Elderly health welfare in Thailand

Abstract

The objectives of this study are to analyze health expenditure and the utilization by the Thai elderfy of health services provided under the Public Assistance Scheme and to develop an optimal elderly health welfare policy. The study analyzed data on elderly health expenditure and utilization in terms of equity by using Lorenz curve, the Gini coefficient and correlation coefficient based on data for 1997-1998 fiscal years from the Office of Health Insurance, MOPH. In addition, the experience of health welfare for the elderly in Singapore, Japan, and the United states were compared to Thailand's own situation to help determine possible policy options for health welfare for the Thai elderly. The results of the study show that the distribution of elderly health expenditure and utilization under the Public Assistance Scheme is slightly associated with the incidence of poverty across provinces. The correlation between the incidence of poverty and elderly health expenditure in 1997 is positive but the true coefficient is not significantly different from zero. The correlation become negative in 1998 but again the true coefficient is not significantly different from zero. The Ginicoefficients of expenditure and utilization show that there is more inequality in the distribution of health expenditure than in utilization. The Lorenz curve is not far from the line of perfect equality for both expenditure and utilization. In summary, this study has found that distribution of elderly health expenditure and utilization is not based on incidence of poverty. This implies that the provinces with greater health needs do not receive a greater share of the expenditure from this Public Assistance Scheme. The review of health welfare policy indicates that the older population has been increasing rapidly in all countries. Aging does not affect a country's overall health care expenditures but the elderly do claim a growing share of overall resources. The United States and Japan are searching for cost-saving measures while Singapore has achieved a balanced through savings orientation. The recommendations for policy options are: 1) modernize and reform health welfare for the elderly under the Public Assistance Scheme. the budget allocation should be associated with poverty that varies across provinces, 2) establish a Health and Medical Service Law for the elderly and unify all of the eldrly from various schemes into this program, introduce Medical savings accounts with the aim of promoting individual responsibility for maintaining good health and help people build up financial resources to create the means to pay for medical care during illnesses including explicit link to any pro poor elements.