The health insurance system, characterized by fragmentation, duplication and
inadequate coverage in some schemes, cannot achieve health systems goals of efficiency
and equity. It does not allow collective financing to exert its monopolistic purchasing power
and send the right signals to health care providers towards efficiency. Fee for service, a
dominant mode of provider payment, exacerbates cost containment problems, as seen by
faster health expenditure growth than GDP growth, even during recession periods. With the
lack of effective primary care, most of the poor are taken care of by hospitals which are
expensive, have long waiting lines and unsatisfactory services. In 1999, two important acts
were promulgated, i.e., the Public Organization Act and the Decentralization Act. If this
movement proves to be a success, there will be many more public independent hospitals.
According to the decentralization act, the majority of the public health service facilities
many be devolved to the local authorities within 2010.
The objective of this study was to describe the health insurance system in Thailand
and evaluated the experience of health insurance schemes in Thailand under the equity
and efficiency consideration with the aim at suggestion. This study has based on
documentary research by reviewing all of the health insurance system in Thailand from
1995 - 2007 (B.E. 2538 to B.E. 2550).
The results of study will be proposed to policy makers of the Ministry of Public Health
and the National Health Security Office for further improvement of health care and service
activities, and health decentralization across health insurance system in Thailand.