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International Health Policy Program (IHPP), Thailand13 March 2013

Post Enumeration Survey (PES) of the household Socio-

Economic Survey (SES) in Thailand

An adjustment of household out-of-pocket payments

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Outline of presentation1. What is PES ?2. Problems in HH out-of-pocket payments3. Objectives of the study4. Methods and conceptual framework5. Results6. Discussion and policy recommendations

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landWhat is PES ?

• An independent survey replicating a census or a national HH survey aiming to evaluate quality and accuracies of the census or the national survey data,

• PES results can be compared with the results of census or national HH surveys, and permit estimates to be made of:– Coverage errors;– Content errors;

• PES is worth conducting if it is carefully planned and well implemented.

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Problems of HH out-of-pocket payments

• OOP, a major component of total health expenditure (THE) in developing countries,

• Potential under-reporting by households due to:– Sampling bias;– Non-sampling bias;

• Respondents • Proxy respondents tend to be under-reporting in

morbidity, utilization, and health expenditure, • The use of proxy respondents instead of

interviews of all eligible household members. • Interviewers

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Objectives• To identify discrepancy among morbidity (OP and

IP), health service utilization, and out-of-pocket payments (OOP) between NSO and IHPP interviewers in three options:

• Full proxy situation • The most knowledgeable HH members provide

information on behalf of all respondents, • Real life situation

• Interviews of all members on the interview day and proxy respondents for non-presence members,

• Gold standard • Interviews of all eligible members, until

exhausted in three visits, • Eligible members, age 15-60, proxy allowed

proxy respondents for those <15 and >60 years.

• To consider applying discrepancies indexes for the adjustment of OOP reported by SES

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landMethodology 1

• NSO SES 2002 • National representative, a 12-months HH survey • Health module available• Interviewers were instructed to use gold

standard approach, • However 2.5 hours to complete one SES

Q’naire, might slip to real life or full proxy. • IHPP-PES

• Post-enumeration survey in 23 provinces in 3 months (Mar-May 03) in the randomly selected households, two weeks after ending SES interviewed by NSO field staffs

• IHPP 20 trained interviewers, instructed to do

gold standard interviews of all eligible respondents until exhausted in the 3rd visit.

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Methodology 2• IHPP methodological testing

• Three methods were applied in the same household by the same IHPP interviewer:

• Full Proxy by interviews of the most knowledgeable person;

• Real life, interviews all eligible present on the first visit and allow proxy respondents for non-presence members;

• Gold standard, three repeated visits to interview the eligible member. Last visit allow proxy respondents.

• PES of the SES completed households in 5 provinces in 1 month (July 03)

• To produce 3 adjusting factors • IHPP Gold standard to NSO real life• IHPP Gold standard to NSO Gold standard • IHPP Gold standard to NSO full proxy

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Conceptual framework of PES SES 2002

Household sampleheadmember < 15member > 15

IHPP Interviewanother set ofsample HHFull proxyReal lifeGold std

PQ approach to estimate national household spendingon H=62 mil pop x morbid rate x choice x baht OOP/visit or admission

Discrepancy index II

Discrepancy index III

Three factor of morbid rate, choice and hh spending OOPFactor 1: Gold std / Full proxyFactor 2: Gold std / Real lifeFactor 3: Real life / Full proxy

Use factor2 adjustNSO-Real life

versionTo be gold standard

Use 1/factor3 adjust

NSO-Real life version

To be Full proxy

2 wk time lagsame recall periodOP: last mo IP: last year

Morbid•OP•IPChoices•OP•IPHH spending•OP•IP

Argument for NSO “Real life” InterviewKI: Key InformantTraining NSO staff 2003, it must be gold standard slip Real life.Nosy interviewees join the interview.

Household sampleheadmember < 15member > 15

IHPPGold standardA billion baht

NSOReal lifeB billion baht

NSOGold standardC billion baht

NSOFull proxyD billion baht

Discrepancy index I

Morbid•OP•IPChoices•OP•IPHH spending•OP•IP

NSO“Real life”Interview

IHPP “Gold std”Interview

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Results

• PES-SES• Total 855 households in 23 provinces, in three

months, • 559 municipality and 296 non-municipality

households,• IHPP methodological testing

• Total 150 households in 5 provinces in 1 month • 80 municipality and 70 non-municipality

households

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PQ approach

Discrepancy index II

1.05Discrepancy index III

1.14Discrepancy index I

1.13

A B C DIHPP NSO NSO NSO

"Gold std" "Real life" "Gold std" "Full proxy" OP (mil baht) 40548, 37499, 40089, 37780,

IP (mil baht) 12374, 9,264

10109, 87,41 Total (mil baht) 52921, 46764, 50198, 46521,

ratio of OP 77 80% 80% 81% ratio of IP 23% 20% 20% 19%

HH spending on health expenditure

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Final adjustment for SES2002Percentage of OOPs increased from 32.7% to 33.8% and 35.7% respectively.

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SES 2000

Adjust with 1.05

Adjust with 1.14

New ratio (min)

New ratio (max)

OOP 32.74 34.38 37.32 33.83 35.69Other 67.26 67.26 67.26 66.17 64.31THE 100% 101.64% 104.58% 100% 100%

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Discussion

• OOPs reported by biennial SES (even years) which discrepancy index should be used to adjust OOP: – Depends on NSO interviewers behaviors

(real life or full proxy), – NSO gold standard is unlikely – costly,

lengthy q’naire of SES, average 2.5 hours

• We decided not use this correcting factor for OOP adjustment due to small sample size of SES.

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Policy recommendations• PES is quite expensive, and needs

carefully plan and well implementation,

• Discussion with Secretary General of NSO – Decided to conduct national PES for the

next population and housing census.

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Acknowledgements• National Statistical Office (NSO)• National Health Security Office (NHSO)• Ministry of Public Health• Health Systems Research Institute

(HSRI)

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Sawasdee Thank you for your attention

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