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Assessing the impact of a policy on universal coverage on financial risk protection, health care finance, and benefit incidence of the Thai health care systemPhusit Prakongsai, MDSupon Limwattananon, PhDWalaiporn Patcharanarumol, BSc MPHKanjana Tisayatikom, MPHViroj Tangcharoensathien, PhD
International Health Policy Program (IHPP) - Thailand
Presentation to the 6th IHEA World Congress9 July 2007, Copenhagen
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Outline of presentationBackgroundHealth insurance coverage after UC implementation in 2003Changes in health service use and benefit incidenceChanges in the incidence of catastrophic health paymentsDiscussion and conclusions
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Health care finance and service provisions of the Thai health care system after implementation of the universal coverage policy
General tax
General tax Standard Benefit package
Tripartite contributions Payroll taxes Risk related contributions Capitation Capitation & global Co-payment budget with DRG for IP Services
Fee for services Fee for services - OPPopulation PatientsMinistry of Finance - CSMBS(6 million beneficiaries)National Health Insurance Office The UC scheme (47 millions of pop.)Social Security Office - SSS(7 millions of formal employees)Voluntary private insurance Public & Private Contractor networks
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Methods and data sourcesBenefit incidence (BIA) and financial incidence analyses (FIA) were employed,
Two different approaches of BIA:Using household income per capita and asset indexes;Using aggregated and regional unit government subsidies.
Data sourcesNationally representative household surveys on health insurance coverage and health service use in the 2001 and 2003 HWS, National household surveys on household income and consumption expenditure,Unit government subsidies for public and private health care providers in 2001 & 2003.
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Health insurance coverage in 2003Source: The 2003 Health and Welfare Survey conducted by the National Statistical Office of Thailand (NSO)Note: PHI = private health insurance, UC = the UC scheme11Source: The 2003 Health and Welfare surveyNote: Q1 = the poorest quintile, Q5 = the richest quintile
Chart1
5.7
6.1
1.1
47.7
3.2
millinon population
3.2(5%)
47.7(75%)
1.1(2%)
6.1(10%)
5.7(9%)
gender
NO insuranceCSMBSSSSUCPrivateAll schemes
male1792235273409830455632375728848898331818167
female1266257298484127554132447392558595032066386
Total30584925718939580097648231213107493363884553
insurance scheme
NO insuranceCSMBSSSSUCPrivateAll schemes
male1,721,8602,580,1463,041,42122,932,017466,90230,742,346
female1,150,9842,791,5382,745,63323,289,321551,53730,529,013
2,872,8445,371,6845,787,05446,221,3381,018,43961,271,359
insurance scheme
NO insuranceCSMBSSSSUCPrivateAll schemes
male60%48%53%50%46%50%
female40%52%47%50%54%50%
100%100%100%100%100%100%
CSMBSSSSPHIUCUninsuredall schemes
48%53%46%50%60%50%
52%47%54%50%40%50%
total100%100%100%100%100%100%
gender
married status
insurance scheme
NO insuranceCSMBSSSSUCPrivate
CountCountCountCountCount
Single140366910025671335412972092431055112773123
couple21952375300988236900052075491430360629710782
widow31814222971892784911808991258882591981
divorce434806451736074932766413072481464
sparate54641253529829584197936004608696
used to married6159748353347414
unknown9924361261047613038
2622717440834054482243304809665912146186498
P&P services
NO insuranceCSMBSSSSUCPrivateAll schemes
P&P servicesno2,746,9315,041,4375,575,60143,749,380965,93458,079,283
immunization23,28631,45417,324981,38916,6541,070,107
ANC17,20317,63217,845176,018837229,535
family planning5,4986534,59876,465087,214
Post natal care2,5513,41716,92296,1450119,035
check up47,828166,63289,907728,26528,0841,060,716
Dental P&P14,86958,85627,111162,1232,799265,758
other14,68051,60337,746251,5524,130359,711
Total2,872,8465,371,6845,787,05446,221,3371,018,43861,271,359
no P&P2,746,9315,041,4375,575,60143,749,380965,93458,079,28395%
got P&P125,915330,247211,4532,471,95752,5043,192,0765%
total2,872,8465,371,6845,787,05446,221,3371,018,43861,271,359100%
% got P&P4%10%7%77%2%100%
NO insuranceCSMBSSSSUCPrivateAll schemes
not get any P&P services96%94%96%95%95%95%
immunization1%1%0%2%2%2%
ANC1%0%0%0%0%0%
family planning0%0%0%0%0%0%
Post natal care0%0%0%0%0%0%
check up2%3%2%2%3%2%
Dental P&P1%1%0%0%0%0%
other1%1%1%1%0%1%
Total100%100%100%100%100%100%
get P&P services4%6%4%5%5%5%
CSMBSSSSPHIUCUninsuredAll schemes
not get any P&P services94%96%95%95%96%95%
get P&P services6%4%5%5%4%5%
P&P services
00
00
00
00
00
00
agegr
insurance scheme
NO insuranceCSMBSSSSUCPrivateAll schemes
AGEGR0 804,5373918514226,201equal or > 800001,8171,817
percent of hospital admissions during the past year among different income quintilesTotal1,100,299863,388624,250560,287366,5803,514,804Total92,94058,930110,136105,404236,815604,225
admissionno hospital admissionTotal
Q17.892.2100.04,119,029
Q26.993.1100.0no. of hosp admission5 quintiles of capinc
Q36.393.7100.0Q1Q2Q3Q4Q5Total
Q45.494.6100.0180.482.985.187.289.983.9
Q55.095.0100.0213.310.19.97.76.910.4
Total6.393.7100.033.62.63.22.62.13.0
41.01.30.51.90.21.0
51.01.10.60.20.40.8
60.41.00.10.00.30.4
70.30.40.50.20.10.3
equal or > 80.00.50.10.20.10.2
Total100.0100.0100.0100.0100.0100.0
Govsub_adm_whole
admission
no hospital admission
income quintiles
percent
percent of hospital admission of individuals during last year in the 2003 HWS
Govsub_adm_UC
80.421503609513.31883424413.56875721961.01654186730.97409885860.41025212240.29001207850
82.921120052610.14538075582.58446955481.31099806811.10680250361.00487845560.40086264810.5254879614
85.10308370049.94361233483.22434921910.48041649980.58181818180.13552262720.46856227470.0626351622
87.22940207437.66964073772.61223265931.89063819080.23844922330.04354910970.1642015610.1518864439
89.92198155936.92290905122.05575863390.20704893880.39963991490.2692454580.10829832510.1151181188
1
2
3
4
5
6
7
equal or > 8
income quintiles
percent
Percentage of different numbers of hospital admissions in public hospitals during last year in the 2003 HWS
0
0
0
0
0
percentage of admission in public hospitals by income quintiles
92940
58930
110136
105404
236815
Percentage of admission in private hospitals among different income quintiles
types of health facilities admitted * 5 quintiles of capinc Crosstabulation
5 quintiles of capinc
12345Total
types of health facilitiescommunity hospital755,406483,557328,067227,761114,8671,909,658
provincial or regional hospitals247,727306,112209,907176,127122,2621,062,135
university hospital15,29211,5069,43815,04014,80766,083
other public hospitals64,15254,33070,787122,14678,526389,941
private polyclinic15,0833,6785,7968,63315,88149,071
private hospital68,23350,755106,74197,339243,834566,902
other8980.03,1002,5671,2467,811
unknown0.00.00.04851,0561,541
Total1,166,791909,938733,836650,098592,4794,053,142
Q1Q2Q3Q4Q5TotalQ1Q2Q3Q4Q5Total
community hospital64.753.144.735.019.447.1community hospital39.625.317.211.96.0100.0
provincial or regional hospitals21.233.628.627.120.626.2provincial or regional hospitals23.328.819.816.611.5100.0
university hospital1.31.31.32.32.51.6university hospital23.117.414.322.822.4100.0
other public hospitals5.56.09.618.813.39.6other public hospitals16.513.918.231.320.1100.0
private polyclinic1.30.40.81.32.71.2private polyclinic30.77.511.817.632.4100.0
private hospital5.85.614.515.041.214.0private hospital12.09.018.817.243.0100.0
other0.10.00.40.40.20.2other11.50.039.732.916.0100.0
unknown0.00.00.00.10.20.0unknown0.00.00.031.568.5100.0
Total100.0100.0100.0100.0100.0100.0Total28.822.518.116.014.6100.0
64.74218604721.2314801881.31060318435.49815691071.29269080755.8479196360.07696322650
53.14175251533.6409733411.26448175595.97073646780.40420336335.57785255700
44.705765320928.60407502491.28611842439.64616072260.789822249114.54562054740.42243771090
35.034871665527.09237684162.313497349618.78885952581.327953631614.97297330560.39486354370.0746041366
19.387522595720.63566809962.499160307813.25380308842.680432555441.15487637540.21030281240.1782341653
com hosp
prov/reg hosp
univ hosp
other pub hosp
priv polyclinic
priv hosp
other
unknown
income quintiles
percent
Percent of different types of hospital admissions among different income quintiles
39.557135361425.321654453317.179358817111.92679526916.0150560991
23.323494659328.820441845919.762742024316.582355350311.5109661201
23.140595917317.411437132114.282039253722.759257297622.4066703993
16.451719619113.93287702518.153259082831.324225972620.1379183005
30.73709522947.495261967411.811456868617.592875629232.3633103055
12.03611911768.953046558318.828827557517.170339847143.0116669195
11.4966073486039.68762002332.863909870715.9518627576
Q1
Q2
Q3
Q4
Q5
Types of hospital admissions
percent
proportion of different income quintiles among types of hospital admissions in the 2003 HWS
Whole population
benefits of hospital admissions gained (Bath)benefits of hospital admissions gained (Bath)
by income quintilespercentby asset quintilespercent
Q110,20930.38,462,943,12234.9
Q28,04523.95,744,538,63523.7
Q36,72520.05,056,376,54120.9
Q44,88614.53,378,717,79013.9
Q53,81211.31,579,003,3166.5
Total33,67610024,221,579,404100.020349
1.6549207332
Note: unit costs of hospital admissions of university and other public hospitals are still unavailable. Therefore, benefits gained by high income quintiles are lower than real figures.
