Reducing Impoverishment from Health Payments : Impact of Universal Health Care Coverage in Thailand

Background: Thailand achieved universal health coverage (UHC) in 2002 by introducing a tax-financed health insurance scheme, the UHC scheme, to approximately 47 million of Thais. With the comprehensive benefit package and clear objectives in ensuring equitable access to essential health care, this study aims to assess the impact of UHC on household impoverishment due to direct payments for health care costs, especially the informal sector households.Methods: This study employed secondary data analysis of the nationally representative household surveys, Socio-Economic Survey: a) to estimate the number of households being impoverished by payments for health care prior to implementation of the UHC policy (1996, 1998, 2000, and 2002) and thereafter (2004, 2006, 2007, and 2008); and b) to compare findings with a counter-factual UHC-absent scenario, using segmented linear regression analysis. In addition, descriptive and difference-in-difference (DID) analysis of health impoverishment from health expenditure is employed.Findings: At the national, regional, and provincial levels, the proportions of households falling below the poverty line declined gradually during the studied periods. Without UHC in 2002, a total of 100,604 households nationwide would be impoverished by out-of-pocket payments for health care in 2008. The UHC 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 Thai households nationwide.Reduction in health-impoverishment in the informal sector and mixed groups was stronger than in the public sector. UHC-mitigated health impoverishment was also found at the sub-national level. Impoverishment in the poorest rural Northeast dropped from 3.4% in 1996 to 2.3-2.4% in 2002-04 and 0.8-1.3% in 2006-09.Conclusions: Comprehensive benefit package and zero copayment at point of services are key contributing factors in reducing health impoverishment. In addition, the extensive geographical coverage of health infrastructure, adequate finance and functioning primary healthcare are other contributing factors