Waluya The International Science Of Health Journal

ISSN:
Vol.

WALUYA THE INTERNATIONAL

SCIENCE OF HEALTH JOURNAL

THE QUALITY OF HEALTH SERVICES AND THEIR

IMPLEMENTATION OF THE HEALTH INSURANCE
SYSTEM IN THAILAND
Ni Ketut Mendria1, Desriatinb2, Sabaruddinc3 Lisbeth Tandumayc4
“Mandala Waluya University, Jl. Gen. A. Nasution No. G-37, Kendari 93117, Indonesia”
“Mandala Waluya University, Jl. Gen. A. Nasution No. G-37, Kendari 93117, Indonesia”
1
niketutmendri729@gmail.com, 2desriatin111fa@gmail.com, 3sabar.odhe.mw2021@gmail.com,
tandumaylisbeth@gmail.com

ARTICLE INFO ABSTRACT

Article History Introduction : Thailand with around 63 million people has achieved universal coverage
of 99% while still maintaining the quality and quality of its health services. That is why
Received
the health insurance system and hospitals in Thailand maintain and even improve the
quality of their services
Revised Purpose
The purpose of writing this journal is to give readers an overview of how hospitals in
Accepted Thailand maintain the quality of service in implementing the health insurance system.
Discussion
The quality of health services at a government hospital in Thailand uses the Total Quality
Management (TQM) system with the Kaizen Method. Total Quality Management is a
management approach to achieve sustainable success through customer satisfaction (Mind
Tools, 2015). The primary elements of Total Quality Management (TQM), namely first,
focus on consumers, because consumers determine the level of quality. Second, overall
employee development, it is hoped that all employees will participate in achieving
Keywords: company goals. Third, centered on the process, starting from the input, up to the output,
Keywords: Health namely up to the consumer. Fourth, an integrated system. Fifth, a strategic and systematic
Services, Health approach, and sixth, continuous development
Insurance System, Conclusion
Social Security Thailand has developed rapidly in the health sector since Universal Health Coverage was
Scheme, Thailand introduced in 2002. In the 13 year period of its implementation, the authors can see that
the health insurance system in Thailand has been running well. This is expected to be a
motivation for the health insurance system in Indonesia, especially in the current BPJS era,
which is still experiencing many obstacles.

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Waluya The International Science Of Health Journal
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insurance (WHO, 2014). The first scheme is the
Civil Servant Medical Benefit Scheme

Background (CSMSC) for government workers with three

Health insurance is one of the generations of protection, which means that

obligations of every country to guarantee the protection also applies to biological parents, and

welfare of its citizens, and is a constitutional a maximum of three biological children under

right of every citizen. In the BPJS era, Indonesia the age of 20, wholly paid by the government.

is still experiencing various obstacles, one of The second scheme is the Social

which is the quality of its health services. Security Scheme (SSS), namely health insurance

Thailand with around 63 million people for private workers. Here, company leaders must

has achieved universal coverage of 99% while pay for employee health insurance a maximum

still maintaining the quality and quality of its of 35,000 Baht (15 million Rupiah). Under

health services. Therefore, it is interesting to certain conditions, it can be paid up to 200,000

discuss why the health insurance system and Baht (90 million Rupiah). For excess bills are

hospitals in Thailand maintain and even improve the responsibility of the workers themselves.

the quality of their services. The third scheme is The Universal Coverage
Scheme (UCS) which protects all Thai citizens

Purpose beyond the two forms of protection above

The purpose of writing this journal is to (Sakunphanit, 2015).

give readers an overview of how hospitals in Implementation of health service

Thailand maintain the quality of service in guarantees should still be guided by patient

implementing the health insurance system. safety and pay attention to service quality. Even
though the health insurance program is cheap or

Discussion even free for all citizens, hospitals must still

Universal quality and security are the provide the best quality and procedures. The

main objectives of the 11th Thailand National World Health Organization emphasizes the

Development Plan 2015-2021. Almost all importance of safety in serving patients, and has

development goals related to health have been launched the World Alliance for

achieved. The Ministry of Public Health started Patient Safety program which states

introducing Universal Health Care in 2002, and that: "patient safety is a fundamental principle of

since then health services in Thailand have service as well as a critical component in quality

continued to develop and innovate. management" (Lestari et al., 2014). Hospital

The Universal Health Care policy has service standards in Thailand refer to the

achieved universal coverage of 99% of all Thai Thailand Hospital Accreditation (THA), Joint

citizens using three forms of national health Commission International (JCI), and