income quintiles
income quintiles
percent
Government health subsidy for hospital admissions gained by whole population among different income quinitles in the 2003 HWS
UC beneficiaries only
benefits of hospital admissions gained (Bath)benefits of hospital admissions gained (Bath)
by different income quintilespercentby different income quintilespercent
Q16,022,111,49029.87,836,975,67338.8
Q26,041,791,75429.95,153,313,87825.5
Q34,557,361,93122.64,438,453,69422.0
Q42,714,882,57913.42,208,972,82910.9
Q5853,510,5084.2551,942,1882.7
Total20,189,658,262100.020,189,658,262100.0
Note: unit costs of hospital admissions of university and other public hospitals are still unavailable. Therefore, benefits gained by high income quintiles are lower than the real figures.
income quintiles
asset quintiles
income and asset quintiles
percent
Government health subsidy for hospital admissions gained by UC beneficiaries among different income and asset quinitles in the 2003 HWS
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The distribution of ambulatory service use among different income quintiles in 2001 and 2003, by types of health facilities20012003Concentration indices of ambulatory service use among different types of health facilities in 2001 & 2003
Chart1
1.1970.710.720.340.046
1.0110.570.620.370.054
0.7460.430.690.430.088
0.450.230.690.450.169
0.1370.160.610.560.365
1.91.840.390.710.139
1.291.270.40.610.092
0.710.890.330.620.145
0.570.660.390.730.186
0.20.250.260.620.626
Health centre
Community hospital
Provincial and regional hospital
Private clinic
Private hospital
Income quintiles
Ambulatory visits per cap per year
Distribution of ambulatory services at different health facilities between the 2001 and 2003 HWS
insurance shift
health insurance scheme in 2003
H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotalA comparison of illness rate between 2001 and 2003 among different income quintiles
no h ins3,041,78626,7297,702221,2653,544,19627,0556,5903,0636,878,386inc quintile20012003% increase
CSMBS7,5695,537,3801,4054,72391,4133,4281,2730.05,647,19114.816.4433.89
employee benefit1,3925,921197,6226,56224,7423390.00.0236,57824.145.1524.40
SSS/WCS35,54120,07015,0005,308,700167,2466,94623425,3455,579,08233.913.951.02
30-Baht scheme0.048,654846108,97123,817,5860.00.00.023,976,05743.393.915.04
priv h insurance27,8374,97777752,626255,376602,1760.00.0943,76953.093.4611.97
VHCs65,20440,2302,282131,5727,354,1814,1683,74414,5467,615,927Total3.944.6818.78
Health volunteer3,2074,0650.01,7461,587,1600.00.00.01,596,178
LICs23,26832,32757122,83311,208,6404,65017,4586,08911,315,836
Other14,5480.00.02,99153,27416913,0810.084,063
Unknown0.00.00.00.010,3560.00.01,13211,488
Total3,220,3525,720,353226,2055,861,98948,114,170648,93142,38050,17563,884,555
health insurance scheme in 2003
H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal
no h ins94.460.473.403.777.374.1715.556.1010.77
CSMBS0.2496.800.620.080.190.533.000.008.84
employee benefit0.040.1087.360.110.050.050.000.000.37
SSS/WCS1.100.356.6390.560.351.070.5550.518.73
30-Baht scheme0.000.850.371.8649.500.000.000.0037.53
priv h insurance0.860.090.340.900.5392.800.000.001.48
VHCs2.020.701.012.2415.280.648.8328.9911.92
Health volunteer0.100.070.000.033.300.000.000.002.50
LICs0.720.570.250.3923.300.7241.1912.1417.71
Other0.450.000.000.050.110.0330.870.000.13
Unknown0.000.000.000.000.020.000.002.260.02
Total100.00100.00100.00100.00100.00100.00100.00100.00100.00
health insurance scheme in 2003
H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal
no h ins44.20.40.13.251.50.40.10.0100.0
CSMBS0.198.10.00.11.60.10.00.0100.0
employee benefit0.62.583.52.810.50.10.00.0100.0
SSS/WCS0.60.40.395.23.00.10.00.5100.0
30-Baht scheme0.00.20.00.599.30.00.00.0100.0
priv h insurance2.90.50.15.627.163.80.00.0100.0
VHCs0.90.50.01.796.60.10.00.2100.0
Health volunteer0.20.30.00.199.40.00.00.0100.0
LICs0.20.30.00.299.10.00.20.1100.0
Other17.30.00.03.663.40.215.60.0100.0
Unknown0.00.00.00.090.10.00.09.9100.0
Total5.09.00.49.275.31.00.10.1100.0
insurance shift
51.5265645167
1.6187339865
10.4582843713
2.9977333189
27.059163842
96.5631760914
99.435025417
99.0526904066
63.3738981478
90.1462395543
Health insurance scheme in 2001
percent
Percent of beneficiaries in different health insurance schemes in 2001 transfering to the 30-Baht scheme in 2003
amb rate 01&03
Health facilitiesYear and percent changeAverage ambulatory services utilizationConcentration index
(visits per capita per year)
Q1Q2Q3Q4Q5Total
Health centre20011.1971.0110.7460.450.1370.749-0.29442
20031.91.290.710.570.20.99-0.36497
Change58.727.6-4.826.746.032.2---
Community hospital20010.710.570.430.230.160.44-0.26983
20031.841.270.890.660.251.03-0.32
Change159.2122.8107.0187.056.3133.6---
Provincial and regional hospital20010.720.620.690.690.610.67-0.03657
20030.390.40.330.390.260.356-0.08019
Change-45.8-35.5-52.2-43.5-57.4-46.9---
Private clinic20010.340.370.430.450.560.420.09307
20030.710.610.620.730.620.66-0.014018
Change108.864.944.262.210.757.1---
Private hospital20010.0460.0540.0880.1690.3650.1350.43131
20030.1390.0920.1450.1860.6260.230.348354
Change202.270.464.810.171.570.4---
Q1Q2Q3Q4Q5Total
2001HC1.1971.0110.7460.450.1370.749
Com Hosp0.710.570.430.230.160.44
Prov/reg Hosp0.720.620.690.690.610.672001
Priv clinic0.340.370.430.450.560.42
Priv hosp0.0460.0540.0880.1690.3650.135
Total3.0132.6252.3841.9891.8322.414
Q1Q2Q3Q4Q5Total
2003HC1.91.290.710.570.20.99
Com Hosp1.841.270.890.660.251.028
Prov/reg Hosp0.390.40.330.390.260.356
Priv clinic0.710.610.620.730.620.66
Priv hosp0.1390.0920.1450.1860.6260.23
Total4.9793.6622.6952.5361.9563.264
amb rate 01&03
Health centre
Community hospital
Provincial and regional hospital
Private clinic
Private hospital
Income quintiles
Ambulatory visits per cap per year
Distribution of ambulatory services at different health facilities between the 2001 and 2003 HWS
hosp rate 01&03
hosptialization rate between 2001 & 2003
20012003
Q10.09480.104810.5
Q20.08070.093315.6
Health facilitiesyearAverage hospitalizationConcentration indexQ30.07570.07863.8
(admissions per capita per year)Q40.07170.0683-4.7
Q1Q2Q3Q4Q5TotalQ50.06590.0598-9.3
Community hospital20010.03600.02730.01900.01080.0050.0209-0.315744Total0.07890.08234.3
20030.06310.04880.03410.02250.01110.0374-0.2934
Diff.75.378.879.5108.3113.578.9---
Provincial and regional hospital20010.05220.04740.04880.04810.03420.0466-0.069053
20030.0230.0330.0210.0180.0120.0216-0.1375
Diff.-55.9-30.4-57.0-62.6-64.9-53.6---
Private hospital20010.00640.00540.00730.01210.02600.01090.319934
20030.00540.00370.01010.0080.02200.00950.316
Diff.-15.6-31.538.4-33.9-15.4-12.8---
Income quintileNet government health subsidy for ambulatory and in-patient services (million Baht)% increase
200120032003
(in 2001 value)20012003
Q116,494.2625,874.6325,240.445328.131.3
Q211,865.6318,442.2917,990.275220.222.3
Q39,899.0812,169.3111,871.042016.914.7
Q410,195.0413,592.6413,259.483017.416.4
Q510,278.9412,625.8512,316.392017.515.3
Total58,732.9582,704.7280,677.6137100.0100.0
quintiles200120022003
Q125,240.4425,417.1225,874.63
