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. 2021 Jul 19;105(3):837-845.
doi: 10.4269/ajtmh.20-1627.

Disparities in Physical Accessibility among Rural Thais Under Universal Health Coverage

Rattanakarun Rojjananukulpong  1 , Mokbul Morshed Ahmad  1 , Shahab E Saqib  2
Affiliations

Disparities in Physical Accessibility among Rural Thais Under Universal Health Coverage

Rattanakarun Rojjananukulpong et al. Am J Trop Med Hyg. .

Abstract

This study aims to explore various barriers in accessing outpatient care among the participants from different age groups and to identify determinants associated with physician visits. The study had adopted Andersen's Behavioral Model (ABM) of Health Services Use. A cross-sectional study design was adopted to collect data from 417 participants through a questionnaire survey. Poisson regression models were used to explore determinants for explaining the differences in outpatient care use. The regression results revealed that divergent relationships existed among age groups. Children and elderly participants tended to decrease the probability of seeking care. Elderly participants confronted more difficulties in access and were dependent on family members. Despite free care provisions, participants visited and spent their out-of-pocket expenditure mostly at non-universal health coverage (non-UHC) facilities. Convenience and the availability of specialist physicians led the higher-income parents to seek care of their children at non-UHC facilities. Highly educated people of working age preferred more self-care or institutionalized care to save time. Children up to the primary level of education were more likely to visit a doctor. We concluded that investments in education or well-informed health services provision would improve health care utilization. Findings of Andersen's Behavioral Model variables suggested that improvements in the quality of services, medical professional skills, and efficient resource allocation may induce seeking care at UHC facilities. Consequently, it will reduce the number of referred cases, caseloads at tertiary care units, and visits to non-UHC facilities at longer distances.

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Figures

Figure 1.
Figure 1.
Percentage distribution of participants by income versus age groups.
Figure 2.
Figure 2.
Number of participants who used to obtain outpatient care at other health care units.
Figure 3.
Figure 3.
Accessibility problems to Tambon Health Promoting Hospitals and District hospitals.
See this image and copyright information in PMC

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