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Waluya The International Science Of Health Journal
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International Standards for Organization (ISO).
The basic quality management used includes
Total Quality Management (TQM) and the
International Society for Quality (ISQUA).
Thailand Hospital Accreditation (THA)
is an independent institution adopted by the
Institute of Hospital Quality Improvement and
Accreditation of Thailand whose job is to
evaluate private and government hospitals.
Thailand's hospital accreditation program is not
just a certification but rather a mechanism to
encourage total, systematic, and standard
improvement of hospital quality.
This program emphasizes the principles
of self-assessment, quality assurance, customer-
focused continuous improvement and total
quality management. This accreditation is
intended to encourage hospitals to improve and
confirm how well hospitals carry out their
activities according to standards rather than as
an external quality audit or inspection of the
hospital's ability to meet minimum standards.
With the accreditation of the hospital, it
means that it has shown a commitment to
patient-based quality improvement and shows
that the hospital has a good quality system
to minimize risk and guarantee quality
(Sriratanaban, 2013).
The quality of health services at a
government hospital in Thailand uses the Total
Quality Management (TQM) system with the
Kaizen Method. Total Quality Management is a
management approach to achieve sustainable
success through customer satisfaction (Mind
Tools, 2015).
DOI:
ISSN:
The primary elements of Total Quality
Management (TQM), namely first, focus on
consumers, because consumers determine the
level of quality. Second, overall employee
development, it is hoped that all employees will
participate in achieving company goals. Third,
centered on the process, starting from the input,
up to the output, namely up to the consumer.
Fourth, an integrated system. Fifth, a
strategic and systematic approach, and sixth,
continuous development (American Society for
Quality, 2015). This system is implemented in
government and private hospitals in Thailand
and is measured using standards including ISO
for service standards, and ISQua for service
quality.
Kaizen is a method that originated in
Japan, using the principle of continuous
improvement that is done every day, everyone,
and everywhere. Currently Kaizen has been
widely recognized as an important pillar of a
company's competitive strategy (Kaizen
Institute, 2015).
With this Kaizen Method, government
hospitals in Thailand carry out quality
improvements starting from the smallest units.
What is expected with this Kaizen method,
every change in the smallest unit that is carried
out continuously and continuously, will produce
enormous changes in an organization. Leaders
set a good example in every ministry, and the
culture of reporting is a hallmark in Thailand.
The culture of "no blame" (no blame
culture) is proven to be able to reduce incidents
in hospitals if it is carried out continuously
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Waluya The International Science Of Health Journal
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starting from the smallest unit to the largest unit. One way is to look at the health insurance
Evaluation becomes a lesson for each unit in system in other countries.
improving systems and resources. This is what
the author thinks should be used an example for What is clear to see in the management
health services in Indonesia, especially in the of hospitals in Thailand is how they use a mix of
current BPJS era where the quality of service is standardized hospital methods aimed at
still a lot of complaints by most patients. improving the quality of service in total.
Limwattananon (2007) in his study Accreditation is not mandatory for private
proves that since 2004 poverty in Thailand has hospitals. But with accreditation, hospitals can
shown a significant reduction due to the show customers that their service is up to
implementation of the health insurance system, standard. Measuring quality with various
due to the "out of pocket" payment method or additional methods shows that accreditation
self-pay, it has been greatly reduced by the alone is not enough to prove to customers that a
insurance system. This means that it is very hospital is truly qualified.
likely that if later the situation related to BPJS in
Indonesia is stable, it will affect the decline in Referensi
the poverty rate. AMERICAN SOCIETY FOR QUALITY.
2015. Total Quality Management
Conclusion [Online]. American Society for
Thailand has developed rapidly in the Quality. Available:
health sector since Universal Health Coverage http://asq.org/learn-
was introduced in 2002. In the 13 year period of about-quality/total-quality-
its implementation, the authors can see that the management/overview/overview.html
health insurance system in Thailand has been [Accessed March 30th 2015].
running well.
KAIZEN INSTITUTE. 2015. What is
This is expected to be a motivation for
Kaizen [Online]. Kaizen Institute.
the health insurance system in Indonesia,
Available:
especially in the current BPJS era, which is still
http://www.kaizen.com/about-us/defi
experiencing many obstacles. Government
nition-of-kaizen.html [Accessed
hospitals have experienced a rapid increase in
the number of patients resulting in complaints of March 30th 2015].
declining quality of service. Of course it takes LESTARI, N. P., SUNJAYA, D. K. &
time to evaluate, learn, and improve the system. SYAEFULLAH, A. 2014. Konsep
Manajemen Keselamatan Pasien

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Waluya The International Science Of Health Journal
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Berbasis Program di RSUD Kapuas
Provinsi Kalimantan Tengah. Pustaka
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SATHIEN, V. & PRA KONGSAI, P.
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MIND TOOLS. 2015. Kaizen : Gaining the
Full Benefits of Continuous
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