RESUMEN
The goal of Universal Health Coverage (UHC) is that everyone needing healthcare can access quality services without financial hardship. Recent research covering countries with UHC systems documents the emergence, and acceleration following the COVID-19 pandemic of unapproved informal payment systems by providers that collect under-the-table payments from patients. In 2001, Thailand extended its '30 Baht' government-financed coverage to all uninsured people with little or no cost sharing. In this paper, we update the literature on the performance of Thailand's Universal Health Coverage Scheme (UCS) with data covering 2019 (pre-COVID-19) through 2021. We find that access to care for Thailand's UCS-covered population (53 million) is similar to access provided to populations covered by the other major public health insurance schemes covering government and private sector workers, and that, unlike reports from other UHC countries, no evidence that informal side payments have emerged, even in the face of COVID-19 related pressures. However, we do find that nearly one out of eight Thailand's UCS-covered patients seek care outside the UCS delivery system where they will incur out-of-pocket payments. This finding predates the COVID-19 pandemic and suggests the need for further research into the performance of the UHC-sponsored delivery system.
Asunto(s)
COVID-19 , Accesibilidad a los Servicios de Salud , SARS-CoV-2 , Cobertura Universal del Seguro de Salud , Humanos , Tailandia , COVID-19/economía , Cobertura Universal del Seguro de Salud/economía , Accesibilidad a los Servicios de Salud/economía , Gastos en Salud/estadística & datos numéricos , Financiación Personal/economía , Pandemias/economíaRESUMEN
In 2007, Thailand's Civil Servant Medical Benefit Scheme (CSMBS), one of the three main public health insurers, adopted a new payment mechanism for hospital admission. There has been a shift from fee-for-service toward Diagnostic Related Group (DRG)-based payment that transfers financial risk from the government to health care providers. This study investigates the effects of this policy change on hospital admission, frequency of admission, length of stay (LOS), type of hospital admitted, and out-of-pocket (OOP) inpatient medical expenditure. By employing nationally representative micro-level data (Health and Welfare surveys) and difference-in-difference approach, this study finds a 1 percentage point decline in hospitalization, a 10% higher chance of admission at community hospitals (the lowest level inpatient public health care facility), and a 7% less chance of admission at higher level public health care facilities like general hospitals. No significant change was observed in LOS, frequency of admission, or OOP inpatient medical expenditure associated with the post-2007 payment mechanism change. Our results emphasize the effectiveness of a close-ended payment mechanism for health care in developing countries. This study also adds to the limited literature on using micro-level data to investigate payment mechanism change in the context of low- and middle-income countries.
Asunto(s)
Reforma de la Atención de Salud , Hospitalización , Gastos en Salud , Hospitales , Humanos , TailandiaRESUMEN
We examined the role of billing processes in health care utilization by exploiting a shift in provider payment from fee-for-service reimbursement towards fee-for-service direct disbursement for outpatient services in Thailand. Specifically, prior to October 2006, affected patients had to pay the full cost of outpatient treatment and subsequently received reimbursement; thereafter, these payments can be sent directly to the providers, without patients having to pay anything upfront. By using nationally representative micro-data and a difference-in-difference methodology, we show that the direct disbursement policy leads to an increase in outpatient utilization among the sick. This non-price change has long-lasting impacts and particularly increases the health care utilization of sick individuals who are living in rural areas, are less educated and earn low incomes. These findings suggest that direct disbursement helps to increase liquidity constraint individuals' health care utilization. The results emphasize the effectiveness of behavioural interventions in health policy making.
Asunto(s)
Atención Ambulatoria , Planes de Aranceles por Servicios , Humanos , Aceptación de la Atención de Salud , TailandiaRESUMEN
This paper uses the Bhutan Living Standards Survey 2012 to assess factors that affect the decision to use outpatient care when ill, outpatient utilization choice, and bypassing decision. Our attention is placed on geographical factors because of the unique geographical landscape in Bhutan, which may act as an important barrier for access to care in the country. We further analyze the pattern of multiple healthcare visits of individuals with the same health symptom. The methods employed for this study consist of binary logit and multinomial logit regressions as well as descriptive statistical approach. The results show that living in rural area, longer travel time, and residing in remote area reduce the chance of receiving formal care when ill, and among those who get formal treatment, these factors lead to higher tendency of visiting primary healthcare facilities and less propensity of getting care from secondary and tertiary providers. We also find that people with lower economic status have less access to care than their richer counterparts. By investigating the pattern of multiple outpatient visits, our analysis reveals incidence of bypassing primary care to higher level of care in Bhutan. There is also evidence of moving up to higher level of care during subsequent visits but in general people are very persistent in their provider choice.
