Socioeconomic Determinants of Healthcare Utilization and Medical Expenditure among Older Adults in Thailand: A Two-Part Model Approach

Abstract

Thailand is rapidly transitioning into an aging society, making healthcare utilization and
healthcare costs for the elderly a key policy issue. This study aims to analyze socio-economic
determinants related to healthcare service utilization behavior and healthcare costs among
the elderly in Thailand. Secondary data from the 2023 Socio-Economic Survey of Households
were used, with a sample of 2,295 elderly individuals aged 60 years and older. A two-part model
was employed, employing logistic regression for the level of service utilization and a Generalized
Linear Model (Gamma distribution) for the level of expenditure. The results showed that 46.95%
of elderly individuals utilized healthcare services. Education level had a positive correlation
with the opportunity to utilize services (OR = 1.48, 95% CI: 1.00–2.19), while the presence of chronic
diseases was significantly correlated with service utilization. Regarding healthcare costs,
elderly individuals in medium-sized households (6–12 people) had significantly lower healthcare
expenditures than those in small households. Furthermore, differences in expenditure levels were
found among different health insurance coverage groups. The findings indicate that factors related
to service access differ from those related to expenditure levels. From a policy perspective,
this study can be used to promote the importance of reducing spatial disparities in healthcare
access. Improving the efficiency of benefits to reduce unnecessary expenses and promoting
health literacy among older adults with low levels of education, along with supporting small
households.

Keywords: elderly; access to healthcare; healthcare expenditure; health insurance system