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

Background During the past few decades, interest in the study of inequalities in health has focused on various types of health outcomes. This paper moves beyond generic health measures, like mortality and nutrition, to focus on disease-specific health outcomes. Methods The Health and Welfare Survey 2003 conducted by the Thai National Statistical Office with 53,020 adult respondents is used for the analysis. The health outcomes of interest derive 20 commonly reported diseases. The concentration index (CI) of ill health is used as a measure of socioeconomic health inequalities, and is subsequently decomposed into contributing factors. Socioeconomic status is measured by adult-equivalent monthly income per household member. Results The findings confirm that many diseases, such as malaria, goitre, tuberculosis, and kidney stones, were concentrated among the poor, while allergic conditions, hypertension, migraine, and thyroid ailments were more commonly reported by the rich. By applying decomposition analysis to four sets of the most common diseases (i.e., respiratory, cardiovascular, digestive, and musculoskeletal diseases), inequalities were found to associate with older age (particularly females), low education, and residence in the rural Northeast and the rural North of Thailand. These population subgroups merit attention from policymakers. Conclusions Knowing the magnitude of socioeconomic inequalities is necessary but insufficient for health policy interventions; explaining the sources of inequalities has also become of great importance. As Thailand moves further into the Universal Health Coverage era, the national health surveys will be particularly useful in monitoring changes in the use of health services among disadvantaged socioeconomic and geographic subgroups. Thai population health policy in future can be informed by national data combining epidemiology, socioeconomic and health statistics in ways not possible before.