Equity in Health Services Utilization among Thai Elderly under the Universal Coverage Scheme - ความเป็นธรรมการใช้บริการสุขภาพเมื่อเจ็บป่วยของผู้สูงอายุภายใต้หลักประกันสุขภาพถ้วนหน้า (30 บาทรักษาทุกโรค)

Abstract

              A policy of free medical care for elderly people was launched in Thailand in 1992, but a substantial number of older people, mainly urban residents, were still paying out of pocket for health care in 2001. In that year, the Thai government introduced a policy of universal coverage, to include all Thais not covered by formal public insurance schemes. The policy is tax funded and has incorporated two main reform initiatives, reform of budget allocation and payment methods and strengthening primary care.

               The study was aimed to assess whether use of health care of elderly people was equitable under the Universal Coverage Policy in a poor province in Northeast Thailand. The study was conducted after the policy has been implementing for one year during April - May 2002. A 2-stage cluster sampling household survey of 956 respondents aged 60 and above and holding a card was employed.

                Results reveal that access to ambulatory care was quite equitable as it was mainly determined by health need; moreover, the health care delivery system seemed to favour those older people who were poor and who were rural residents. However access to inpatient care was inequitable, most likely due to problems of physical access and travel costs for rural residents. The study concludes that the combination of the Universal Coverage Policy and the health care delivery system appears to provide relatively equitable access to health care for elderly people, but issues of hospital access for rural residents require addressing. Further study is needed on quality of care.