การใช้เงินในกองทุนเงินทดแทนและกองทุนประกันสังคม : เปรียบเทียบอุตสาหกรรมต่าง ๆ

บทคัดย่อ

Differences in benefit usage of insured persons from various industries according to the Moral Hazard theory may affect the spending of the Social Security Fund (SSF) and the Workmen’s Compensation Fund (WCF) such as medical service utilization rates of insured persons. This study’s objectives were to (1) compare the contribution and spending of the SSF and the WCF in Thailand to those of other countries, (2) compare spending of 7 benefits of the SSF i.e. Sickness, Maternity, Invalidity, Death, Child Allowance, Old-Age, and Unemployment of different industries from service utilization information and employers’ view, (3) compare spending of 5 benefits of the WCF i.e. less than or equal to 3 days Incapacitated, more than 3 days Incapacitated, Partially loss of organs, Invalidity, and Death of different industries from service utilization information and employers’ view, and (4) suggest appropriate preventive regimens or solutions to related persons. The data collection and analyses consisted of 3 parts: 1) Reviewed literature of the structure of the SSF and WCF in Thailand as compared to the United States and Sweden, 2) Compared spending of the SSF and WCF of different industries using secondary data from the population data of the Social Security Office (SSO) and the sampling data from the National Statistical Office (NSO), and 3) Compared spending of the SSF and WCF of different industries from the employers’ viewpoint. The analyses included comparing rates of spending from the SSO and, using the sampling data, assessing the relationship between different industries and usage of outpatient, inpatient, and dental services with the Logistic Regression. Employers were interviewed to assess their attitudes toward spending of both funds using the focus group technique. The results showed that death rates reimbursed from the WCF in 2006 and 2007 in Surveying, Mining, Facility, and Transportation industries were greater than other types of reimbursement (Death, Invalidity, more than 3 days Incapacitated, and less than or equal to 3 days Incapacitated). Therefore, insured persons in these industries had greater risk from work than other industries. However, the WCF does have the penalty for workplaces that have reimbursed more than other workplaces. These workplaces would have to contribute more than others. Therefore, there is an existing preventive measure for the moral hazard for the WCF. Most of employers agreed to the contribution to the WCF and suggested that more workplaces should contribute to the WCF, especially the Construction industry, to enlarge the WCF and more employees would benefit from the WCF. For the SSF, spending was reimbursed most on the Sickness benefit. Data from the NSO showed that outpatient services were utilized more by insured persons in Electricity, Gas, and Water industries (OR = 2.22) and Construction industry (OR = 1.90), as compared to the reference group (Agriculture, Hunting and Logging, and Fishing industries (OR = 1.00)). For inpatient services, insured persons in most of the industries utilized the service less than the reference group. For dental services, insured persons in most industries utilized the service less than the reference group except for those working in private home (OR = 2.38) utilized the service greater than the reference group. Therefore, this may indicate the moral hazard between insured persons in different industries to use the benefit from the SSF. In addition, from the interview, most of the employers suggested the SSO to improve the quality and quantity of medical services of both private and public hospitals. Therefore, the service quality should be better controlled. And, if the government would provide medical services for their sickness, there should be more public hospitals with improved quality to better serve insured persons. In addition, employers suggested the SSO to effectively administer the SSF to be able to benefit the old-aged insured persons.

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