Phusit Prakongsai, MD Supon Limwattananon, PhD Walaiporn Patcharanarumol, BSc MPH

Assessing the impact of a policy on universal coverage on financial risk protection, health care finance, and benefit incidence of the Thai health care systemPhusit Prakongsai, MDSupon Limwattananon, PhDWalaiporn Patcharanarumol, BSc MPHKanjana Tisayatikom, MPHViroj Tangcharoensathien, PhD

International Health Policy Program (IHPP) - Thailand

Presentation to the 6th IHEA World Congress9 July 2007, Copenhagen

Outline of presentationBackgroundHealth insurance coverage after UC implementation in 2003Changes in health service use and benefit incidenceChanges in the incidence of catastrophic health paymentsDiscussion and conclusions

Health care finance and service provisions of the Thai health care system after implementation of the universal coverage policy

General tax

General tax Standard Benefit package

Tripartite contributions Payroll taxes Risk related contributions Capitation Capitation & global Co-payment budget with DRG for IP Services

Fee for services Fee for services - OPPopulation PatientsMinistry of Finance - CSMBS(6 million beneficiaries)National Health Insurance Office The UC scheme (47 millions of pop.)Social Security Office - SSS(7 millions of formal employees)Voluntary private insurance Public & Private Contractor networks

Methods and data sourcesBenefit incidence (BIA) and financial incidence analyses (FIA) were employed,

Two different approaches of BIA:Using household income per capita and asset indexes;Using aggregated and regional unit government subsidies.

Data sourcesNationally representative household surveys on health insurance coverage and health service use in the 2001 and 2003 HWS, National household surveys on household income and consumption expenditure,Unit government subsidies for public and private health care providers in 2001 & 2003.

Health insurance coverage in 2003Source: The 2003 Health and Welfare Survey conducted by the National Statistical Office of Thailand (NSO)Note: PHI = private health insurance, UC = the UC scheme11Source: The 2003 Health and Welfare surveyNote: Q1 = the poorest quintile, Q5 = the richest quintile

Chart1

5.7

6.1

1.1

47.7

3.2

millinon population

3.2(5%)

47.7(75%)

1.1(2%)

6.1(10%)

5.7(9%)

