As Thailand faced rapid demographic changes with economic growth, single-person households (e.g., elderly people living alone) have become emerging types of family. Thus, this study, using single-person and non-single-person household factors, examined the impact of the Universal Coverage Scheme (UCS) on household catastrophic health expenditure with the national-level health survey data 2015. Specifically, defining household catastrophic health expenditure as out-of-pocket expenditure exceeding 40% of household disposable income, this study analyzed whether the selected factors were related to the catastrophic expenditure by performing binary logistic regression analysis. The study findings indicated that among all households which received the UCS inpatient services, around 2.78% experienced the catastrophic expenditure. Lower- income and single-person households were more likely to encounter catastrophic expenditure. Among the single-person households, those with lower socioeconomic conditions had a higher incidence of the catastrophic expenditure. Specifically, the elderly, female, low-educated, unemployed, or had any chronic diseases were more likely to encounter the catastrophic expenditure. To address the issue, in the short term, the current copayment rate, which is equally levied to beneficiaries, should be adjusted by socioeconomic conditions. Additionally, the UCS should consider a copayment ceiling as a supplementary policy intervention in the situations where the copayment rate adjustment is not sufficient to prevent catastrophic expenditure. In the long-term, the government’s effort to expand the benefits package should be continued by health care needs on the demand side as well as the cost-effectiveness of the policy on the supply side.
Keywords: catastrophic health expenditure, Thailand, Universal Coverage SchemeAmaya Lara, J. L., & Ruiz Gomez, F. (2011). Determining factors of catastrophic health spending in Bogota, Colombia. International Journal of Health Care Finance and Economics, 11, 83–100. doi: 10.1007/s10754-011-9089-3
Cleopatra, I., & Eunice, K. (2018). Household catastrophic health expenditure: Evidence from Nigeria. Microeconomics and Macroeconomics, 6(1), 1–8. doi:10.5923/j.m2economics.20180601.01
Gottret, P., & Schieber, G. (2006). Health financing revisited: A practitioner’s guide. Washington, DC: World Bank. Retrieved from http://documents.worldbank.org/curated/en/874011468313782370/Health-financing-revisited-a-practitioners-guide
Health Insurance System Research Office. (2012). Thailand’s universal coverage scheme: Achievements and challenges. An independent assessment of the first 10 years (2001–2010). Nonthaburi, Thailand: HISRO. Retrieved from http://www.social-protection.org/gimi/gess/ShowRessource.action?ressource.ressourceId=28441
Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression (2nd ed.). New York, NY: Wiley.
Limwattananon, S., Tangcharoensathien, V., & Prakongsai, P. (2007). Catastrophic and poverty impacts of health payments: Results from national household surveys in Thailand. Bulletin of the World Health Organization, 85(8), 600–606. doi: 10.2471/BLT.06.033720
Li, Y., Wu, Q., Xu, L., Legge, D., Hao, Y., Gao, L., . . . Wan, G. (2012). Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: Policy implications of universal health insurance. Bulletin of the World Health Organization, 90(9), 664–671. doi: 10.2471/BLT.12.102178
Masiye, F., Kaonga, O., & Kirigia, J. M. (2016). Does the user fee removal policy provide financial protection from catastrophic health care payments? Evidence from Zambia. Plos One, 11, 1–15. doi: 10.1371/journal.pone.0146508
National Health Insurance Service. (2015). Copayment ceiling policy: Impact analysis and policy recommendation. (Annual Policy Research Report (Code Number: 2015-1-0007). Seoul, South Korea: NHIS (in Korean).