Q217,990.2718,116.2018,442.29
Q311,871.0411,954.1412,169.31
Q413,259.4813,352.3013,592.64
Q512,316.3912,402.6012,625.85
Total80,677.6181,242.3682,704.72
CPI1.60.71.8
hosp rate 01&03
00
00
00
00
00
2001
2003
Income quintile
percent
A comparison of percent distribution of net government health subsidies among different income quintiles in 2001 and 2003
asset index_2003
Net government health subsidies for amb services and hospitalization among different asset quintiles in 2003
qfactor1meanse(mean)sum (million Baht)total amount (Baht)percentincome quintile
11,479.4855.787824,569.1824,569,180,0003031
21,210.6243.167216,985.3316,985,330,0002122
31,299.5856.363916,547.6016,547,600,0002015
41,218.1549.126712,924.9912,924,990,0001616
51,179.0563.366111,677.6311,677,630,0001415
Total1,294.6023.974282,704.7382,704,730,000100100
asset index_2003
00
00
00
00
00
asset quintile
income quintile
asset and income quintiles
percent
A comparison of percent distribution of net government health subsidies between using income and asset quintiles in 2003
Geographical BIA
2001
regmeanse(mean)sum (million Baht)total amountpercent2003
BKK613.1833.064,752.514,752,510,0008.099.43
Central (excl. BKK)960.6218.7111,075.3111,075,310,00018.8618.31
North995.6418.5011,254.1711,254,170,00019.1623.01
Northeastern970.7115.4320,559.3420,559,340,00035.0034.51
South1,066.5922.388,972.258,972,253,00015.2812.26
East786.1832.842,119.362,119,361,0003.612.49
Total934.188.4458,732.9458,732,944,000100.00100.00
2003
regmeanse(mean)sum (million Baht)total amountpercent
BKK970.87105.067,795.597,795,587,0009.43
Central (excl. BKK)1,260.6749.4515,140.5215,140,520,00018.31
North1,679.5058.4519,030.3119,030,310,00023.01
Northeastern1,332.0546.0228,539.6328,539,630,00034.51
South1,183.0056.4010,139.1110,139,110,00012.26
East817.8953.462,059.572,059,574,0002.49
Total1,294.6023.9782,704.7382,704,731,000100.00
Geographical BIA
00
00
00
00
00
00
2001
2003
Regions
percent
Geographical distribution of net government health subsidies for ambulatory services and hospitalization in 2001 and 2003
Regional BIA
Net government health subsidies among different income quintiles in 2003 (using different regional costs)
quintileTotal gov sub for amb services (Baht)total gov subsidy for IP (Baht)overall government health subsidies (million Baht)percentaverage gov sub per capstandard error of mean95% CI2003 (national unit costs)2003 (regional BIA)
Q125368.6928.11,659.3960.992971,539.841,778.9531.328.1
Q217942.8219.91,376.4554.834191,268.961,483.9322.319.9
Q314794.3716.41,172.2145.301371,083.411,261.0114.716.4
Q414322.7715.91,300.9352.80861,197.421,404.4416.415.9
Q517870.2119.81,497.8767.542771,365.471,630.2615.319.8
Total90,298.86100.01,413.4725.485191,363.521,463.42100.0100.0
Regional BIA
00
00
00
00
00
Aggregated unit subsidies
Regional unit subsidies
income quintiles
percent
The distribution of net government health subsidies in 2003 between using aggregated and regional unit subsidies
Gender BIA
2001
gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent2003
Male803.9111.39781.58826.2325,185.0525,185,050,00042.3243.9
Female1,088.2312.401,063.931,112.5334,325.6234,325,620,00057.6856.1
Total946.558.44930.00963.1059,510.6759,510,670,000100.00100.0
2003
gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent20012003% changes
Male1,166.2233.971,099.641,232.8037,106.9837,106,980,00043.9male803.911,166.2245.07
Female1,481.3433.341,416.001,546.6947,501.3547,501,350,00056.1female1,088.231,481.3436.12
Total1,324.3923.791,277.761,371.0384,608.3484,608,340,000100.0total946.551,324.3939.92
0.724137931
1.380952381
1.2727272727
Gender BIA
00
00
2001
2003
gender
percent
The distribution of net government health subsidies between male and female in 2001 and 2003
-
The distribution of hospitalization among different income quintiles of Thais in 2001 and 2003, by types of health facilitiesConcentration indices of hospitalization among different types of health facilities in 2001 & 200320032001
Chart4
0.0360.05220.0064
0.02730.04740.0054
0.0190.04880.0073
0.01080.04810.0121
0.0050.03420.026
0.06310.0230.0054
0.04880.0330.0037
0.03410.0210.0101
0.02250.0180.008
0.01110.0120.022
district hospitals
prov / reg hospitals
private hospitals
Income quintiles
Hosptial admission per cap per year
The distribution of hospitalization among different income quintiles of Thais in 2001 and 2003
Sheet1
Average hospitalization
(admissions per capita per year)
Q1Q2Q3Q4Q5TotalConcentration indexQ1Q2Q3Q4Q5Q1Q2Q3Q4Q5
2001district hospitals0.0360.0270.0190.0110.0050.021-0.3157district hospitals0.0360.0270.0190.0110.0050.0630.0490.0340.0230.011
prov / reg hospitals0.0520.0470.0490.0480.0340.047-0.0691prov / reg hospitals0.0520.0470.0490.0480.0340.0230.0330.0210.0180.012
private hospitals0.0060.0050.0070.0120.0260.0110.3199private hospitals0.0060.0050.0070.0120.0260.0050.0040.0100.0080.022
2003district hospitals0.0630.0490.0340.0230.0110.037-0.2934
prov / reg hospitals0.0230.0330.0210.0180.0120.022-0.1375
private hospitals0.0050.0040.0100.0080.0220.0100.3160
Sheet1
0.0360.02730.0190.01080.005
0.05220.04740.04880.04810.0342
0.00640.00540.00730.01210.026
0.06310.04880.03410.02250.0111
0.0230.0330.0210.0180.012
0.00540.00370.01010.0080.022
Q1
Q2
Q3
Q4
Q5
Types of health facilities
Admission per cap per year
Distribution of hospitalization among different types of health facilities between the 2001 and 2003 HWS
Sheet2
district hospitals
prov / reg hospitals
private hospitals
Income quintiles
Hosptial admission per cap per year
The distribution of hospitalization among different income quintiles of Thais in 2001 and 2003
Sheet3
MBD00043790.xls
Chart1
1.1970.710.720.340.046
1.0110.570.620.370.054
0.7460.430.690.430.088
0.450.230.690.450.169
0.1370.160.610.560.365
1.91.840.390.710.139
1.291.270.40.610.092
0.710.890.330.620.145
0.570.660.390.730.186
0.20.250.260.620.626
Health centre
Community hospital
Provincial and regional hospital
Private clinic
Private hospital
Income quintiles
Ambulatory visits per cap per year
Distribution of hospitalization among different health facilities between the 2001 and 2003 HWS
insurance shift
health insurance scheme in 2003
H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotalA comparison of illness rate between 2001 and 2003 among different income quintiles
no h ins3,041,78626,7297,702221,2653,544,19627,0556,5903,0636,878,386inc quintile20012003% increase
CSMBS7,5695,537,3801,4054,72391,4133,4281,2730.05,647,19114.816.4433.89
employee benefit1,3925,921197,6226,56224,7423390.00.0236,57824.145.1524.40
SSS/WCS35,54120,07015,0005,308,700167,2466,94623425,3455,579,08233.913.951.02
30-Baht scheme0.048,654846108,97123,817,5860.00.00.023,976,05743.393.915.04
priv h insurance27,8374,97777752,626255,376602,1760.00.0943,76953.093.4611.97
VHCs65,20440,2302,282131,5727,354,1814,1683,74414,5467,615,927Total3.944.6818.78
Health volunteer3,2074,0650.01,7461,587,1600.00.00.01,596,178
LICs23,26832,32757122,83311,208,6404,65017,4586,08911,315,836
Other14,5480.00.02,99153,27416913,0810.084,063
Unknown0.00.00.00.010,3560.00.01,13211,488