gender

NO insuranceCSMBSSSSUCPrivateAll schemes

male1792235273409830455632375728848898331818167

female1266257298484127554132447392558595032066386

Total30584925718939580097648231213107493363884553

insurance scheme

NO insuranceCSMBSSSSUCPrivateAll schemes

male1,721,8602,580,1463,041,42122,932,017466,90230,742,346

female1,150,9842,791,5382,745,63323,289,321551,53730,529,013

2,872,8445,371,6845,787,05446,221,3381,018,43961,271,359

insurance scheme

NO insuranceCSMBSSSSUCPrivateAll schemes

male60%48%53%50%46%50%

female40%52%47%50%54%50%

100%100%100%100%100%100%

CSMBSSSSPHIUCUninsuredall schemes

48%53%46%50%60%50%

52%47%54%50%40%50%

total100%100%100%100%100%100%

gender

married status

insurance scheme

NO insuranceCSMBSSSSUCPrivate

CountCountCountCountCount

Single140366910025671335412972092431055112773123

couple21952375300988236900052075491430360629710782

widow31814222971892784911808991258882591981

divorce434806451736074932766413072481464

sparate54641253529829584197936004608696

used to married6159748353347414

unknown9924361261047613038

2622717440834054482243304809665912146186498

P&P services

NO insuranceCSMBSSSSUCPrivateAll schemes

P&P servicesno2,746,9315,041,4375,575,60143,749,380965,93458,079,283

immunization23,28631,45417,324981,38916,6541,070,107

ANC17,20317,63217,845176,018837229,535

family planning5,4986534,59876,465087,214

Post natal care2,5513,41716,92296,1450119,035

check up47,828166,63289,907728,26528,0841,060,716

Dental P&P14,86958,85627,111162,1232,799265,758

other14,68051,60337,746251,5524,130359,711

Total2,872,8465,371,6845,787,05446,221,3371,018,43861,271,359

no P&P2,746,9315,041,4375,575,60143,749,380965,93458,079,28395%

got P&P125,915330,247211,4532,471,95752,5043,192,0765%

total2,872,8465,371,6845,787,05446,221,3371,018,43861,271,359100%

% got P&P4%10%7%77%2%100%

NO insuranceCSMBSSSSUCPrivateAll schemes

not get any P&P services96%94%96%95%95%95%

immunization1%1%0%2%2%2%

ANC1%0%0%0%0%0%

family planning0%0%0%0%0%0%

Post natal care0%0%0%0%0%0%

check up2%3%2%2%3%2%

Dental P&P1%1%0%0%0%0%

other1%1%1%1%0%1%

Total100%100%100%100%100%100%

get P&P services4%6%4%5%5%5%

CSMBSSSSPHIUCUninsuredAll schemes

not get any P&P services94%96%95%95%96%95%

get P&P services6%4%5%5%4%5%

P&P services

00

00

00

00

00

00

agegr

insurance scheme

NO insuranceCSMBSSSSUCPrivateAll schemes

AGEGR0 804,5373918514226,201equal or > 800001,8171,817

percent of hospital admissions during the past year among different income quintilesTotal1,100,299863,388624,250560,287366,5803,514,804Total92,94058,930110,136105,404236,815604,225

admissionno hospital admissionTotal

Q17.892.2100.04,119,029

Q26.993.1100.0no. of hosp admission5 quintiles of capinc

Q36.393.7100.0Q1Q2Q3Q4Q5Total

Q45.494.6100.0180.482.985.187.289.983.9

Q55.095.0100.0213.310.19.97.76.910.4

Total6.393.7100.033.62.63.22.62.13.0

41.01.30.51.90.21.0

51.01.10.60.20.40.8

60.41.00.10.00.30.4

70.30.40.50.20.10.3

equal or > 80.00.50.10.20.10.2

Total100.0100.0100.0100.0100.0100.0

Govsub_adm_whole

admission

no hospital admission

income quintiles

percent

percent of hospital admission of individuals during last year in the 2003 HWS

Govsub_adm_UC

80.421503609513.31883424413.56875721961.01654186730.97409885860.41025212240.29001207850

82.921120052610.14538075582.58446955481.31099806811.10680250361.00487845560.40086264810.5254879614

85.10308370049.94361233483.22434921910.48041649980.58181818180.13552262720.46856227470.0626351622

87.22940207437.66964073772.61223265931.89063819080.23844922330.04354910970.1642015610.1518864439

89.92198155936.92290905122.05575863390.20704893880.39963991490.2692454580.10829832510.1151181188

1

2

3

4

5

6

7

equal or > 8

income quintiles

percent

Percentage of different numbers of hospital admissions in public hospitals during last year in the 2003 HWS

0

0

0

0

0

percentage of admission in public hospitals by income quintiles

92940

58930

110136

105404

236815

Percentage of admission in private hospitals among different income quintiles

types of health facilities admitted * 5 quintiles of capinc Crosstabulation

5 quintiles of capinc

12345Total

types of health facilitiescommunity hospital755,406483,557328,067227,761114,8671,909,658

provincial or regional hospitals247,727306,112209,907176,127122,2621,062,135

university hospital15,29211,5069,43815,04014,80766,083

other public hospitals64,15254,33070,787122,14678,526389,941

private polyclinic15,0833,6785,7968,63315,88149,071

private hospital68,23350,755106,74197,339243,834566,902

other8980.03,1002,5671,2467,811

unknown0.00.00.04851,0561,541

Total1,166,791909,938733,836650,098592,4794,053,142

Q1Q2Q3Q4Q5TotalQ1Q2Q3Q4Q5Total

community hospital64.753.144.735.019.447.1community hospital39.625.317.211.96.0100.0

provincial or regional hospitals21.233.628.627.120.626.2provincial or regional hospitals23.328.819.816.611.5100.0

university hospital1.31.31.32.32.51.6university hospital23.117.414.322.822.4100.0

other public hospitals5.56.09.618.813.39.6other public hospitals16.513.918.231.320.1100.0

private polyclinic1.30.40.81.32.71.2private polyclinic30.77.511.817.632.4100.0

private hospital5.85.614.515.041.214.0private hospital12.09.018.817.243.0100.0

other0.10.00.40.40.20.2other11.50.039.732.916.0100.0

unknown0.00.00.00.10.20.0unknown0.00.00.031.568.5100.0

Total100.0100.0100.0100.0100.0100.0Total28.822.518.116.014.6100.0

64.74218604721.2314801881.31060318435.49815691071.29269080755.8479196360.07696322650

