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Funding, Coverage, and Access Under Thailand’s Universal Health Insurance Program: An Update After Ten Years

Abstract

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.

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Notes

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    200 Health officials to discuss medical cost sharing. The Nation. 15 July 2014. Retrieved from http://www.nationmultimedia.com/national/200-health-officials-to-discuss-medical-cost-shari-30238529.html.

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Disclosure

No external funding was received for the conduct of this study and/or preparation of this manuscript. Both authors have no conflicts of interest to declare.

Author contributions

Kannika Damrongplasit was the main researcher of this study. Her responsibilities included obtaining the data, conducting empirical analysis, interpreting the results as well as writing up the manuscript. Professor Glenn Melnick helped with the study concept and design, as well as writing up the manuscript. Revision of the manuscript was done by both authors. Kannika Damrongplasit is the guarantor for the overall content of the manuscript.

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Correspondence to Kannika Damrongplasit.

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Damrongplasit, K., Melnick, G. Funding, Coverage, and Access Under Thailand’s Universal Health Insurance Program: An Update After Ten Years. Appl Health Econ Health Policy 13, 157–166 (2015). https://doi.org/10.1007/s40258-014-0148-z

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Keywords

  • Inpatient Care
  • Health Insurance Coverage
  • Contact Rate
  • Universal Health Insurance Coverage
  • Informal Payment