Situational analysis of the health insurance market and related educational needs in the era of health care reform in Thailand.

The purposes of this study were to explore the situation of health insurance in Thailand, to compare public and private perspectives and to identify related educational needs. Between March and April of 1998, the study employed in-depth interviews of 12 public and private major stakeholders of the health insurance systems, including policy makers, providers and insurers. Additional inputs were gathered in a brainstorming session with 41 participants from organizations with important roles in regulating, monitoring, paying, or providing health care services, as well as research and education. The findings indicated the health insurance market was expanding. But there was no national policy on health insurance. Insurance-related law was outdated. Public and private schemes overlapped, and were generally characterized by inadequate risk diversification, overutilization of services, lack of effective cost containment, inconsistent service quality, and poor understanding of health insurance principles. There were needs for more education and training in various aspects of health services management and health-insurance related functions. Consequently, continuing education and training related to health insurance services for policy makers, system administrators, managers, providers and insurers are strongly recommended during the health-care reform process.

Predictors of leadership styles of medical students: implications for medical education.

Providing effective health care services for a population involves a great deal of team-work among health care workers and leadership of physicians. The primary purpose of this study was to assess the leadership styles of medical students, and to explore factors that may be associated with them. Leadership questionnaires were used to assess leadership styles of 97 sixth-year medical students of the 1995 class at Chulalongkorn University attending the community medicine III program which was designed to introduce basic knowledge and skills in health care management. The baseline leadership styles of the students were more people-oriented than task-oriented. Multivariate analyses revealed that administrative experiences from extracurricular activities and perceived importance of a health administration course were significantly associated with leadership styles. Medical students should be encouraged to participate in extracurricular activities during their medical studies, taking leader positions, in order to develop an optimal leadership style to be effective health team leaders.

Intention of private hospitals to become contractors in the prepaid social security scheme in Thailand: why and why not?

The objective of the study was to examine whether private hospitals wanted be main contractors (MCs) under the social security scheme. Data were obtained from a cross-sectional survey of 94 private hospitals in Bangkok and its vicinity area conducted between August 1995 and May 1996 using in-person interview and hospital survey forms. The overall response rate was 88.3%. The results showed that some 46 hospitals (55%) expressed their intention to become MCs. However, nearly 40% of MCs in 1995 indicated that they really did not want to join the scheme while several non-MC hospitals said that they wanted to participate. The most prevalent justifications for the intention of the hospitals to become MCs, or not, were operational and marketing-related in nature. While the scheme was considered a profitable market opportunity by many, it affected hospital positioning. Participation in the scheme might also complicate health services delivery. Whether private hospitals wanted, or did not want, to become MCs was associated with ownership status (p = 0.001) and leading competitive strategies of the hospitals (p = 0.041).