53.14175251533.6409733411.26448175595.97073646780.40420336335.57785255700

44.705765320928.60407502491.28611842439.64616072260.789822249114.54562054740.42243771090

35.034871665527.09237684162.313497349618.78885952581.327953631614.97297330560.39486354370.0746041366

19.387522595720.63566809962.499160307813.25380308842.680432555441.15487637540.21030281240.1782341653

com hosp

prov/reg hosp

univ hosp

other pub hosp

priv polyclinic

priv hosp

other

unknown

income quintiles

percent

Percent of different types of hospital admissions among different income quintiles

39.557135361425.321654453317.179358817111.92679526916.0150560991

23.323494659328.820441845919.762742024316.582355350311.5109661201

23.140595917317.411437132114.282039253722.759257297622.4066703993

16.451719619113.93287702518.153259082831.324225972620.1379183005

30.73709522947.495261967411.811456868617.592875629232.3633103055

12.03611911768.953046558318.828827557517.170339847143.0116669195

11.4966073486039.68762002332.863909870715.9518627576

Q1

Q2

Q3

Q4

Q5

Types of hospital admissions

percent

proportion of different income quintiles among types of hospital admissions in the 2003 HWS

Whole population

benefits of hospital admissions gained (Bath)benefits of hospital admissions gained (Bath)

by income quintilespercentby asset quintilespercent

Q110,20930.38,462,943,12234.9

Q28,04523.95,744,538,63523.7

Q36,72520.05,056,376,54120.9

Q44,88614.53,378,717,79013.9

Q53,81211.31,579,003,3166.5

Total33,67610024,221,579,404100.020349

1.6549207332

Note: unit costs of hospital admissions of university and other public hospitals are still unavailable. Therefore, benefits gained by high income quintiles are lower than real figures.

income quintiles

income quintiles

percent

Government health subsidy for hospital admissions gained by whole population among different income quinitles in the 2003 HWS

UC beneficiaries only

benefits of hospital admissions gained (Bath)benefits of hospital admissions gained (Bath)

by different income quintilespercentby different income quintilespercent

Q16,022,111,49029.87,836,975,67338.8

Q26,041,791,75429.95,153,313,87825.5

Q34,557,361,93122.64,438,453,69422.0

Q42,714,882,57913.42,208,972,82910.9

Q5853,510,5084.2551,942,1882.7

Total20,189,658,262100.020,189,658,262100.0

Note: unit costs of hospital admissions of university and other public hospitals are still unavailable. Therefore, benefits gained by high income quintiles are lower than the real figures.

income quintiles

asset quintiles

income and asset quintiles

percent

Government health subsidy for hospital admissions gained by UC beneficiaries among different income and asset quinitles in the 2003 HWS

The distribution of ambulatory service use among different income quintiles in 2001 and 2003, by types of health facilities20012003Concentration indices of ambulatory service use among different types of health facilities in 2001 & 2003

Chart1

1.1970.710.720.340.046

1.0110.570.620.370.054

0.7460.430.690.430.088

0.450.230.690.450.169

0.1370.160.610.560.365

1.91.840.390.710.139

1.291.270.40.610.092

0.710.890.330.620.145

0.570.660.390.730.186

0.20.250.260.620.626

Health centre

Community hospital

Provincial and regional hospital

Private clinic

Private hospital

Income quintiles

Ambulatory visits per cap per year

Distribution of ambulatory services at different health facilities between the 2001 and 2003 HWS

insurance shift

health insurance scheme in 2003

H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotalA comparison of illness rate between 2001 and 2003 among different income quintiles

no h ins3,041,78626,7297,702221,2653,544,19627,0556,5903,0636,878,386inc quintile20012003% increase