Total3,220,3525,720,353226,2055,861,98948,114,170648,93142,38050,17563,884,555
health insurance scheme in 2003
H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal
no h ins94.460.473.403.777.374.1715.556.1010.77
CSMBS0.2496.800.620.080.190.533.000.008.84
employee benefit0.040.1087.360.110.050.050.000.000.37
SSS/WCS1.100.356.6390.560.351.070.5550.518.73
30-Baht scheme0.000.850.371.8649.500.000.000.0037.53
priv h insurance0.860.090.340.900.5392.800.000.001.48
VHCs2.020.701.012.2415.280.648.8328.9911.92
Health volunteer0.100.070.000.033.300.000.000.002.50
LICs0.720.570.250.3923.300.7241.1912.1417.71
Other0.450.000.000.050.110.0330.870.000.13
Unknown0.000.000.000.000.020.000.002.260.02
Total100.00100.00100.00100.00100.00100.00100.00100.00100.00
health insurance scheme in 2003
H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal
no h ins44.20.40.13.251.50.40.10.0100.0
CSMBS0.198.10.00.11.60.10.00.0100.0
employee benefit0.62.583.52.810.50.10.00.0100.0
SSS/WCS0.60.40.395.23.00.10.00.5100.0
30-Baht scheme0.00.20.00.599.30.00.00.0100.0
priv h insurance2.90.50.15.627.163.80.00.0100.0
VHCs0.90.50.01.796.60.10.00.2100.0
Health volunteer0.20.30.00.199.40.00.00.0100.0
LICs0.20.30.00.299.10.00.20.1100.0
Other17.30.00.03.663.40.215.60.0100.0
Unknown0.00.00.00.090.10.00.09.9100.0
Total5.09.00.49.275.31.00.10.1100.0
insurance shift
51.5265645167
1.6187339865
10.4582843713
2.9977333189
27.059163842
96.5631760914
99.435025417
99.0526904066
63.3738981478
90.1462395543
Health insurance scheme in 2001
percent
Percent of beneficiaries in different health insurance schemes in 2001 transfering to the 30-Baht scheme in 2003
amb rate 01&03
Health facilitiesYear and percent changeAverage ambulatory services utilizationConcentration index
(visits per capita per year)
Q1Q2Q3Q4Q5Total
Health centre20011.1971.0110.7460.450.1370.749-0.29442
20031.91.290.710.570.20.99-0.36497
Change58.727.6-4.826.746.032.2---
Community hospital20010.710.570.430.230.160.44-0.26983
20031.841.270.890.660.251.03-0.32
Change159.2122.8107.0187.056.3133.6---
Provincial and regional hospital20010.720.620.690.690.610.67-0.03657
20030.390.40.330.390.260.356-0.08019
Change-45.8-35.5-52.2-43.5-57.4-46.9---
Private clinic20010.340.370.430.450.560.420.09307
20030.710.610.620.730.620.66-0.014018
Change108.864.944.262.210.757.1---
Private hospital20010.0460.0540.0880.1690.3650.1350.43131
20030.1390.0920.1450.1860.6260.230.348354
Change202.270.464.810.171.570.4---
Q1Q2Q3Q4Q5Total
2001HC1.1971.0110.7460.450.1370.749
Com Hosp0.710.570.430.230.160.44
Prov/reg Hosp0.720.620.690.690.610.672001
Priv clinic0.340.370.430.450.560.42
Priv hosp0.0460.0540.0880.1690.3650.135
Total3.0132.6252.3841.9891.8322.414
Q1Q2Q3Q4Q5Total
2003HC1.91.290.710.570.20.99
Com Hosp1.841.270.890.660.251.028
Prov/reg Hosp0.390.40.330.390.260.356
Priv clinic0.710.610.620.730.620.66
Priv hosp0.1390.0920.1450.1860.6260.23
Total4.9793.6622.6952.5361.9563.264
amb rate 01&03
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
Health centre
Community hospital
Provincial and regional hospital
Private clinic
Private hospital
Income quintiles
Ambulatory visits per cap per year
Distribution of ambulatory services at different health facilities between the 2001 and 2003 HWS
hosp rate 01&03
hosptialization rate between 2001 & 2003
20012003
Q10.09480.104810.5
Q20.08070.093315.6
yearAverage hospitalizationConcentration indexQ30.07570.07863.8
(admissions per capita per year)Q40.07170.0683-4.7
Q1Q2Q3Q4Q5TotalQ50.06590.0598-9.3
district hospitals20010.03600.02730.01900.01080.0050.0209-0.315744Total0.07890.08234.3
20030.06310.04880.03410.02250.01110.0374-0.2934
prov / reg hospitals20010.05220.04740.04880.04810.03420.0466-0.069053
20030.0230.0330.0210.0180.0120.0216-0.1375
private hospitals20010.00640.00540.00730.01210.02600.01090.319934
20030.00540.00370.01010.0080.02200.00950.316
Income quintileNet government health subsidy for ambulatory and in-patient services (million Baht)% increase
200120032003
(in 2001 value)20012003
Q116,494.2625,874.6325,240.445328.131.3
Q211,865.6318,442.2917,990.275220.222.3
Q39,899.0812,169.3111,871.042016.914.7
Q410,195.0413,592.6413,259.483017.416.4
Q510,278.9412,625.8512,316.392017.515.3
Total58,732.9582,704.7280,677.6137100.0100.0
quintiles200120022003
Q125,240.4425,417.1225,874.63
Q217,990.2718,116.2018,442.29
Q311,871.0411,954.1412,169.31
Q413,259.4813,352.3013,592.64
Q512,316.3912,402.6012,625.85
Total80,677.6181,242.3682,704.72
CPI1.60.71.8
hosp rate 01&03
00
00
00
00
00
2001
2003
Income quintile
percent
A comparison of percent distribution of net government health subsidies among different income quintiles in 2001 and 2003
asset index_2003
Net government health subsidies for amb services and hospitalization among different asset quintiles in 2003
qfactor1meanse(mean)sum (million Baht)total amount (Baht)percentincome quintile
11,479.4855.787824,569.1824,569,180,0003031
21,210.6243.167216,985.3316,985,330,0002122
31,299.5856.363916,547.6016,547,600,0002015
41,218.1549.126712,924.9912,924,990,0001616
51,179.0563.366111,677.6311,677,630,0001415
Total1,294.6023.974282,704.7382,704,730,000100100
asset index_2003
00
00
00
00
00
asset quintile
income quintile
asset and income quintiles
percent
A comparison of percent distribution of net government health subsidies between using income and asset quintiles in 2003
Geographical BIA
2001
regmeanse(mean)sum (million Baht)total amountpercent2003
BKK613.1833.064,752.514,752,510,0008.099.43
Central (excl. BKK)960.6218.7111,075.3111,075,310,00018.8618.31
North995.6418.5011,254.1711,254,170,00019.1623.01
Northeastern970.7115.4320,559.3420,559,340,00035.0034.51
South1,066.5922.388,972.258,972,253,00015.2812.26
East786.1832.842,119.362,119,361,0003.612.49
Total934.188.4458,732.9458,732,944,000100.00100.00
2003
regmeanse(mean)sum (million Baht)total amountpercent
BKK970.87105.067,795.597,795,587,0009.43
Central (excl. BKK)1,260.6749.4515,140.5215,140,520,00018.31
North1,679.5058.4519,030.3119,030,310,00023.01
Northeastern1,332.0546.0228,539.6328,539,630,00034.51
South1,183.0056.4010,139.1110,139,110,00012.26
East817.8953.462,059.572,059,574,0002.49
Total1,294.6023.9782,704.7382,704,731,000100.00
Geographical BIA
00
00
00
00
00
00
2001
2003
Regions
percent
Geographical distribution of net government health subsidies for ambulatory services and hospitalization in 2001 and 2003
Regional BIA
Net government health subsidies among different income quintiles in 2003 (using different regional costs)
quintileTotal gov sub for amb services (Baht)total gov subsidy for IP (Baht)overall government health subsidies (million Baht)percentaverage gov sub per capstandard error of mean95% CI2003 (national unit costs)2003 (regional BIA)
Q125368.6928.11,659.3960.992971,539.841,778.9531.328.1
Q217942.8219.91,376.4554.834191,268.961,483.9322.319.9
Q314794.3716.41,172.2145.301371,083.411,261.0114.716.4
Q414322.7715.91,300.9352.80861,197.421,404.4416.415.9
Q517870.2119.81,497.8767.542771,365.471,630.2615.319.8
Total90,298.86100.01,413.4725.485191,363.521,463.42100.0100.0
