The social security scheme in Thailand : what lessons can be drawn ?
International Conference on the Economics of health insurance in low and middle-income countries. Antwerp, BEL, 1997/01/17.
The Social Security Scheme was launched in 1990, covering formal sector private employees for non-work related sickness, maternity and invalidity including cash benefits and funeral grants.
The scheme is financed by tripartite contributions from government, employers and employees, each of 1.5% of payroll (total of 4.5%). The scheme decided to pay health care providers, whether public or private, on a flat rate capitation basis to cover both ambulatory and inpatient care.
Registration of the insured with a contractor hospital was a necessary consequcnce of the chosen capitation payment system.
The aim of this paper is to review the operation of the scheme, and to explore the implications of capitation payment and registration for utilisation levels and provider behaviour.
A key weakness of the scheme's design is suggested to be the initial decision to give employers not employees the responsibility for choosing the registered hospitals.
This was done for administrative reasons, but it contributed to low levels of use of the contractor hospitals.
In addition, low levels of use were also probably the result of the potential for cream skimming, cost shifting from inpatient to ambulatory care and under-provision of patient care, though since monitoring mechanisms by the Social Security Office were weak, these effects are difficult to detect conclusively. (...)
Mots-clés Pascal : Assurance maladie, Thaïlande, Asie, Protection sociale, Financement, Organisation, Système santé, Article synthèse, Marché public, Modèle, Politique sanitaire
Mots-clés Pascal anglais : Health insurance, Thailand, Asia, Welfare aids, Financing, Organization, Health system, Review, Public contract, Models, Health policy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0167064
Code Inist : 002B30A01B. Création : 16/11/1999.