Progress towards full financial risk protection in Thailand : A national and subnational assessment, 1996-2015

概要

Objective: After the achievement of universal health coverage (UHC) in 2002, the incidence of financial catastrophe due to healthcare is decreasing in Thailand. However, many Thai population still incur financial risk when they seek health services. This study estimated the levels and trends in three aspects of financial risk protection in Thailand: healthcare utilization, financial risks, and equity in the distribution of financial burden. The present study also investigated the determinants of healthcare utilization and financial risk.

Methods: Two nationally representative household surveys, the Household Socio-Economic Survey (SES) and the Health and Welfare Survey (HWS) for the period from 1996 to 2015, were used in this study. Utilization of health services and three health-related financial risk indicators—catastrophic payment, impoverishment, and fairness in financial contribution (FFC)—were considered as primary outcomes in this study. Bayesian hierarchical models were used to estimate the trend in mean proportion with 95% credible interval (CrI) of each outcome variable at the provincial, regional, and national levels. Bayesian hierarchical models were also used to identify the determinants of catastrophic health payments, impoverishment, and healthcare utilization.

Results: The incidence of catastrophic payment at the national level declined, regardless of residence (urban-rural) and household socioeconomic status, from 9.3% (95% CrI: 3.4%-20.0%) in 1996 to 1.4% (95% CrI: 0.7%-2.4%) in 2015. However, there was still an increase in catastrophic payment in some provinces and regions. A similar trend was observed for impoverishing health payments. Households of laborer, agriculture or entrepreneur and those with children under 5 and elderly aged 65 years and above were found to have had a higher probability of catastrophic payments or impoverishment. The FFC has improved at both national and regional level, reflecting more equitable health financing system in Thailand. Healthcare utilization decreased in 2007 and later increased again in 2015. Children aged 14 years and under and those aged 55 years and above had higher odds of utilizing the outpatient services.

Conclusion: Thailand has made substantial progress in both financial risk protection and fairness in financing contribution at the national level; however, this is not occurring uniformly across regions and provinces.