Explanation of Inequality in Utilization of Ambulatory Care Before and After Universal Health Insurance in Thailand

Health Policy and Planning, August 2010

10 Pages Posted: 30 Oct 2010 Last revised: 12 Aug 2014

See all articles by Vasoontara Yiengprugsawan

Vasoontara Yiengprugsawan

Australian National University (ANU)

Gordon A. Carmichael

Australian National University (ANU)

Lynette L. Y. Lim

Australian National University (ANU) - Main

Sam-Ang Seubsman

Australian National University (ANU)

Adrian Sleigh

Australian National University (ANU) - National Centre for Epidemiology and Population Health

Date Written: August 24, 2010

Abstract

Thailand implemented a Universal Coverage Scheme (UCS) of national health insurance in April 2001 to finance equitable access to health care. This paper compares inequalities in health service use before and after the UCS, and analyses the trend and determinants of inequality. The national Health and Welfare Surveys of 2001 and 2005 are used for this study. The concentration index for use of ambulatory care among the population reporting a recent illness is used as a measure of health inequality, decomposed into contributing demographic, socio-economic, geographic and health insurance determinants. As a result of the UCS, the uninsured group fell from 24% in 2001 to 3% in 2005 and health service patterns changed. Use of public primary health care facilities such as health centres became more concentrated among the poor, while use of provincial/general hospitals became more concentrated among the better-off. Decomposition analysis shows that the increasingly common use of health centres among the poor in 2005 was substantially associated with those with lower income, residence in the rural northeast and the introduction of the UCS. The increasing use of provincial/general hospitals and private clinics among the better-off in 2005 was substantially associated with the government and private employee insurance schemes. Although the UCS scheme has achieved its objective in increasing insurance coverage and utilization of primary health services, our findings point to the need for future policies to focus on the quality of this primary care and equitable referrals to secondary and tertiary health facilities when required.

Keywords: Health Services Research, Health Care Utilization, Health Inequalities, Universal Health Insurance, Decomposition, Thailand

JEL Classification: I00, I30

Suggested Citation

Yiengprugsawan, Vasoontara and Carmichael, Gordon A. and Lim, Lynette L. Y. and Seubsman, Sam-Ang and Sleigh, Adrian, Explanation of Inequality in Utilization of Ambulatory Care Before and After Universal Health Insurance in Thailand (August 24, 2010). Health Policy and Planning, August 2010, Available at SSRN: https://ssrn.com/abstract=1700053

Vasoontara Yiengprugsawan (Contact Author)

Australian National University (ANU) ( email )

Canberra, Australian Capital Territory 2601
Australia

Gordon A. Carmichael

Australian National University (ANU) ( email )

Canberra, Australian Capital Territory 2601
Australia

Lynette L. Y. Lim

Australian National University (ANU) - Main ( email )

Canberra, Australian Capital Territory 2601
Australia

Sam-Ang Seubsman

Australian National University (ANU) ( email )

Canberra, Australian Capital Territory 2601
Australia

Adrian Sleigh

Australian National University (ANU) - National Centre for Epidemiology and Population Health ( email )

Canberra, Australian Capital Territory
Australia

Do you have negative results from your research you’d like to share?

Paper statistics

Downloads
29
Abstract Views
632
PlumX Metrics