National Health Security Office. (2014). Annual report: Fiscal year 2013. Bangkok, Thailand: NHSO. Retrieved from http://www.nhso.go.th/eng/Files/content/255804/7beb65df-fd3e-4871-b7af-9781896ee255-130740737044951250.pdf
National Statistical Office of Thailand. (2019). Health and welfare survey 2015 [Data file and codebook]. Bangkok, Thailand: NSO. Retrieved from http://web.nso.go.th/en/survey/hw/hw_11.htm
Osornprasop, S., & Sondergaard, L. M. (2016). Closing the health gaps for the elderly: Promoting health equity and social inclusion in Thailand. Washington, DC: World Bank Group. Retrieved from http://documents.worldbank.org/curated/en/148431468299339382/Closing-the-health-gaps-for-the-elderly-promoting-health-equity-and-social-inclusion-in-Thailand
Organization for Economic Co-operation and Development. (2017). Health at a glance 2017: OECD indicators. Paris: OECD Publishing. Retrieved from http://dx.doi.org/10.1787/health_glance-2017-en
O’Donnell, O., van Doorslaer, E., Rannan-Eliya, R. P., Somanathan, A., Adhikari, S. R., Akkazieva, B., . . . Zhao, Y. (2008). Who pays for health care in Asia? Journal of Health Economics, 27(2), 460–475. doi: 10.1016/j.jhealeco.2007.08.005
Pandey, A., Ploubidis, G. B., Clarke, L., & Dandona. L. (2018). Trends in catastrophic health expenditure in India: 1993 to 2014. Bulletin of the World Health Organization, 96(1), 18–28. doi: 10.2471/BLT.17.191759
Peek, C., Im-em, W., & Tangthanaseth, R. (2015). The state of Thailand’s population 2015. Features of Thai families in the era of low fertility and longevity. Bangkok, Thailand: The United Nations Population Fund Thailand and the Office of the National Economic and Social Development Board. Retrieved from https://thailand.unfpa.org/sites/default/files/pub-pdf/State%20of%20Thailand%20Population%20report%202015-Thai%20Family_en.pdf
Puteh, S. E. W., & Almualm, Y. (2017). Catastrophic health expenditure among developing countries. Health Systems and Policy Research, 4, 1–5. doi: 10.21767/2254-9137.100069
Rousseau, T. (2014). Thailand social health protection. Report of study visit (24–27 June 2014). Project Collaborator COOPAMI. Retrieved from http://www.coopami.org/en/countries/countries/thailand/projects/2014/pdf/2014062207.pdf
Sakunphanit, T. (2006). Thailand: Universal health care coverage through pluralistic approaches. ILO Subregional Office for East Asia. Retrieved from http://www.ilo.org/secsoc/information-resources/publications-and-tools/Workingpapers/WCMS_SECSOC_6612/lang--en/index.htm
Sakunphanit, T., & Suwanrada, W. (2011). The universal coverage scheme. In ILO, SU/SSC, & UNDP (Eds.), Sharing innovative experiences: Successful social protection floor experiences (pp. 385–400). New York, NY: UNDP. Retrieved from http://www.ilo.org/secsoc/information-resources/publications-and-tools/books-and-reports/WCMS_SECSOC_20840/lang--en/index.htm
Somkotra T., & Lagrada, L. P. (2009). Which households are at risk of catastrophic health spending: Experience in Thailand after universal coverage. Health Affairs (Millwood), 28(3), w467–w478. doi: 10.1377/hlthaff.28.3.w467
Teerawichitchainan, B., Knodel, J., & Pothisiri, W. (2015). What does living alone really mean for older persons? A comparative study of Myanmar, Vietnam, and Thailand. Demographic Research, 32(48), 1329–1360. Retrieved from https://www.demographic-research.org/volumes/vol32/48/32-48.pdf
World Bank. (2007). Health care financing in Thailand: Modeling and sustainability. Washington, DC: World Bank. Retrieved from http://documents.worldbank.org/curated/en/875351468305329741/Health-care-financing-in-Thailand-modeling-and-sustainability
World Bank. (2018). The World Bank: Open data. Retrieved from https://data.worldbank.org/
World Health Organization. (2005). Designing health financing systems to reduce catastrophic health expenditure. Geneva: WHOAuthor. Retrieved from https://www.who.int/health_financing/pb_2.pdf
World Health Organization. (2014). WHO global health expenditure atlas. Geneva: WHO. Retrieved from https://www.who.int/health-accounts/atlas2014.pdf
Xu, K., Evans, D. B., Kadama, P., Nabyonga, J., Ogwal, P. O., Nabukhonzo, P., & Aguilar, A. M. (2006). Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda. Social Science and Medicine, 62(4), 866–876. doi: 10.1016/j.socscimed.2005.07.004
Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J., & Murray, C. J. (2003). Household catastrophic health expenditure: A multicountry analysis. Lancet, 362(9378), 111–117. doi: 10.1016/S0140-6736(03)13861-5
Yang, T., Chu, J., Zhou, C., Medina, A., Li, C., Jiang, S., . . . Liu, J. (2016). Catastrophic health expenditure: A comparative analysis of empty-nest and non-empty-nest households with seniors in Shandong, China. BMJ Open, 6, 1–8. doi: 10.1136/bmjopen-2015-010992