Asunto(s)
Toma de Decisiones , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Población Rural , Adulto , Atención Ambulatoria/estadística & datos numéricos , Bután , Conducta de Elección , Humanos , Persona de Mediana Edad , Modelos Econométricos , Factores Socioeconómicos , Medicina Estatal , Factores de Tiempo , ViajeRESUMEN
BACKGROUND: In 2001, Thailand implemented a universal coverage program by expanding government-funded health coverage to uninsured citizens and limited their out-of-pocket payments to 30 Baht per encounter and, in 2006, eliminated out-of-pocket payments entirely. Prior research covering the early years of the program showed that the program effectively expanded coverage while a more recent paper of the early effects of the program found that improved access from the program led to a reduction in infant mortality. OBJECTIVE: We expand and update previous analyses of the effects of the 30 Baht program on access and out-of-pocket payments. DATA AND METHODS: We analyze national survey and governmental budgeting data through 2011 to examine trends in health care financing, coverage and access, including out-of-pocket payments. RESULTS: By 2011, only 1.64 % of the population remained uninsured in Thailand (down from 2.61 % in 2009). While government funding increased 75 % between 2005 and 2010, budgetary requests by health care providers exceeded approved amounts in many years. The 30 Baht program beneficiaries paid zero out-of-pocket payments for both outpatient and inpatient care. Inpatient and outpatient contact rates across all insurance categories fell slightly over time. CONCLUSIONS: Overall, the statistical results suggest that the program is continuing to achieve its goals after 10 years of operation. Insurance coverage is now virtually universal, access has been more or less maintained, government funding has continued to grow, though at rates below requested levels and 30 Baht patients are still guaranteed access to care with limited or no out-of-pocket costs. Important issues going forward are the ability of the government to sustain continued funding increases while minimizing cost sharing.
Asunto(s)
Reforma de la Atención de Salud/tendencias , Política de Salud/tendencias , Atención no Remunerada/tendencias , Cobertura Universal del Seguro de Salud/tendencias , Seguro de Costos Compartidos/economía , Seguro de Costos Compartidos/tendencias , Países en Desarrollo , Financiación Gubernamental/economía , Financiación Gubernamental/tendencias , Financiación Personal/economía , Financiación Personal/tendencias , Reforma de la Atención de Salud/economía , Política de Salud/economía , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Beneficios del Seguro/economía , Beneficios del Seguro/tendencias , Pacientes no Asegurados/estadística & datos numéricos , Tailandia , Atención no Remunerada/economía , Cobertura Universal del Seguro de Salud/economíaRESUMEN
OBJECTIVES: This study investigates the importance of medical fee and distance to health care provider on individual's decision to seek care in developing countries. METHODS: The estimation method used a mixed logit model applied to data from the third wave of the Indonesian family life survey (2000). The key variables of interest include medical fee and distance to different types of health care provider and individual characteristic variables. RESULTS: Urban dweller's decision to choose health care providers are sensitive to the monetary cost of medical care as measured by medical fee but they are not sensitive to distance. For those who reside in rural area, they are sensitive to the non-medical component cost of care as measured by travel distance but they are not sensitive to medical fee. CONCLUSIONS: As a result of those findings, policy makers should consider different sets of policy instruments when attempting to expand health service's usage in urban and rural areas of Indonesia. To increase access in urban areas, we recommend expansion of health insurance coverage in order to lower out-of-pocket medical expenditures. As for rural areas, expansion of medical infrastructures to reduce commuting distance and costs will be needed to increase utilization.
Asunto(s)
Servicios de Salud/estadística & datos numéricos , Cobertura del Seguro , Seguro de Salud , Población Rural , Población Urbana , Adulto , Recolección de Datos , Femenino , Humanos , Indonesia , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Adulto JovenRESUMEN
Efforts by countries to attain universal coverage are often hampered by supply constraints that can reduce access to care for those already in the system and, in many Asian and developing countries, by the emergence of informal payment systems that extract under-the-table payments from patients. In 2001, Thailand extended government-financed coverage to all uninsured people with little or no cost sharing. We found that Thailand has added nearly fourteen million people to the system and achieved near-universal coverage without compromising access for those with prior coverage; we also found that, to date, no informal payment system has emerged.