Crisis of Health Insurance under Thai Civil Servant Medical Benefit Scheme (CSMBS)

Abstract

Civil Servant Medical Benefit Scheme (CSMBS) in Thailand provides health care benefits to government officials and their dependences (parents and up to three children). The payment mechanism is retrospective unlimited fee-for-service from the Comptroller General’s Department (CGD) for both out-patient and in-patient services. Even though Thai people in CSMBS are approximately 10%, during the past 13 years (1988-2001), the program cost has increased six-folds which higher than expected budget per annum every year. In the Fiscal year 2008, the budget for CSMBS was 54,904.48 million baht which 80% of this were the cost of medicines in out-patient unit. Consideration of the crisis of CSMBS was raised during the year 1997-2010 with many strategies. Limitation in budget controlling were (1) CSMBS was an open end budget, people who used this scheme could reimburse all payments from the CGD, (2) CSMBS covered high ratio of elderly because it covers retired people and their old-age family members, and (3) the hospital had motivation to make income from reimbursement of non-essential drug lists. In future, we need to study appropriate reimbursement system and continuing to find addition strategies to renovate health scheme benefit e.g. co-operative from physicians in rational drug use with evidence-based medicines, building attitude of lay people in good health or treatment without medicines in some cases, and supporting mind-set to use low cost but high quality medicines. Moreover, we need federal law of appropriate benefit for the low-income civil servants.