AN APPROACH TO DEVELOP A FAIR PRIVATE HEALTH INSURANCE SYSTEM: A CASE STUDY OF THE STAKEHOLDER IN CHANTHABURI PROVINCE

Abstract

This research aims to achieve three main objectives: 1) to investigate the current state of private health insurance systems, 2) to analyze the ethical issues within the context of private health insurance from an interdisciplinary perspective, and 3) to propose a framework for the ethical development of a private health insurance system. The research employs an interdisciplinary approach, encompassing the dimensions of economics, management, ethics, and law. This research employs a mixed-methods research approach. 1) This qualitative research utilizes structured interviews and analyzes data through content analysis, along with examining life and health insurance policies of life insurance companies. The analysis is conducted based on fundamental legal contract criteria. 2) This quantitative study employs surveys and analyzes data using statistical methods, along with documents related to compensation payouts and insurance premiums and benefits from life insurance companies. Financial analysis is performed, drawing a comparison with economic analysis.

            The findings of the research reveal that:

            private health insurance purchasers lack knowledge regarding the time value of money and often withhold health information. Life insurance agents market private health insurance without explaining information pertinent to the time value of money. Additionally, discrepancies exist between the actions of life insurance agents and ethical standards. Life insurance companies design insurance policies and benefits without indicating information related to the time value of money, leading to supplementary health insurance contracts being appended to life insurance policies. Furthermore, compensation claims are often inaccurate and do not comply with legal contract terms. Private hospitals exceed standard and medically necessary healthcare treatments, and actions related to incorrect disbursements of compensation payouts are conducted, violating the principles outlined in the criteria for claim reimbursements. It is therefore imperative to revise the policies and responsibilities of the stakeholders across from key dimensions by collaborating with interdisciplinary knowledge. The proposed framework for the ethical advancement of private health insurance system includes the following elements: 1) Cultivating knowledge on life insurance, health insurance, and investments, and fostering a heightened ethical awareness among policyholders, 2) Monitoring knowledge about health insurance investments, establishing oversight mechanisms, and enforcing life insurance agents adhere to ethical conduct, 3) Creating procedures for accurate compensation aligned with contractual agreements and generating supplementary private health insurance policies in line with legal principles, and 4) Guiding medical treatment processes by following standardized medical practices, guaranteeing compliance with medical standards, and executing related compensation measures thoroughly and accurately. When the private health insurance system attains ethical maturity, the anticipated societal outcome and impact will manifest as improved public health and well-being for the Thai population.