Public health insurance for low-income population	Social security	Public Health insurance for government employees
Accessibility and quality of public health services	•	Budget of 2,100 Baht per capita 2008.
•	Integrated health care.	•	Budget of 1,600 Baht per capita in 2006.
•	Exclude health promotion and prevention.	•	Budget of 4,000 Baht in  2006 and 6,000 Baht in 2008
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Rights to choose health care providers	•	Recipients must register their service units and primary health care providers, which mostly are public hospitals. They do  not have enough personnel to meet patients’ demands.	•	Recipients must register health care providers contracted with social security administration. Most recipients choose private hospitals because of their perceived superior quality of services.	•	Recipients may choose to receive services from any government hospitals
- no private hospitals are allowed except in cases of emergency.
Rights to complain and receive assistance and compensation payments from public health services	•	The National Health Insurance Act of 2002 and the National Health Act of 2007 clearly specified the right to complain and receive assistance, and processes and procedures of managing compensation payments from public health services.	•	The Social Security Act of 1990 and its amendments did not specify consumer rights. It did, however, provide different venues for complaints such as office of Social Security Administration, Social Security Hotline, and Medical board, along with clear processes for grievances and compensation payments.	•	No laws determining employee rights to complain and receive compensation payments. The Central Budget Office coordinates with health care providers and government offices. Grievances are handled through courts.


Various laws guarantee consumer rights to receive public health information, such as the Consumer Protection Act of 1979,  the Information and News Act of 1997, the National Health Insurance Act of 2002, and the National Health Act of 2007. They also specify monitoring system. This study found, however, that consumers could not access to accurate information and did not know their rights guaranteed by laws. There was a communication gap between policy and implementation levels because of fear of  complaints to echelons.
The rights to participate in health insurance management system are granted by the related laws mentioned above and the Protection of Compensation claimants in Public Health Services Act of 2007. The insurance scheme for low-income populations has committees formed at national and local levels. The social security scheme has a national committed working with representatives from employees, employers, and government. However, their collaboration was still limited. Under government employees’ scheme, there was no participation from its recipients.
1.2	 The current situations of consumer protection in health insurance system in other countries
This study’s literature review included three countries representing different levels of development: the United States of America, South Africa, and Ghana. The review was aimed to find best practices of consumer protection in health insurance system. Through various channels. Recently, the country has implemented a voluntary social security system which will be converted to a mandatory system.
	Ghana-In the past, its citizens had health insurances through local communities which covered only a small portion of populations. Many people were neglected and refused treatments. Recently, the country has implemented a universal health insurance system where all citizens must be insured through either local community plans or private insurance. The state only subsidizes the former, however, Consumer protection mechanisms are at the national level through a committee that monitors quality and standards of services,.
2.  Efficiency and effectiveness of consumer protection processes in health insurance system in Thailand
2.1 Efficiency
Both public health insurance for low-income populations and social security schemes include consumer protection mechanisms. The former has clear processes at national, regional, provincial, and, organizational levels, while the latter national and regional levels. The government employees’ scheme only has national level mechanism which was the Central Budget Office’s monitoring reimbursement issues and escalading complaints to other agencies. In private sector, there are consumer protection agencies and networks that assist consumers in general.
	Even though several laws clearly guaranteed consumer protection, there were various problems at the implementation level. Besides a communication gap mentioned above, there were tensions between health care providers and patients regarding medical errors. Patients have higher expectations from treatments and demand more rights and services, especially low-income populations. Medical personnel are sued more and thus stressed. In addition, health care providers are experiencing budget and personnel shortage and unfair resource allocation. They have to cut costs which affect quality of health services. In addition, different laws guaranteed different rights, but did not define responsibilities of consumers. At a policy level, complicated structure of consumer protection created duplication of roles and thus conflicts among various agencies such as the Ministry of Public Health and Office of National Health Insurance.
	Although there is a mechanism of consumer participation through various committees, its implementation needs improvement. Under low-income populations’ scheme, there were more representatives from private sector than consumers. Local communities could not collaborate with health care providers because they lacked understanding of the laws. Under social security scheme, employees could not select the own representatives and did not know their representatives. Under government employees’ scheme, the Central budget Office needs to invite representatives from government offices and from government employee associations.
	Proper consumer protection processes should cover five sets of activities as follow. Medical errors were an example in this study where these processes may be beneficial when all sets of activities are utilized.
	1. Prevention-study nature of consumer rights violations, collect data, anticipate and prepare for problems, and develop new policies
	2. Monitoring-monitor expected problems closely
	3. Information dissemination-educate, motivate, and empower consumers
	4. Advocacy-establish complaints and grievance processes, and provide assistance and compensation payments	
5. Fair law enforcement-enforce existing consumer protection laws fairly and ethically	
2.2  Effectiveness
	2.2.1 Consumer protection provision – There were different problems that must be carefully examined, including accessibility, quality of care, coverage, effectiveness, efficiency, rights to choose primary health acre providers, rights to complain and receive assistance, rights to receive public health information, and rights to participate in health insurance management. Various processes must be restructured: policy implementation, law enforcement, consumer awareness and education, grievances and appeals and information dissemination.
		2.2.2 Health care provider satisfaction- Health care providers are under scrutiny especially under low-income scheme. They have a shortage of staff and resources while their patients have high expectations. This creates conflicts and complaints. The laws only protect consumers, but not health care providers, and neglect  responsibilities of consumers. They demand their rights, but did not know their responsibilities. Therefore, health care providers are under a tremendous pressure and stress. Equal treatment should not mean that consumers receive all treatments they wish. Rather, they have equal access to basic necessary treatments.
		2.2.3 Consumer satisfaction-Consumers could not access to public health information, were not aware of their rights and how to protect them, did not understand limitations of health systems, therefore had unrealistically high expectations which led to complaints and lawsuits, Sincerity form officers and continuity of assistance made consumers feel satisfied and motivated however.
	3. Based on results from this study, several suggestions to improve effectiveness and efficiency of consumer protection in health insurance system in Thailand are chosen. They are presented as follow.
1. Revise laws, regulations, and guidelines that hinder implementation.
2. Make various aspects such as consumer rights, grievances, information dissemination, and true participation in health insurance systems in three major health insurance schemes consistent.
3. Improve reimbursement processes to lessen level of discriminated services 
4. Include responsibilities of consumers in related laws.
5. Enforce consumer protection laws to empower consumers and their networks
6. Institutionalize independent ombudsman services in local communities to assist consumers.
		7. Add monitoring component to consumer protection processes.
8. Add channels for information dissemination, including formal and informal education from kindergarten to higher education, and life long learning.
9. Analyze true causes of medical errors and solutions to reduce grievances and lawsuits, which could include personnel shortage, management, and consumers’ understandings of health care service limitations.
10. Develop professional consumer rights  activists who are educated, competent, and motivated to help consumers and improve effectiveness and efficiency of consumer protection processes.