The response of the private sector to competitive contracting : a case study of a private health provider network in Thailand
Social health . lnsurance in developed countries , lS facing problems concerning cost control. In developing countries, problems are of low coverage, the provision of care to include access to the private sector, equity in access to services, as well as cost control. In Thailand, the recently introduced social insurance scheme requires the insured or their employer to select a main contractor to provide care a general hospital with >100 beds - which is paid on a capitation basis. In response the private sector is developing provider networks to ensure health services to be more accessible and to attract insured workers to enroll with the network. The primary concern of the research is to evaluate MEDSEC, the biggest private network in terms of the number of facilities and insured covered. Nopparat, the biggest publicly-organized network, was selected for comparison with MEDSEC. The aim is to identify policy recommendations regarding networks and their internal payment mechanisms. The obj ecti ves are to examine: how MEDSEC is organized and how it has grown over time; the health seeking behaviour of the insured of MEDSEC; and the utilization rate, payment system, and quality of care of MEDSEC. Four substudies were done: the MEDSEC operating and financial system; the health seeking behaviour of the insured, their utilization rate, knowledge, and satisfaction; the providers' knowledge and attitudes; and evaluation of quality of care concerning four aspects: infrastructure, patient satisfaction, outpatient drug treatment, and inpatient care. The study identifies policy implications concerning the functions of a good network office, the monitoring of a network's quality of care, the payment system of networks, and improving the knowledge of the insured concerning the regulation on access to care.