location: nan, 'Thailand 
year: 2008 source: HSRI 
title: การประเมินการดำเนินการตามพระราชบัญญัติคุ้มครองผู้ประสบภัยจากรถ 
abstract:In 1992 Thailand made another big step in reforming her health care financing system i.e., the promulgation of the Act on Road Accident Victim Protection.  This was aimed to ensure that over a million of people suffering from road traffic injuries(100,000 cases need hospitalization) would be promptly taken care of; those becoming disabled(10,000 cases per year) or families of the deceased(13,000-15,000 cases per year) from the injury would be compensated. 
According to the law, auto-insurance industry was assigned to collect premium from all motor vehicle owners and to pay compensation to hospitals caring for the victims, the disabled and families of the deceased. These roles and functions of the industry were under supervision of the Department of Insurance, Ministry of Commerce. The compensation for each case was divided into 2 parts. The first was paid on no-fault basis. The rest was on fault-basis which meant only victims not found to be responsible for the accident were entitled to the second part. For each type of compensation, the amount of money for the first part was about 1/3 that of the second part. 
This report is another step of on-going academic contributions commenced in 1995 to shed light on the performance of the law. To do so, it employed a combined approach comprising literature review; cross-sectional surveys on hospitalized victims and on disabled accessed through telephones; analysis of in-patient dataset submitted to the National Health Security Office and injury surveillance dataset; and informal interviews with hospital officers dealing with the compensation for medical care of the victims.
16 years after the law came into effect, coverage of the compensation to the hospitalized victims had increased from under 10% in 1995 to 35% (an estimate for the best case scenario) in 2008.  46% of the disabled were compensated for medical care in 2008. 
Among hospitalized victims, the barriers to full coverage were identified as ignorance of the entitlement, difficulties in gathering documents demanded for compensation, perceived threats of legal actions on failure to renew vehicle license or to pay the premium.  
With regard to financial performance, evidence from the Department of Insurance revealed that since the law was in operation a surplus had been accumulated to 10,759 million baths (1997-2006). Regrettably, a loss ratio of 46% on average was recorded for the period. This strongly indicated that the money had been far from adequate to fulfill the aims of the law. In addition, it was found that 40% of the premium went to administration.  As a result, it raises a serious question about efficiency in compensating the victims.
Probably, the concern on efficiency could be more alarming when the financial performance of the law was compared to 1) that of the Road Accident Fund of South Africa which spent just 1/3 the administrative cost of the Thai counterpart, yet with a loss ratio of 109% in 2003 or to 2) that of the National Health Security Office spending just 0.6% on administration to disburse 129,627 million baths for health care of 48 million people in 2007.
Rooms for improvement of the law were, thus, clear.  Two alternative approaches were offered. One is a radical approach to replace the existing law with a new proposal endorsed by the Government of former PM Surayut Chulanont.  In essence, the new proposal hoped to install a virtually no-fault system in which the premium would be collected by the Department of Land Transport and the payment to be made by the Comptroller General’s Department currently overseeing compensation to hospitals under the Civil Servant Medical Benefit Scheme. Under the proposed system, overall administrative cost would be cut down to just 6% of the premium. As a result, more money would be available to compensate the victims to a much larger extent in terms of % of victims being covered and the amount of compensation in each case.
The other approach is to improve efficiency of the operation of the existing law through: 1) cutting down administrative cost by switching to fuel levy instead of the premium collection; and 2) setting up so-called “compensation recovery unit” similar to that of the U.K. to act as a clearing house for the compensation to victims and health care providers.