Abstract:
Thailand launched the Universal Coverage Scheme (UCS) in 2001 and most studies are focusing on the impact of the UCS on healthcare utilization and out-of-pocket (OOP) expenditure. None of the studies, however, examines healthcare utilization and OOP expenditure across the three main public health insurance schemes, i.e. UCS, Social Security Scheme (SSS), and Civil Servant Medical Benefit Scheme (CSMBS). Therefore, this study aims to examine the impact of health insurance status and use of health insurance on outpatient service utilization and healthcare OOP expenditure by using the 2017 Health and Welfare Survey data. Given large income and other disparities across Thailand’s regions, regional differences are also explored. The study employed a multinomial logit model for the analysis of healthcare utilization and a two–part model for the analysis of healthcare OOP expenditure. The results reveal that the SSS beneficiaries are more likely to seek care at healthcare facilities than the UCS beneficiaries, but this is only observed in the Bangkok and central region. The use of public health insurance is found to decrease the amount of OOP expenditure, conditional on incurring OOP, in case of total healthcare cost and direct medical cost, while it increases the amount of OOP expenditure in case of transportation cost. Individuals who use the UCS incur the lowest amount of OOP spending in terms of total healthcare cost, direct medical cost and transportation cost. In addition, people who live outside of Bangkok incur lower OOP for total healthcare cost and transportation cost than those living in Bangkok. Overall, the results suggest that the UCS is very successful in creating financial protection for the majority of Thai citizens. The area of residence is found to have an impact on both healthcare utilization, as well as probability of incurring OOP and amount of OOP expenditure. These findings raise some concerns about the inequality across the three public health insurance schemes and the regional disparities in Thailand, which should be solved in order to increase equality in healthcare utilization across the Thai population.