Regional BIA
00
00
00
00
00
Aggregated unit subsidies
Regional unit subsidies
income quintiles
percent
The distribution of net government health subsidies in 2003 between using aggregated and regional unit subsidies
Gender BIA
2001
gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent2003
Male803.9111.39781.58826.2325,185.0525,185,050,00042.3243.9
Female1,088.2312.401,063.931,112.5334,325.6234,325,620,00057.6856.1
Total946.558.44930.00963.1059,510.6759,510,670,000100.00100.0
2003
gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent20012003% changes
Male1,166.2233.971,099.641,232.8037,106.9837,106,980,00043.9male803.911,166.2245.07
Female1,481.3433.341,416.001,546.6947,501.3547,501,350,00056.1female1,088.231,481.3436.12
Total1,324.3923.791,277.761,371.0384,608.3484,608,340,000100.0total946.551,324.3939.92
0.724137931
1.380952381
1.2727272727
Gender BIA
00
00
2001
2003
gender
percent
The distribution of net government health subsidies between male and female in 2001 and 2003
-
Percent distribution of net government health subsidies among different income quintiles in 2001 and 2003Note: Overall net government health subsidies in 2001 were approximately 58,733 million Baht, and in 2003 were 80,678 million Baht (in 2001-value) The concentration index of government health subsidies in 2001 was -0.044 and in 2003 was -0.123
-
Benefit incidence in 2003 between using aggregate and regional unit subsidiesBenefit incidence in 2003 between using household income per capita and an asset index to rank individuals
Chart2
31.285554198128.0941420523
22.29895947919.8704834147
14.714168671416.3837838041
16.435138163815.8615180745
15.266179487719.7900726543
Aggregated unit subsidies
Regional unit subsidies
income quintiles
percent
The distribution of net government health subsidies in 2003 between using aggregated and regional unit subsidies
insurance shift
health insurance scheme in 2003
H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotalA comparison of illness rate between 2001 and 2003 among different income quintiles
no h ins3,041,78626,7297,702221,2653,544,19627,0556,5903,0636,878,386inc quintile20012003% increase
CSMBS7,5695,537,3801,4054,72391,4133,4281,2730.05,647,19114.816.4433.89
employee benefit1,3925,921197,6226,56224,7423390.00.0236,57824.145.1524.40
SSS/WCS35,54120,07015,0005,308,700167,2466,94623425,3455,579,08233.913.951.02
30-Baht scheme0.048,654846108,97123,817,5860.00.00.023,976,05743.393.915.04
priv h insurance27,8374,97777752,626255,376602,1760.00.0943,76953.093.4611.97
VHCs65,20440,2302,282131,5727,354,1814,1683,74414,5467,615,927Total3.944.6818.78
Health volunteer3,2074,0650.01,7461,587,1600.00.00.01,596,178
LICs23,26832,32757122,83311,208,6404,65017,4586,08911,315,836
Other14,5480.00.02,99153,27416913,0810.084,063
Unknown0.00.00.00.010,3560.00.01,13211,488
Total3,220,3525,720,353226,2055,861,98948,114,170648,93142,38050,17563,884,555
health insurance scheme in 2003
H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal
no h ins94.460.473.403.777.374.1715.556.1010.77
CSMBS0.2496.800.620.080.190.533.000.008.84
employee benefit0.040.1087.360.110.050.050.000.000.37
SSS/WCS1.100.356.6390.560.351.070.5550.518.73
30-Baht scheme0.000.850.371.8649.500.000.000.0037.53
priv h insurance0.860.090.340.900.5392.800.000.001.48
VHCs2.020.701.012.2415.280.648.8328.9911.92
Health volunteer0.100.070.000.033.300.000.000.002.50
LICs0.720.570.250.3923.300.7241.1912.1417.71
Other0.450.000.000.050.110.0330.870.000.13
Unknown0.000.000.000.000.020.000.002.260.02
Total100.00100.00100.00100.00100.00100.00100.00100.00100.00
health insurance scheme in 2003
H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal
no h ins44.20.40.13.251.50.40.10.0100.0
CSMBS0.198.10.00.11.60.10.00.0100.0
employee benefit0.62.583.52.810.50.10.00.0100.0
SSS/WCS0.60.40.395.23.00.10.00.5100.0
30-Baht scheme0.00.20.00.599.30.00.00.0100.0
priv h insurance2.90.50.15.627.163.80.00.0100.0
VHCs0.90.50.01.796.60.10.00.2100.0
Health volunteer0.20.30.00.199.40.00.00.0100.0
LICs0.20.30.00.299.10.00.20.1100.0
Other17.30.00.03.663.40.215.60.0100.0
Unknown0.00.00.00.090.10.00.09.9100.0
Total5.09.00.49.275.31.00.10.1100.0
insurance shift
51.5265645167
1.6187339865
10.4582843713
2.9977333189
27.059163842
96.5631760914
99.435025417
99.0526904066
63.3738981478
90.1462395543
Health insurance scheme in 2001
percent
Percent of beneficiaries in different health insurance schemes in 2001 transfering to the 30-Baht scheme in 2003
amb rate 01&03
Health facilitiesYear and percent changeAverage ambulatory services utilizationConcentration index
(visits per capita per year)
Q1Q2Q3Q4Q5Total
Health centre20011.1971.0110.7460.450.1370.749-0.29442
20031.91.290.710.570.20.99-0.36497
Change58.727.6-4.826.746.032.2---
Community hospital20010.710.570.430.230.160.44-0.26983
20031.841.270.890.660.251.03-0.32
Change159.2122.8107.0187.056.3133.6---
Provincial and regional hospital20010.720.620.690.690.610.67-0.03657
20030.390.40.330.390.260.356-0.08019
Change-45.8-35.5-52.2-43.5-57.4-46.9---
Private clinic20010.340.370.430.450.560.420.09307
20030.710.610.620.730.620.66-0.014018
Change108.864.944.262.210.757.1---
Private hospital20010.0460.0540.0880.1690.3650.1350.43131
20030.1390.0920.1450.1860.6260.230.348354
Change202.270.464.810.171.570.4---
Q1Q2Q3Q4Q5Total
2001HC1.1971.0110.7460.450.1370.749
Com Hosp0.710.570.430.230.160.44
Prov/reg Hosp0.720.620.690.690.610.672001
Priv clinic0.340.370.430.450.560.42
Priv hosp0.0460.0540.0880.1690.3650.135
Total3.0132.6252.3841.9891.8322.414
Q1Q2Q3Q4Q5Total
2003HC1.91.290.710.570.20.99
Com Hosp1.841.270.890.660.251.028
Prov/reg Hosp0.390.40.330.390.260.356
Priv clinic0.710.610.620.730.620.66
Priv hosp0.1390.0920.1450.1860.6260.23
Total4.9793.6622.6952.5361.9563.264
amb rate 01&03
Health centre
Community hospital
Provincial and regional hospital
Private clinic
Private hospital
Income quintiles
Amb visits per cap per year
Distribution of ambulatory services at different health facilities between the 2001 and 2003 HWS
hosp rate 01&03
hosptialization rate between 2001 & 2003
20012003
Q10.09480.104810.5
Q20.08070.093315.6
Health facilitiesyearAverage hospitalizationConcentration indexQ30.07570.07863.8
(admissions per capita per year)Q40.07170.0683-4.7
Q1Q2Q3Q4Q5TotalQ50.06590.0598-9.3
Community hospital20010.03600.02730.01900.01080.0050.0209-0.315744Total0.07890.08234.3
20030.06310.04880.03410.02250.01110.0374-0.2934
Diff.75.378.879.5108.3113.578.9---
Provincial and regional hospital20010.05220.04740.04880.04810.03420.0466-0.069053
20030.0230.0330.0210.0180.0120.0216-0.1375
Diff.-55.9-30.4-57.0-62.6-64.9-53.6---
Private hospital20010.00640.00540.00730.01210.02600.01090.319934
20030.00540.00370.01010.0080.02200.00950.316
Diff.-15.6-31.538.4-33.9-15.4-12.8---
Income quintileNet government health subsidy for ambulatory and in-patient services (million Baht)% increase
200120032003
(in 2001 value)20012003
Q116,494.2625,874.6325,240.445328.131.3
Q211,865.6318,442.2917,990.275220.222.3
Q39,899.0812,169.3111,871.042016.914.7
Q410,195.0413,592.6413,259.483017.416.4
