Despite nearly free health services offered by the Universal Coverage Scheme (UCS), the UCS services have been found to be underutilized. Thus, this study, employing the concept of unmet health needs, investigated factors and reasons for the underutilization. Specifically, performing logistic models with the national health survey of 2015, we analyzed who and why did not utilize the UCS services in availability, accessibility, and acceptability perspectives of the services. The study results indicated that among UCS beneficiaries who needed care, about 45% and 7% did not utilize the UCS outpatient and inpatient services, respectively. These non-users had a relatively higher socioeconomic status. Specifically, they were more likely to be high-income, employed, not chronically-ill, or urban people. Availability-related (e.g., long wait-time and unavailability due to emergencies) and acceptability-related reasons (e.g., time constraints and uncertainty of service quality) were major barriers of access to the UCS services. Although the UCS, by this study, was found to work better for socially vulnerable people, there are still concerns that some people, who actually wanted to use the UCS services, might be ultimately forced to use other private services due to such barriers. Particularly, employed people who have time constraints during daytime and people who need inpatient services due to emergencies are our main concerns. In the short term, the public-private partnership should be strengthened to support the urgent needs of emergency cases. In the long term, the expansion of the UCS services boundary should be continued by the National Health Development Plan.
Keywords: underutilization, unmet health needs, health-seeking behavior, health insurance, Universal Coverage SchemeAday, L. A., & Andersen, R. M. (1974). A framework for the study of access to medical care. Health Services Research, 9(3), 208–220.
Bradley, E. H., McGraw, S. A., Curry, L., Buckser, A., King, K. L., Kasl, S. V., & Andersen, R. (2002). Expanding the Andersen model: The role of psychosocial factors in long-term care use. Health Services Research, 37(5), 1221–1242. https://doi.org/doi: 10.1111/1475-6773.01053
Budan Pusat Statistik. (2018). Statistik Kesejahteraan Rakyat 2018 (Welfare Statistics 2018). Jakarta, Indonesia: BPS (in Indonesian). Retrieved from https://www.bps.go.id/publication/2018/11/26/81ede2d56698c07d510f6983/statistik-kesejahteraan-rakyat-2018.html
Chen, J., & Hou, F. (2002). Unmet needs for health care. Health Reports, 13(2),: 23–34.
Dayrit, M. M., Lagrada, L. P., Picazo, O. F., Pons, M. C., & Villaverde, M. C. (2018). The Philippines health system review. WHO, Regional Office for South-East Asia. Retrieved from https://apps.who.int/iris/handle/10665/274579
Giang, N. H., Oanh, T. T. M., Tuan, K. A., Van, P. H., & Jayasuriya, R. (2019). Is health insurance associated with health service utilization and economic burden of non-communicable diseases on households in Vietnam? Health Systems & Reform, 6(1), 1–35. https://doi.org/doi: 10.1080/23288604.2019.1619065
Gruber, J., Hendren, N., & Townsend, R. M. (2014). The great equalizer: Health care access and infant mortality in Thailand. American Economic Journal: Applied Economics, 6(1), 91–107. https://doi.org/doi: 10.1257/app.6.1.91
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.hisro.or.th/main/download/10UCS_Eng.pdf
Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression (2nd ed.). New York, NY: Wiley.
Hwang, J. (2018). Understanding reasons for unmet health care needs in Korea: What are health policy implications? BMC Health Services Research, 18, 1–9. https://doi.org/doi: 10.1186/s12913-018-3369-2
Kirdruang, P. (2011). Essays in economics of public health insurance in developing countries: Evidence from Thailand and Vietnam [(Unpublished doctoral dissertation]). Retrieved from the University of Minnesota Digital Conservancy, Location. http://hdl.handle.net/11299/119863
Limwattananon, S., Neelsen, S., O’Donnell, O., Prakongsai, P., Tangcharoensathien, V., Van Doorslaer, E., & Vongmongkol, V. (2015). Universal coverage with supply-side reform: The impact on medical expenditure risk and utilization in Thailand. Journal of Public Economics, 121, 79–94. https://doi.org/doi: 10.1016/j.jpubeco.2014.11.012
Meemon, N., & Paek, S. C. (2018). Health-seeking behavior of the uninsured before and after the Universal Coverage Scheme in Thailand. Asia-Pacific Social Science Review, 18(1), 1–14.
National Statistical Office of Thailand. (2018). 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
Nguyen, V. C. (2010). Public health services and health care utilization in Vietnam (MPRA Paper No. 33610). Germany: University Library of Munich. Retrieved from https://mpra.ub.uni-muenchen.de/33610/1/Health_care_services_in_Vietnam.pdf
Organisation for Economic Co-operation and Development. (2009). What are equivalence scales? Paris: OECD Publishing. Retrieved from http://www.oecd.org/eco/growth/OECD-Note-EquivalenceScales.pdf
Organisation for Economic Co-operation and Development. (2013). Health at a glance 2013: OECD indicators. Paris: OECD Publishing. doi: https://doi.org/10.1787/health_glance-2013-en
Paek, S. C., Meemon, N., & Wan, T. T. (2016). Thailand’s universal coverage scheme and its impact on health-seeking behavior. Springerplus, 5, 1–16. https://doi.org/doi: 10.1186/s40064-016-3665-4
Pagaiya, N., & Noree, T. (2009). Thailand’s health workforce: A review of challenges and experiences (English) (HNP Discussion Paper 54633). Washington, DC: World Bank. Retrieved from http://documents.worldbank.org/curated/en/453661468171879780/Thailands-health-workforce-a-review-of-challenges-and-experiences
Pappa, E., Kontodimopoulos, N., Papadopoulos, A., Tountas, Y., & Niakas., D. (2013). Investigating unmet health needs in primary health care services in a representative sample of the Greek population. International Journal of Environmental Research and Public Health, 10, 2017–2027. https://doi.org/doi: 10.3390/ijerph10052017
Ruiz, M. E. (2010). Risks of self-medication practices. Current Drug Safety, 5(4), 315–323.
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
Sibley, L. M., & Glazier, R. H. (2009). Reasons for self-reported unmet healthcare needs in Canada: A population-based provincial comparison. Healthcare Policy, 5(1),: 87–101.
Tangcharoensathien, V., Prakongsai, P., Limwattananon, S., Patcharanarumol, W., & Jongudomsuk, P. (2007). Achieving universal coverage in Thailand: What lessons do we learn? Health System Knowledge Network, WHO Commission on Social Determinants of Health. http://dx.doi.org/10.2139/ssrn.1111870
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. (2006). Health service utilization and the financial burden on households in Vietnam: The impact of social health insurance. Geneva: WHO. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/85632/EIP_HSF_DP.06.6_eng.pdf
World Health Organization. (2017). WHO country cooperation strategy, Thailand: 2017–2021. New Delhi, India: WHO, Regional Office for South-East Asia. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/255510/9789290225829-eng.pdf?sequence=1