

@mastersthesis {6696,
	title = {The impact of the universal coverage policy on equity of the {Thai} health care system},
	year = {2008},
	note = {U500763},
	school = {University of London, London School of Hygiene and Tropical Medicine (United Kingdom)},
	type = {phdPh.{D}.},
	address = {Ann Arbor},
	abstract = {{\textless}p {\textgreater}In 2001, the government of Thailand implemented a policy on universal coverage (UC) in access to health care by introducing a tax-funded health insurance scheme or {\^a}{\textquestiondown}{\textquestiondown}the UC scheme{\^a}{\textquestiondown}{\textquestiondown} to approximately 47 million people who were not beneficiaries of the Civil Servant Medical Benefit Scheme (CSMDB) or the Social Security Scheme (SSS).{\^A} The instigation of the UC scheme resulted in considerable changes in health financing arrangements and reduction in financial barriers to health services.{\^A} This research explored the impact of the UC policy on health service use, equity in health care finance, and the distribution of government subsidies for health gained by different socio-economic groups. The sensitivity of conclusions to choice of socio-economic group indicator (household income per capita or an asset index), and use of aggregate or regional unit subsidies to calculate benefit incidence, was also explored. {\textless}p {\textgreater}Two nationally representative household surveys were mainly used for the analyses of equity and distribution of government subsidies.{\^A} The effectiveness of the UC policy in protecting households against financial hardship was explored through two case studies of expensive medical services: renal replacement therapy (RRT) for end-stage renal disease (ESRD) and cardiac operations for heart disease patients. {\textless}p {\textgreater}Results show that the UC policy expanded health insurance coverage to nearly all Thais and enhanced the pro-poor nature of the Thai health care system.{\^A} The poorest quintiles gained the highest amount and share of government subsidies prior to and after UC.{\^A} Choice of socio-economic indicator or different levels of unit government subsidies did not significantly affect the distribution of government subsidies among different socio-economic groups.{\^A} The analysis of financing incidence between 2000 an 2002 showed a greater decrease in household expenditure among poorer quintiles, and a slight decrease in catastrophic incidence. {\textless}p {\textgreater}The decision not to include RRT into the UC benefit package resulted in a significant financial barrier and a substantial economic impact on poor ESRD patients, their families and relatives.{\^A} Financial barriers prevented poor ESRD patients from accessing essential health services, and the financial burden of RRT meant all poor patients faced financial catastrophe.},
	keywords = {0501:Economics, 499190, Bibliographies, economics, Psychology{\textendash}Abstracting, Social sciences, Statistics},
	url = {http://search.proquest.com/docview/899722357?accountid=14270},
	author = {Prakongsai, P}
}
