Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Equitable health financing is embodied in the reform strategies of Thailand health care system when the country moved toward implementing Universal Coverage (UC) policy in 2001. This study aims to measure the progressivity of household out-of-pocket payments for health care and to examine effects on catastrophe and impoverishment by such payments during the transitional period (pre- and post- Universal Coverage policy implementation) in Thailand. The former objective is measured by employing Kakwani index approach. Furthermore, the latter is measured by employing two basic measures in relation to catastrophe and impoverishment i.e. the incidence and intensity of catastrophic health expenditures, and the poverty headcount and gap to measure impoverishing effect of out-of-pocket payments for health care. This study used data from national representative Socioeconomic Surveys in 2000 (pre-UC) and 2002 & 2004 (post-UC) containing data of 24747, 34758 and 34843 individual households, respectively. Kakwani indices of out-of-pocket payments for health care are positive indicating that out-of-pocket payments for health care among Thai households are progressive during the observed period. Moreover, the incidence and intensity of catastrophic health payments decline from the pre-UC to post-UC. The quintile distributions of incidence and intensity also indicate that the worse-off (1st and 2nd quintile) are less likely to incur catastrophic health care payments than the better-off. The UC policy is effective in reducing poverty due to out-of-pocket payments for health care since both the poverty headcount and gap decline from the pre-UC to post-UC. The evidence in this study indicates that UC policy implementation contributes to prevention of catastrophic and impoverishing effects of out-of-pocket payments for health care. Conclusively, the lesson drawn from this study is that the UC policy in Thailand achieves the goal to improve one of the functions of health system through equitable health care financing as observed by the progressivity of household out-of-pocket payments for health care as well as the decrease in household catastrophe and impoverishment by such payments.