Reducing Impoverishment Caused by Costly Health-Care Payments : Outcome of Universal Health Care Coverage in Thailand

The major aims of the universal health care coverage (UC) program initiated in Thailand in 2002 are not only to increase the access of people to essential health services, but also to reduce the financial risk they face due to out-of-pocket payments for health care. This study employed secondary data analysis of the Socio-Economic Survey (SES) conducted by the National Statistical Office of Thailand to estimate the number of households becoming impoverished because of the payments for health care they had to make before implementation of the UC policy (1996, 1998, 2000, and 2002) and thereafter (2004, 2006, 2007, and 2008), and to compare the findings with a counter-factual UC-absent scenario, using segmented linear regression analysis. At the national, regional, and provincial levels, the proportions of households falling below the poverty line declined gradually during the study periods. Without the 2002-UC, a total of 100,604 households nationwide would be impoverished by out-of-pocket payments for health care in 2008. The UC policy in the same year could reduce the number of health-impoverished households by 37,628 (37.4%), which is equivalent to 0.2 percent of 19 million households nationwide. The health insurance system design that takes into account both “breadth” (that is, the number of the population covered) and the benefit package’s “depth” dimensions, which provide better financial risk protection and prevent households from falling into the poverty trap due to the necessity of making costly health expenditures