The impact of Universal Health Coverage on health care consumption and risky behaviours: evidence from Thailand

Ghislandi, Simone; Manachotphong, Wanwiphang; Perego, Viviana Maria Eugenia

doi:10.1017/s1744133114000334

Cited by 32 publications

(25 citation statements)

References 28 publications

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“…Since the achievement of UHC in Thailand in 2002, several evaluations have reported substantial improvement in the health status [4, 5], overall use of health services [6, 7], preventive activities [8], and reduction in catastrophic health expenditure and medical impoverishment [9, 10]. To our knowledge, there is only one study from Japan reporting the long-term impact of UHC on mortality; however, without assessment across geographical areas [11].…”

Section: Introductionmentioning

confidence: 99%

Post universal health coverage trend and geographical inequalities of mortality in Thailand

Aungkulanon

Tangcharoensathien

Shibuya

et al. 2016

Int J Equity Health

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BackgroundThailand has achieved remarkable improvement in health status since the achievement of universal health coverage in 2002. Health equity has improved significantly. However, challenges on health inequity still remain.This study aimed to determine the trends of geographical inequalities in disease specific mortality in Thailand after the country achieved universal health coverage.MethodsNational vital registration data from 2001 to 2014 were used to calculate age-adjusted mortality rate and standardized mortality ratio (SMR). To minimize large variations in mortality across administrative districts, the adjacent districts were systematically grouped into “super-districts” by taking into account the population size and proximity. Geographical mortality inequality among super-districts was measured by the coefficient of variation. Mixed effects modeling was used to test the difference in trends between super-districts.ResultsThe overall SMR steadily declined from 1.2 in 2001 to 0.9 in 2014. The upper north and upper northeast regions had higher SMR whereas Greater Bangkok achieved the lowest SMR. Decreases in SMR were mostly seen in Greater Bangkok and the upper northern region. Coefficient of variation of SMR rapidly decreased from 20.0 in 2001 to 12.5 in 2007 and remained close to this value until 2014. The mixed effects modelling revealed significant differences in trends of SMR across super-districts. Inequality in mortality declined among adults (≥15 years old) but increased in children (0–14 years old). A declining trend in inequality of mortality was seen in almost all regions except Greater Bangkok where the inequality in SMR remained high throughout the study period.ConclusionsA decline in the adult mortality inequality across almost all regions of Thailand followed universal health coverage. Inequalities in child mortality rates and among residents of Greater Bangkok need further exploration.

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Section: Introductionmentioning

confidence: 99%

Post universal health coverage trend and geographical inequalities of mortality in Thailand

Aungkulanon

Tangcharoensathien

Shibuya

et al. 2016

Int J Equity Health

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show abstract

“…The causes for the differences between INA-CBG payment and hospital rates should be investigated, especially in anticipation of an increase in NHI patient visits to the hospital. Moreover, the fact that hospitalization will increase and that reporting of minor illnesses will decrease (although not significantly) among rural residents actually supports the idea that UHC benefits the poor more [2]. Table 2 shows that the total acceptance of service cost increased by IDR 99,034,017.…”

Section: Resultsmentioning

confidence: 85%

Strategic Efforts of X Hospital Towards Universal Health Coverage in 2019

Haniputra¹,

Ayuningtyas²,

Aljauza³

2018

KLS

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With the change in payment system from retrospective to prospective for National Health Insurance (NHI) patients, X Hospital must perform strategic efforts for managing the acceptance of service cost (46%) and facility cost (54%) for every Indonesia Case-Based Group (INA-CBG) payment. This study aimed to describe the difference in service cost and facility cost acceptance based on the hospital's billing and INA-CBG payment plus additional costs for patients with wards of an upgraded class, and it also describes X Hospital's strategic efforts toward universal health coverage (UHC).This study has an observational-descriptive design, and it collects quantitative and qualitative data. For this purpose, a total of 432 hospital bills and INA-CBG payments for NHI inpatients in January-February 2016 are collected, and in-depth interviews with several participants from the management, service providers, and administration are conducted. The results show that the total payment acceptance of INA-CBG plus additional costs is lower than the hospital's billing. The total service cost acceptance increased by IDR 99,034,017.00. The highest increase came from the internist ward and the highest decrease, from the obstetric ward. The total facility cost acceptance decreased by IDR 279,521,491.00. All wards showed a decrease, with the highest decrease coming from the internist ward. The proportion of service and facility costs must be balanced with behavior management of healthcare providers, arrangement of clinical pathways, optimization of various costs without reducing the quality of care, providing the hospital's formulary and ensuring usage of drugs and medical devices, and using the hospital management and information system to improve efficiency.By doing so, X Hospital will become ready to provide high-quality healthcare services under UHC.

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“…Studies in Thailand have supported the notion that universal health coverage increases healthcare utilisation in terms of hospital admissions and outpatient visits [14, 20]. This finding could reflect that patients, as consumers, may not be concerned about the cost associated with healthcare, which leads to the overuse of healthcare services [21].…”

Section: Discussionmentioning

confidence: 98%

“…After more than one decade of launching universal health coverage in Thailand, several studies published recently have focused on: (i) coverage, effectiveness, and economic evaluation of universal health coverage [7–11]; (ii) impacts of universal health coverage on other aspects of health and the health system [12–14]; and (iii) universal health coverage of specific health conditions (e.g., prevention of diabetes mellitus, and renal dialysis) [15, 16]. …”

Section: Introductionmentioning

confidence: 99%

Patients’ perspectives regarding hospital visits in the universal health coverage system of Thailand: a qualitative study

Wattanapisit

Saengow

2018

Asia Pac Fam Med

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BackgroundA universal health coverage policy was implemented in Thailand in 2002 and led to an increase in accessibility to, and equity of, healthcare services. The Thai government and academics have focused on the large-scale aspects, including effectiveness and impacts, of universal health coverage over one decade. Here, we aimed to identify patients’ perspectives on hospital visits under universal health coverage.MethodsA qualitative study was carried out in four public hospitals in rural Thailand. We collected data through focus group discussions (FGDs) and in-depth interviews (IDIs). The semi-structured interview guide was designed to elicit perspectives on hospital visits among participants covered by the Universal Coverage Scheme, Social Security Scheme or Civil Servant Medical Benefit Scheme. Data were transcribed and analysed using a thematic approach.ResultsTwenty-nine participants (mean age, 56.76 ± 16.65 years) participated in five FGDs and one IDI. The emerging themes and sub-themes were identified. Factors influencing decisions to visit hospitals were free healthcare services, perception of serious illness, the need for special tests, and continuity of care. Long waiting times were barriers to hospital visits. Employees, who could not leave their work during office hours, could not access some services such as health check-ups. From the viewpoint of participants, public hospitals provided quality and equitable healthcare services. Nevertheless, shared decision making for treatment plans was not common.ConclusionsThe factors and barriers to utilisation of healthcare services provide exploratory data to understand the healthcare-seeking behaviours of patients. Perceptions towards free services under universal health coverage are positive, but participation in decision making is rare. Future studies should focus on finding ways to balance the needs and barriers to hospital visits and to introduce the concept of shared decision making to both doctors and patients.

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The impact of Universal Health Coverage on health care consumption and risky behaviours: evidence from Thailand

Cited by 32 publications

References 28 publications

Post universal health coverage trend and geographical inequalities of mortality in Thailand

Post universal health coverage trend and geographical inequalities of mortality in Thailand

Strategic Efforts of X Hospital Towards Universal Health Coverage in 2019

Patients’ perspectives regarding hospital visits in the universal health coverage system of Thailand: a qualitative study

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