TY - JOUR
T1 - Health insurance and private providers
T2 - A study of the civil servants' medical benefit scheme in bangkok, Thailand
AU - Bennett, Sara
AU - Tangcharoensathien, Viroj
PY - 1993/4
Y1 - 1993/4
N2 - Compulsory health insurance schemes have received attention recently as a means of creating a reliable extra‐budgetary source of health care funding. Yet, the full implications of such schemes in a developing country context are unclear; in particular, the impact on and relationship with private sector providers has infrequently been explored. This study examines patterns of public and private sector utilization under the Civil Servants' Medical Benefit Scheme (CSMBS) in Bangkok, Thailand. The CSMBS currently provides limited reimbursement for private inpatient care, but recent proposals suggest increasing benefit levels for care sought in the private sector. The study shows that despite high level of cost recovery in the public sector, charges were much lower than those in the private sector. Different patterns of diagnosis in the two sectors were found with private hospitals tending to treat a less complex case mix. Within the private sector, there was a limited tendency to specialize in certain types of care. It is concluded that under the current payment mechanism of fee‐for‐service reimbursement, measures to enhance access to private sector care should be approached with caution. In the long run, the scheme should merge with the recently established social security scheme.
AB - Compulsory health insurance schemes have received attention recently as a means of creating a reliable extra‐budgetary source of health care funding. Yet, the full implications of such schemes in a developing country context are unclear; in particular, the impact on and relationship with private sector providers has infrequently been explored. This study examines patterns of public and private sector utilization under the Civil Servants' Medical Benefit Scheme (CSMBS) in Bangkok, Thailand. The CSMBS currently provides limited reimbursement for private inpatient care, but recent proposals suggest increasing benefit levels for care sought in the private sector. The study shows that despite high level of cost recovery in the public sector, charges were much lower than those in the private sector. Different patterns of diagnosis in the two sectors were found with private hospitals tending to treat a less complex case mix. Within the private sector, there was a limited tendency to specialize in certain types of care. It is concluded that under the current payment mechanism of fee‐for‐service reimbursement, measures to enhance access to private sector care should be approached with caution. In the long run, the scheme should merge with the recently established social security scheme.
KW - Health insurance: Payment mechanism
KW - Private sector
KW - Thailand
UR - http://www.scopus.com/inward/record.url?scp=0027789305&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0027789305&partnerID=8YFLogxK
U2 - 10.1002/hpm.4740080207
DO - 10.1002/hpm.4740080207
M3 - Article
AN - SCOPUS:0027789305
SN - 0749-6753
VL - 8
SP - 137
EP - 152
JO - The International Journal of Health Planning and Management
JF - The International Journal of Health Planning and Management
IS - 2
ER -