The equity impact of Universal Coverage: health care finance, catastrophic health expenditure, utilization and government subsidies in Thailand
The objective of this study was to assess the equity impact of achieving universal coverage (UC) on the distribution of benefits of public health service utilization, health care financing burdens (measured by financing incidence), and protection from the risk of expensive medical care costs (financial catastrophe).
It is concluded that the Thai system has an equitable distribution of financing burdens, a low incidence of catastrophic health expenditure, and a pro-poor distribution of service utilization and public subsidies. Factors contributing to equity in financing are: the increasing share of progressive financing sources, in particular direct tax and the decreasing share of the regressive out-of-pocket payments for health. Using general taxation to finance services used by the poor and the informal sector not only helps to reach universal coverage quickly, it is the most progressive financing source. To ensure the progressivity of SHI contributions, regular review of the maximum wage for assessed contribution is required. The same system design factors contribute to both the low incidence of catastrophic heath expenditure and the equitable distribution of service utilization and public subsidies. These include a comprehensive benefit package covering almost all interventions, services which are free at point of use, and accessible and well-functioning service providers at the primary care level. Strategic purchasing within the UC scheme further underpins equity in the system by contracting primary care networks at the district level — the “close to client services” which are easily accessed and used by the rural poor.
Limwattananon, S.; Vongmongkol, V.; Prakongsai, P.; Patcharanarumol, W.; Hanson, K.; Tangcharoensathien, V.; Mills, A. The equity impact of Universal Coverage: health care finance, catastrophic health expenditure, utilization and government subsidies in Thailand. (2011)