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Review
. 2024 May 13;9(5):e015179.
doi: 10.1136/bmjgh-2024-015179.

Utilisation, out-of-pocket payments and access before and after COVID-19: Thailand's Universal Health Coverage Scheme

Kannika Damrongplasit  1 , Glenn Melnick  2
Affiliations
Review

Utilisation, out-of-pocket payments and access before and after COVID-19: Thailand's Universal Health Coverage Scheme

Kannika Damrongplasit et al. BMJ Glob Health. .

Abstract

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.

Keywords: Health economics; Health insurance; Health policy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Contact rates by source of health insurance coverage, 2019 and 2021. Source/Notes: Author’s calculations using data from 2019 and 2021 Thailand Health and Welfare Surveys (HWS). CSMBS, Civil Servant Medical Benefit Scheme; SSS, Social Security Scheme; UCS, Universal Health Coverage Scheme.
Figure 2
Figure 2
Out-of-pocket payments by Universal Health Coverage Scheme (UCS) covered population to UCS designated providers, 2019 and 2021. Source/Notes: Author’s calculations using data from 2019 and 2021 Thailand Health and Welfare Surveys (HWS).
Figure 3
Figure 3
‘Leakage rate’—utilisation of non-Universal Health Coverage Scheme (UCS) providers by UCS members. Source/Notes: Author’s calculations using data from 2019 and 2021 Thailand Health and Welfare Surveys (HWS).
See this image and copyright information in PMC

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