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Abstract

Before Thailand implemented the Universal Coverage Scheme (UCS) in 2002, 18 million people were uninsured. Thus, this study assessed the impact of the UCS on healthcare utilization by investigating the changes in health-seeking behavior among the previously uninsured before and after UCS. Using the nationwide Health and Welfare Survey data of 2001 and 2003–2005, multinomial logistic regression and mixed-effects multinomial logistic regression were used to investigate the relationship between health-seeking behavior and individual characteristics, and how the relationship changed over time. The study findings indicated that the UCS significantly increased utilization of public facility care and simultaneously decreased utilization of informal care. The observed changes were more significant in lower income, female, lower educated, and married people. But, there was no significant change in utilization of private facility care after the UCS. The changes in health-seeking behavior among lower income people from informal care requiring fully out-of-pocket (OOP) payment into public facility care requiring no or minimum OOP payment implied that UCS contributed to financial protection and equity in healthcare utilization. It also contributed to safety in healthcare utilization by decreasing the utilization of informal care which had the potential risk from inaccurate self-diagnosis and treatment. However, more than 50% of the beneficiaries still utilized care outside the UCS service boundary, which might be due to insufficient healthcare resources in public sector. Thus, the UCS should continue an effort to improve the infrastructure in public sector and to encourage the involvement of private sector in the scheme.

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