estimation for compensation is about 341-679 million baht per year, with the average
being 5-10 baht per capita. Discussion by stakeholders on this topic would allow the facts to be revealed
to the public who could then participate more effectively in the policy-making process. One should be
aware that if the quality of the health service delivery system is poor and the problems are caused mostly
by complications or the system itself, then the amount of compensation paid for these damages would be
higher than the compensation for damages caused by the practitioners; hence, this would lead to rising
costs. Furthermore, the no-fault compensation process should also be protective of the providers’ reputation
and try to give encouragement and feedback in order for them to improve their performance.