Q510,278.9412,625.8512,316.392017.515.3
Total58,732.9582,704.7280,677.6137100.0100.0
quintiles200120022003
Q125,240.4425,417.1225,874.63
Q217,990.2718,116.2018,442.29
Q311,871.0411,954.1412,169.31
Q413,259.4813,352.3013,592.64
Q512,316.3912,402.6012,625.85
Total80,677.6181,242.3682,704.72
CPI1.60.71.8
hosp rate 01&03
2001
2003
Income quintile
percent
A comparison of percent distribution of net government health subsidies among different income quintiles in 2001 and 2003
asset index_2003
Net government health subsidies for amb services and hospitalization among different asset quintiles in 2003
qfactor1meanse(mean)sum (million Baht)total amount (Baht)percentincome quintile
11,479.4855.787824,569.1824,569,180,0003031
21,210.6243.167216,985.3316,985,330,0002122
31,299.5856.363916,547.6016,547,600,0002015
41,218.1549.126712,924.9912,924,990,0001616
51,179.0563.366111,677.6311,677,630,0001415
Total1,294.6023.974282,704.7382,704,730,000100100
asset index_2003
Q1Q1
Q2Q2
Q3Q3
Q4Q4
Q5Q5
asset quintile
income quintile
asset and income quintiles
percent
A comparison of percent distribution of net government health subsidies between using income and asset quintiles in 2003
Geographical BIA
2001
regmeanse(mean)sum (million Baht)total amountpercent2003
BKK613.1833.064,752.514,752,510,0008.099.43
Central (excl. BKK)960.6218.7111,075.3111,075,310,00018.8618.31
North995.6418.5011,254.1711,254,170,00019.1623.01
Northeastern970.7115.4320,559.3420,559,340,00035.0034.51
South1,066.5922.388,972.258,972,253,00015.2812.26
East786.1832.842,119.362,119,361,0003.612.49
Total934.188.4458,732.9458,732,944,000100.00100.00
2003
regmeanse(mean)sum (million Baht)total amountpercent
BKK970.87105.067,795.597,795,587,0009.43
Central (excl. BKK)1,260.6749.4515,140.5215,140,520,00018.31
North1,679.5058.4519,030.3119,030,310,00023.01
Northeastern1,332.0546.0228,539.6328,539,630,00034.51
South1,183.0056.4010,139.1110,139,110,00012.26
East817.8953.462,059.572,059,574,0002.49
Total1,294.6023.9782,704.7382,704,731,000100.00
Geographical BIA
2001
2003
Regions
percent
Geographical distribution of net government health subsidies for ambulatory services and hospitalization in 2001 and 2003
Regional BIA
Net government health subsidies among different income quintiles in 2003 (using different regional costs)
quintileTotal gov sub for amb services (Baht)total gov subsidy for IP (Baht)overall government health subsidies (million Baht)percentaverage gov sub per capstandard error of mean95% CI2003 (national unit costs)2003 (regional BIA)
Q125368.6928.11,659.3960.992971,539.841,778.9531.328.1
Q217942.8219.91,376.4554.834191,268.961,483.9322.319.9
Q314794.3716.41,172.2145.301371,083.411,261.0114.716.4
Q414322.7715.91,300.9352.80861,197.421,404.4416.415.9
Q517870.2119.81,497.8767.542771,365.471,630.2615.319.8
Total90,298.86100.01,413.4725.485191,363.521,463.42100.0100.0
Regional BIA
Aggregated unit subsidies
Regional unit subsidies
income quintiles
percent
The distribution of net government health subsidies in 2003 between using aggregated and regional unit subsidies
Gender BIA
2001
gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent2003
Male803.9111.39781.58826.2325,185.0525,185,050,00042.3243.9
Female1,088.2312.401,063.931,112.5334,325.6234,325,620,00057.6856.1
Total946.558.44930.00963.1059,510.6759,510,670,000100.00100.0
2003
gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent20012003% changes
Male1,166.2233.971,099.641,232.8037,106.9837,106,980,00043.9male803.911,166.2245.07
Female1,481.3433.341,416.001,546.6947,501.3547,501,350,00056.1female1,088.231,481.3436.12
Total1,324.3923.791,277.761,371.0384,608.3484,608,340,000100.0total946.551,324.3939.92
0.724137931
1.380952381
1.2727272727
Gender BIA
00
00
2001
2003
gender
percent
The distribution of net government health subsidies between male and female in 2001 and 2003
Chart1
29.707103813831.2855541981
20.537313887622.298959479
20.008045489114.7141686714
15.627872795216.4351381638
14.119664014415.2661794877
asset quintile
income quintile
asset and income quintiles
percent
A comparison of percent distribution of net government health subsidies between using income and asset quintiles in 2003
insurance shift
health insurance scheme in 2003
H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotalA comparison of illness rate between 2001 and 2003 among different income quintiles
no h ins3,041,78626,7297,702221,2653,544,19627,0556,5903,0636,878,386inc quintile20012003% increase
CSMBS7,5695,537,3801,4054,72391,4133,4281,2730.05,647,19114.816.4433.89
employee benefit1,3925,921197,6226,56224,7423390.00.0236,57824.145.1524.40
SSS/WCS35,54120,07015,0005,308,700167,2466,94623425,3455,579,08233.913.951.02
30-Baht scheme0.048,654846108,97123,817,5860.00.00.023,976,05743.393.915.04
priv h insurance27,8374,97777752,626255,376602,1760.00.0943,76953.093.4611.97
VHCs65,20440,2302,282131,5727,354,1814,1683,74414,5467,615,927Total3.944.6818.78
Health volunteer3,2074,0650.01,7461,587,1600.00.00.01,596,178
LICs23,26832,32757122,83311,208,6404,65017,4586,08911,315,836
Other14,5480.00.02,99153,27416913,0810.084,063
Unknown0.00.00.00.010,3560.00.01,13211,488
Total3,220,3525,720,353226,2055,861,98948,114,170648,93142,38050,17563,884,555
health insurance scheme in 2003
H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal
no h ins94.460.473.403.777.374.1715.556.1010.77
CSMBS0.2496.800.620.080.190.533.000.008.84
employee benefit0.040.1087.360.110.050.050.000.000.37
SSS/WCS1.100.356.6390.560.351.070.5550.518.73
30-Baht scheme0.000.850.371.8649.500.000.000.0037.53
priv h insurance0.860.090.340.900.5392.800.000.001.48
VHCs2.020.701.012.2415.280.648.8328.9911.92
Health volunteer0.100.070.000.033.300.000.000.002.50
LICs0.720.570.250.3923.300.7241.1912.1417.71
Other0.450.000.000.050.110.0330.870.000.13
Unknown0.000.000.000.000.020.000.002.260.02
Total100.00100.00100.00100.00100.00100.00100.00100.00100.00
health insurance scheme in 2003
H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal
no h ins44.20.40.13.251.50.40.10.0100.0
CSMBS0.198.10.00.11.60.10.00.0100.0
employee benefit0.62.583.52.810.50.10.00.0100.0
SSS/WCS0.60.40.395.23.00.10.00.5100.0
30-Baht scheme0.00.20.00.599.30.00.00.0100.0
priv h insurance2.90.50.15.627.163.80.00.0100.0
VHCs0.90.50.01.796.60.10.00.2100.0
Health volunteer0.20.30.00.199.40.00.00.0100.0
LICs0.20.30.00.299.10.00.20.1100.0
Other17.30.00.03.663.40.215.60.0100.0
Unknown0.00.00.00.090.10.00.09.9100.0
Total5.09.00.49.275.31.00.10.1100.0
insurance shift
51.5265645167
1.6187339865
10.4582843713
2.9977333189
27.059163842
96.5631760914
99.435025417
99.0526904066
63.3738981478
90.1462395543
Health insurance scheme in 2001
percent
Percent of beneficiaries in different health insurance schemes in 2001 transfering to the 30-Baht scheme in 2003
amb rate 01&03
Health facilitiesYear and percent changeAverage ambulatory services utilizationConcentration index
(visits per capita per year)
Q1Q2Q3Q4Q5Total
Health centre20011.1971.0110.7460.450.1370.749-0.29442
20031.91.290.710.570.20.99-0.36497
Change58.727.6-4.826.746.032.2---