CSMBS7,5695,537,3801,4054,72391,4133,4281,2730.05,647,19114.816.4433.89

employee benefit1,3925,921197,6226,56224,7423390.00.0236,57824.145.1524.40

SSS/WCS35,54120,07015,0005,308,700167,2466,94623425,3455,579,08233.913.951.02

30-Baht scheme0.048,654846108,97123,817,5860.00.00.023,976,05743.393.915.04

priv h insurance27,8374,97777752,626255,376602,1760.00.0943,76953.093.4611.97

VHCs65,20440,2302,282131,5727,354,1814,1683,74414,5467,615,927Total3.944.6818.78

Health volunteer3,2074,0650.01,7461,587,1600.00.00.01,596,178

LICs23,26832,32757122,83311,208,6404,65017,4586,08911,315,836

Other14,5480.00.02,99153,27416913,0810.084,063

Unknown0.00.00.00.010,3560.00.01,13211,488

Total3,220,3525,720,353226,2055,861,98948,114,170648,93142,38050,17563,884,555

health insurance scheme in 2003

H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal

no h ins94.460.473.403.777.374.1715.556.1010.77

CSMBS0.2496.800.620.080.190.533.000.008.84

employee benefit0.040.1087.360.110.050.050.000.000.37

SSS/WCS1.100.356.6390.560.351.070.5550.518.73

30-Baht scheme0.000.850.371.8649.500.000.000.0037.53

priv h insurance0.860.090.340.900.5392.800.000.001.48

VHCs2.020.701.012.2415.280.648.8328.9911.92

Health volunteer0.100.070.000.033.300.000.000.002.50

LICs0.720.570.250.3923.300.7241.1912.1417.71

Other0.450.000.000.050.110.0330.870.000.13

Unknown0.000.000.000.000.020.000.002.260.02

Total100.00100.00100.00100.00100.00100.00100.00100.00100.00

health insurance scheme in 2003

H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal

no h ins44.20.40.13.251.50.40.10.0100.0

CSMBS0.198.10.00.11.60.10.00.0100.0

employee benefit0.62.583.52.810.50.10.00.0100.0

SSS/WCS0.60.40.395.23.00.10.00.5100.0

30-Baht scheme0.00.20.00.599.30.00.00.0100.0

priv h insurance2.90.50.15.627.163.80.00.0100.0

VHCs0.90.50.01.796.60.10.00.2100.0

Health volunteer0.20.30.00.199.40.00.00.0100.0

LICs0.20.30.00.299.10.00.20.1100.0

Other17.30.00.03.663.40.215.60.0100.0

Unknown0.00.00.00.090.10.00.09.9100.0

Total5.09.00.49.275.31.00.10.1100.0

insurance shift

51.5265645167

1.6187339865

10.4582843713

2.9977333189

27.059163842

96.5631760914

99.435025417

99.0526904066

63.3738981478

90.1462395543

Health insurance scheme in 2001

percent

Percent of beneficiaries in different health insurance schemes in 2001 transfering to the 30-Baht scheme in 2003

amb rate 01&03

Health facilitiesYear and percent changeAverage ambulatory services utilizationConcentration index

(visits per capita per year)

