

@mastersthesis {6469,
	title = {Community financing: the urban health card in {Chiangmai}, {Thailand}},
	year = {1991},
	note = {U555761},
	school = {University of London, London School of Hygiene and Tropical Medicine (United Kingdom)},
	type = {phdPh.{D}.},
	address = {Ann Arbor},
	abstract = {Urbanization and health of the urban poor in developing countries is an issue of growing importance. There is little research on the financing of urban health. The health card project, a voluntary community-based prepaid health insurance scheme was implemented for three years in two slums of Chiangmai, Thailand. 723 individuals from 179 households with different types of health insurance were non-proportionately randomly selected in order to examine their socio-economic characteristics, morbidity, consultation patterns, household expenses on health and demand for the health card. {\textless}p{\textgreater} A health interview survey, participatory observation, in-depth interviews and document analysis at the community and health providers were used. {\textless}p{\textgreater} The 20\&\#37 poorest in the slums earned 8\&\#37 and the 20\&\#37 richest earned 38\&\#37 of the total income. Slum dwellers had a lower income, higher morbidity, less consultation with physicians, and spent a higher proportion of household income on health than their counterparts outside slums. {\textless}p{\textgreater} Prevalence of acute and chronic illness in two-week period was 22.6\&\#37 and 25.4\&\#37 respectively. Per capita household expense on health was 21.3 Baht or 3\&\#37 of income in the last two weeks, mainly for chonic illness consultation. For acute illness, self-prescribed drugs and private clinics were commonly used. Insurance coverage did not relieve the household{\textquoteright}s financial burden as patients preferred to use private curative services not covered by the insurance scheme. {\textless}p{\textgreater} Future demand for the health card was governed by past experience and use of the health card. Potential card holders tend to be the ill and users of the card. This {\textquoteleft}selection bias{\textquoteright} decreases the enrolment rate and risk sharing. The scheme is thus financially non-sustainable although the average annual use rate was 1.2-1.5 services per card in three years. Despite this, it is recommended that the scheme continues to be subsidized as an alternative measure until a formal social security scheme is implemented to cover the urban poor engaged in the informal sector. The project{\textquoteright}s strength is in its potential as a community development approach to health.},
	keywords = {(UMI)AAIU555761, 0630:Public policy, Bibliographies, Psychology{\textendash}Abstracting, Public policy, Social sciences, Statistics},
	url = {http://search.proquest.com/docview/899770448?accountid=14270},
	author = {Tangcharoensathien, V}
}
