Abstract
This study analyses urban and rural health service use before and after the introduction of the Universal Coverage Scheme (UCS). Using data from the Thai national health surveys of 2001 and 2005, the study utilises age–sex adjusted concentration indices to measure within-area differences in use of health services among populations distinguished by socioeconomic status. Between 2001 and 2005, the UCS substantially reduced Thailand’s uninsured population (from 42.5% to 7.0% in urban areas and from 24.9% to 2.7% in rural areas). The implementation of the UCS changed patterns of health services use, particularly for rural people and the urban poor, by placing greater emphasis on primary healthcare. Relevant policy recommendations should focus on continued improvement of primary health services, and ensuring adequate and timely referrals to secondary and tertiary health services when the need arises.
Highlights
Population health and economic development have improved significantly in many developing countries over the past three decades
Using data from the Thai national health surveys of 2001 and 2005, we analyse urban and rural health service utilisation for recent illness and non-maternity conditions requiring hospital admission before and after the introduction of the Universal Coverage Scheme (UCS), and provide evidence to assess the impact of this health insurance initiative on socioeconomic inequalities in health service use in urban and rural areas
Single persons were substantially more common in urban than in rural areas, and urban respondents were more likely to live in households of 1–2 persons and less likely to live in households with three or more, and especially five or more, family members
Summary
Population health and economic development have improved significantly in many developing countries over the past three decades. Using data from the Thai national health surveys of 2001 and 2005, we analyse urban and rural health service utilisation for recent illness and non-maternity conditions requiring hospital admission before and after the introduction of the Universal Coverage Scheme (UCS), and provide evidence to assess the impact of this health insurance initiative on socioeconomic inequalities in health service use in urban and rural areas. As part of an epidemiological transition, Thailand has moved on from having high levels of maternal and infant mortality and poverty-related disease to a new set of emerging health problems that include chronic diseases and injuries. The infant mortality rate has dropped by half in the past 20 years it has fallen more slowly in rural areas, so that the rural–urban ratio has widened from 1.3 times in 1964 to 1.5 times in 1985 and 1.8 times in 2005 (NSO, 2006)
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