Impoverishment associated with out-of-pocket health care spending and access to health care in Thailand's 4 regions pre and post Universal Coverage implementation

Abstract

Thailand introduced universal coverage (UC) aiming to ensure people accessing to health services and to reduce their burden of health care cost. This study aimed to analyze the change after implementation of universal coverage scheme in terms of poverty impact from health care payments and access to health care in Thailand’s 4 regions. The study used data from Socio-Economic Surveys (SES) in year 2001, 2006 and 2009, and Health and Welfare Surveys (HWS) in year 2001 and 2009. This study measured impoverishment from health care payments by calculating poverty headcounts and poverty gap. Logistic regression models were used to find determinants of poverty due to health care payments and health care utilization. The results indicate that after UC implementation, poverty impact due to health care payments declined gradually over time; in addition, health care utilization of insured people when they were ill increased as well. However, North and Northeast obviously still had greater poverty impact from health care more than Central and South. This can partly indicate that UC still had limitations. Household size, number of elderly, number of children, age of the head, living standards, medical expenses, and health insurance correlated with poverty due to health care payments similarly in every region. For determinants of health care utilization, the likelihood of health service use increased in individuals increasing in age, family size, and covered by health insurance especially Civil Servants Medical Benefits Scheme (CSMBS). Individuals who married, higher education and working in agricultural industry were less likely to use health service.