Community hospital20010.710.570.430.230.160.44-0.26983
20031.841.270.890.660.251.03-0.32
Change159.2122.8107.0187.056.3133.6---
Provincial and regional hospital20010.720.620.690.690.610.67-0.03657
20030.390.40.330.390.260.356-0.08019
Change-45.8-35.5-52.2-43.5-57.4-46.9---
Private clinic20010.340.370.430.450.560.420.09307
20030.710.610.620.730.620.66-0.014018
Change108.864.944.262.210.757.1---
Private hospital20010.0460.0540.0880.1690.3650.1350.43131
20030.1390.0920.1450.1860.6260.230.348354
Change202.270.464.810.171.570.4---
Q1Q2Q3Q4Q5Total
2001HC1.1971.0110.7460.450.1370.749
Com Hosp0.710.570.430.230.160.44
Prov/reg Hosp0.720.620.690.690.610.672001
Priv clinic0.340.370.430.450.560.42
Priv hosp0.0460.0540.0880.1690.3650.135
Total3.0132.6252.3841.9891.8322.414
Q1Q2Q3Q4Q5Total
2003HC1.91.290.710.570.20.99
Com Hosp1.841.270.890.660.251.028
Prov/reg Hosp0.390.40.330.390.260.356
Priv clinic0.710.610.620.730.620.66
Priv hosp0.1390.0920.1450.1860.6260.23
Total4.9793.6622.6952.5361.9563.264
amb rate 01&03
Health centre
Community hospital
Provincial and regional hospital
Private clinic
Private hospital
Income quintiles
Amb visits per cap per year
Distribution of ambulatory services at different health facilities between the 2001 and 2003 HWS
hosp rate 01&03
hosptialization rate between 2001 & 2003
20012003
Q10.09480.104810.5
Q20.08070.093315.6
Health facilitiesyearAverage hospitalizationConcentration indexQ30.07570.07863.8
(admissions per capita per year)Q40.07170.0683-4.7
Q1Q2Q3Q4Q5TotalQ50.06590.0598-9.3
Community hospital20010.03600.02730.01900.01080.0050.0209-0.315744Total0.07890.08234.3
20030.06310.04880.03410.02250.01110.0374-0.2934
Diff.75.378.879.5108.3113.578.9---
Provincial and regional hospital20010.05220.04740.04880.04810.03420.0466-0.069053
20030.0230.0330.0210.0180.0120.0216-0.1375
Diff.-55.9-30.4-57.0-62.6-64.9-53.6---
Private hospital20010.00640.00540.00730.01210.02600.01090.319934
20030.00540.00370.01010.0080.02200.00950.316
Diff.-15.6-31.538.4-33.9-15.4-12.8---
Income quintileNet government health subsidy for ambulatory and in-patient services (million Baht)% increase
200120032003
(in 2001 value)20012003
Q116,494.2625,874.6325,240.445328.131.3
Q211,865.6318,442.2917,990.275220.222.3
Q39,899.0812,169.3111,871.042016.914.7
Q410,195.0413,592.6413,259.483017.416.4
Q510,278.9412,625.8512,316.392017.515.3
Total58,732.9582,704.7280,677.6137100.0100.0
quintiles200120022003
Q125,240.4425,417.1225,874.63
Q217,990.2718,116.2018,442.29
Q311,871.0411,954.1412,169.31
Q413,259.4813,352.3013,592.64
Q512,316.3912,402.6012,625.85
Total80,677.6181,242.3682,704.72
CPI1.60.71.8
hosp rate 01&03
2001
2003
Income quintile
percent
A comparison of percent distribution of net government health subsidies among different income quintiles in 2001 and 2003
asset index_2003
Net government health subsidies for amb services and hospitalization among different asset quintiles in 2003
qfactor1meanse(mean)sum (million Baht)total amount (Baht)percentincome quintile
11,479.4855.787824,569.1824,569,180,0003031
21,210.6243.167216,985.3316,985,330,0002122
31,299.5856.363916,547.6016,547,600,0002015
41,218.1549.126712,924.9912,924,990,0001616
51,179.0563.366111,677.6311,677,630,0001415
Total1,294.6023.974282,704.7382,704,730,000100100
asset index_2003
Q1Q1
Q2Q2
Q3Q3
Q4Q4
Q5Q5
asset quintile
income quintile
asset and income quintiles
percent
A comparison of percent distribution of net government health subsidies between using income and asset quintiles in 2003
Geographical BIA
2001
regmeanse(mean)sum (million Baht)total amountpercent2003
BKK613.1833.064,752.514,752,510,0008.099.43
Central (excl. BKK)960.6218.7111,075.3111,075,310,00018.8618.31
North995.6418.5011,254.1711,254,170,00019.1623.01
Northeastern970.7115.4320,559.3420,559,340,00035.0034.51
South1,066.5922.388,972.258,972,253,00015.2812.26
East786.1832.842,119.362,119,361,0003.612.49
Total934.188.4458,732.9458,732,944,000100.00100.00
2003
regmeanse(mean)sum (million Baht)total amountpercent
BKK970.87105.067,795.597,795,587,0009.43
Central (excl. BKK)1,260.6749.4515,140.5215,140,520,00018.31
North1,679.5058.4519,030.3119,030,310,00023.01
Northeastern1,332.0546.0228,539.6328,539,630,00034.51
South1,183.0056.4010,139.1110,139,110,00012.26
East817.8953.462,059.572,059,574,0002.49
Total1,294.6023.9782,704.7382,704,731,000100.00
Geographical BIA
8.09172787259.4258053992
18.857065976518.3067157307
19.161596939523.009941233
35.004783686634.5078566304
15.276354953412.259407506
3.60847057152.4902735008
2001
2003
Regions
percent
Geographical distribution of net government health subsidies for ambulatory services and hospitalization in 2001 and 2003
Regional BIA
Net government health subsidies among different income quintiles in 2003 (using different regional costs)
quintileTotal gov sub for amb services (Baht)total gov subsidy for IP (Baht)overall government health subsidies (million Baht)percentaverage gov sub per capstandard error of mean95% CI2003 (national unit costs)2003 (regional BIA)
Q125368.6928.11,659.3960.992971,539.841,778.9531.328.1
Q217942.8219.91,376.4554.834191,268.961,483.9322.319.9
Q314794.3716.41,172.2145.301371,083.411,261.0114.716.4
Q414322.7715.91,300.9352.80861,197.421,404.4416.415.9
Q517870.2119.81,497.8767.542771,365.471,630.2615.319.8
Total90,298.86100.01,413.4725.485191,363.521,463.42100.0100.0
Regional BIA
00
00
00
00
00
Aggregated unit subsidies
Regional unit subsidies
income quintiles
percent
The distribution of net government health subsidies in 2003 between using aggregated and regional unit subsidies
Gender BIA
2001
gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent2003
Male803.9111.39781.58826.2325,185.0525,185,050,00042.3243.9
Female1,088.2312.401,063.931,112.5334,325.6234,325,620,00057.6856.1
Total946.558.44930.00963.1059,510.6759,510,670,000100.00100.0
2003
gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent20012003% changes
Male1,166.2233.971,099.641,232.8037,106.9837,106,980,00043.9male803.911,166.2245.07
Female1,481.3433.341,416.001,546.6947,501.3547,501,350,00056.1female1,088.231,481.3436.12
Total1,324.3923.791,277.761,371.0384,608.3484,608,340,000100.0total946.551,324.3939.92
0.724137931
1.380952381
1.2727272727
Gender BIA
00
00
2001
2003
gender
percent
The distribution of net government health subsidies between male and female in 2001 and 2003
-
The incidence of catastrophic health payments in 2000, 2002, and 2004 Note: Catastrophic health expenditure refers to household out-of-pocket payments for health over 10% of total household consumption
-
Conclusions (1)The UC policy has improved equity in access to and utilization of health services in Thailand through four strategies:The expansion of public health insurance to nearly universal coverageThe removal of financial barriers to essential health services The comprehensive benefit package of the schemeThe promotion of primary care use as the main contracting unit
The distribution of government health subsidies in Thailand was pro-poor before UC, and the re-distributive effect is getting better after implementation of the UC policy.
Health services at primary and secondary care levels were more pro-poor than health services at tertiary care and private facilities.
-
Conclusions (2)Using different figures of government unit subsidies (aggregated vs regional unit subsidies) and different measures to categorize individual socio-economic status (income and asset index) does not provide different pictures of improvements in health care use and the distribution of government health subsidies in Thailand.
The incidence of catastrophic health expenditure after UC is better than the situation before UC, particularly in poorer quintiles, but some expensive health services such as RRT for end-stage renal disease patients is still excluded from the UC benefit package and causes households to be financially catastrophic.
Changes in the allocation method of government health resource and health financing mechanisms appear to be a key factor in the success of UC in improving equity in the Thai health care system.
-
Limitations of the studyDifferences in questions and answer choices between the 2001 and 2003 HWS questionnaires,Lack of rigorous welfare indicators to categorize individuals into different socio-economic status,Variations of unit government subsidies among different regions and health care levels,The estimates of unit subsidies for CSMBS and SSS beneficiaries,Limitations in identifying UC members before implementation of the UC policy.
-
AcknowledgementsNational Statistical Office of Thailand (NSO)Ministry of Public Health (MOPH)Thailand Research Fund (TRF)Health Systems Research Institute (HSRI)World Health Organization (WHO)
We analyzed two nationally representative household surveys in 2001 and 2003 by using financial and benefit incidence analyses. We found that after implementation of the UC policy in 2001, the proportion of Thai population covered by a public or a private health insurance scheme increased from 71% in 2001 to 95% in 2003, and approximately 5% of Thais were still uninsured. The UC scheme covers approximately 75% of the population, while the CSMBS and SSS covered only 9 and 10%, respectively.
When beneficiaries of each health insurance scheme were categorized into different income quintiles, we found that around 53% of the UC beneficiaries were in the first and second quintiles, while 45% of the SSS beneficiaries and 53% of the CSMBS beneficiaries were in the richest category. The analysis of health service use in the 2001 and 2003 HWS indicates that after UC, ambulatory service use of the first and second quintiles increased significantly, especially at health centers and community hospitals. The concentration indexes show the more pro-poor nature of ambulatory service use at health centre, community, and regional hospitals; while the concentration indexes of private hospitals reveal the pro-rich nature of ambulatory service use both situations of before and after UC. Similar to ambulatory service use, the analysis of hospitalization in the 2001 and 2003 HWS indicates that the proportion of hospitalization at the community hospitals increased significantly at the first and second quintiles, while hospitalization at regional and provincial hospitals decreased in all income quintiles after UC. The increase in hospitalization of the first and the second quintiles at community hospitals reflected the success in promoting the close-to-client policy of the UC policy and the strategy to use primary care as a gate-keeper. In addition, the concentration indexes of hospitalization show the pro-poor nature of community, and regional hospitals; while the concentration indexes of private hospitals reveal the pro-rich nature both situations of before and after UC. It should be noted that the negative value of the concentration index of community hospitals decreased after UC because of an increase in hospitalization of richer quintiles at the community hospitals. When we analyzed the benefit incidence before and after UC by combining health service use with unit government subsidies, we found that in 2003, the first and second quintiles gained higher percentage of net government health subsidies, compared to the situation before UC. In contrast, the proportion of the net government health subsidies in the third to the fifth quintiles decreased after implementation of universal coverage. The concentration indexes of the net government health subsidies in 2003 had a higher negative value than the subsidy in 2001, which means the poorer gained more government health subsidies in 2003 than the situation before UC. A comparison of benefit incidence in 2001 and 2003 between using aggregate and regional unit subsidies and between using household income per capita and asset index to categorize individuals into different socio-economic groups show no significant difference in the distribution of the net government health subsidies before and after UC.
We also analyzed the incidence of catastrophic health expenditure which refers to the level of household out-of-pocket payments for health care over 10% of total household expenditure. The incidence of catastrophic health expenditure decreased from 5.4% in 2000 to 3.3% and 2.8% in 2002 and 2004, respectively. The decrease of catastrophic health expenditure was greater in poorer quintiles because most of them are covered by the UC scheme, while those is richer quintiles are beneficiaries of SSS and CSMBS. From these research findings, we can conclude that the UC policy has improved equity in access to and utilization of health services in Thailand through four strategies, which are 1) the expansion of public health insurance to nearly universal coverage; 2) the removal of financial barriers to essential health services; 3) the comprehensive benefit package of the scheme; and 4) the promotion of primary care use as the main contracting unit.
The distribution of government health subsidies in Thailand was pro-poor before UC, and the re-distribution is getting better after implementation of the policy. From our analyses, we also found that health service use at primary and secondary care levels were more pro-poor than health service use at tertiary care and private facilities. Another finding of this study is that using different figures of government unit subsidies (aggregated vs regional unit subsidies) and different measures to categorize individual socio-economic status (income and asset index) does not provide different pictures of improvements in health care use and the distribution of government health subsidies in Thailand.
For health financing perspective, the incidence of catastrophic health expenditure after UC is better than the situation before UC, particularly in poorer quintiles, but it should be noted that some expensive health services such as RRT for end-stage renal disease patients is still excluded from the UC benefit package and this may cause households to be financially catastrophic.
Finally, changes in the allocation methods of government health resources and health financing mechanisms appear to be a key factor in the success of the UC policy in improving health equity of the Thai health care system.We would like to note limitations of this study which comprise five areas of limitations. The first one is differences in questions and answer choices between the 2001 and 2003 HWS questionnaires, which interviewed period on illness, and . The second issue is a lack of rigorous welfare indicators to categorize individuals into different socio-economic status in the HWS. The third one is variations in unit subsidies among different regions and health care levels which pose an uncertainty of the benefit incidence analysis. Difficulties in the estimates of unit subsidies for CSMBS and SSS beneficiaries and limitations in identifying UC members before implementation of the UC policy are two other limitations of this study.