Q1Q2Q3Q4Q5Total

Health centre20011.1971.0110.7460.450.1370.749-0.29442

20031.91.290.710.570.20.99-0.36497

Change58.727.6-4.826.746.032.2---

Community hospital20010.710.570.430.230.160.44-0.26983

20031.841.270.890.660.251.03-0.32

Change159.2122.8107.0187.056.3133.6---

Provincial and regional hospital20010.720.620.690.690.610.67-0.03657

20030.390.40.330.390.260.356-0.08019

Change-45.8-35.5-52.2-43.5-57.4-46.9---

Private clinic20010.340.370.430.450.560.420.09307

20030.710.610.620.730.620.66-0.014018

Change108.864.944.262.210.757.1---

Private hospital20010.0460.0540.0880.1690.3650.1350.43131

20030.1390.0920.1450.1860.6260.230.348354

Change202.270.464.810.171.570.4---

Q1Q2Q3Q4Q5Total

2001HC1.1971.0110.7460.450.1370.749

Com Hosp0.710.570.430.230.160.44

Prov/reg Hosp0.720.620.690.690.610.672001

Priv clinic0.340.370.430.450.560.42

Priv hosp0.0460.0540.0880.1690.3650.135

Total3.0132.6252.3841.9891.8322.414

Q1Q2Q3Q4Q5Total

2003HC1.91.290.710.570.20.99

Com Hosp1.841.270.890.660.251.028

Prov/reg Hosp0.390.40.330.390.260.356

Priv clinic0.710.610.620.730.620.66

Priv hosp0.1390.0920.1450.1860.6260.23

Total4.9793.6622.6952.5361.9563.264

amb rate 01&03

Health centre

Community hospital

Provincial and regional hospital

Private clinic

Private hospital

Income quintiles

Ambulatory visits per cap per year

Distribution of ambulatory services at different health facilities between the 2001 and 2003 HWS

hosp rate 01&03

hosptialization rate between 2001 & 2003

20012003

Q10.09480.104810.5

Q20.08070.093315.6

Health facilitiesyearAverage hospitalizationConcentration indexQ30.07570.07863.8

(admissions per capita per year)Q40.07170.0683-4.7

Q1Q2Q3Q4Q5TotalQ50.06590.0598-9.3

Community hospital20010.03600.02730.01900.01080.0050.0209-0.315744Total0.07890.08234.3

20030.06310.04880.03410.02250.01110.0374-0.2934

Diff.75.378.879.5108.3113.578.9---

Provincial and regional hospital20010.05220.04740.04880.04810.03420.0466-0.069053

20030.0230.0330.0210.0180.0120.0216-0.1375

Diff.-55.9-30.4-57.0-62.6-64.9-53.6---

Private hospital20010.00640.00540.00730.01210.02600.01090.319934

20030.00540.00370.01010.0080.02200.00950.316

Diff.-15.6-31.538.4-33.9-15.4-12.8---

Income quintileNet government health subsidy for ambulatory and in-patient services (million Baht)% increase

200120032003

(in 2001 value)20012003

Q116,494.2625,874.6325,240.445328.131.3

Q211,865.6318,442.2917,990.275220.222.3

Q39,899.0812,169.3111,871.042016.914.7

Q410,195.0413,592.6413,259.483017.416.4

Q510,278.9412,625.8512,316.392017.515.3

Total58,732.9582,704.7280,677.6137100.0100.0

quintiles200120022003

Q125,240.4425,417.1225,874.63

Q217,990.2718,116.2018,442.29

Q311,871.0411,954.1412,169.31

Q413,259.4813,352.3013,592.64

Q512,316.3912,402.6012,625.85

Total80,677.6181,242.3682,704.72

CPI1.60.71.8

hosp rate 01&03

00

00

00

00

00

2001

2003

Income quintile

percent

A comparison of percent distribution of net government health subsidies among different income quintiles in 2001 and 2003

asset index_2003

Net government health subsidies for amb services and hospitalization among different asset quintiles in 2003

qfactor1meanse(mean)sum (million Baht)total amount (Baht)percentincome quintile

11,479.4855.787824,569.1824,569,180,0003031

21,210.6243.167216,985.3316,985,330,0002122

31,299.5856.363916,547.6016,547,600,0002015

41,218.1549.126712,924.9912,924,990,0001616

51,179.0563.366111,677.6311,677,630,0001415

Total1,294.6023.974282,704.7382,704,730,000100100

asset index_2003

00

00

00

00

00

asset quintile

income quintile

asset and income quintiles

percent

A comparison of percent distribution of net government health subsidies between using income and asset quintiles in 2003

Geographical BIA

2001

regmeanse(mean)sum (million Baht)total amountpercent2003

BKK613.1833.064,752.514,752,510,0008.099.43

Central (excl. BKK)960.6218.7111,075.3111,075,310,00018.8618.31

North995.6418.5011,254.1711,254,170,00019.1623.01

Northeastern970.7115.4320,559.3420,559,340,00035.0034.51

South1,066.5922.388,972.258,972,253,00015.2812.26

East786.1832.842,119.362,119,361,0003.612.49

Total934.188.4458,732.9458,732,944,000100.00100.00

2003

regmeanse(mean)sum (million Baht)total amountpercent

BKK970.87105.067,795.597,795,587,0009.43

Central (excl. BKK)1,260.6749.4515,140.5215,140,520,00018.31

North1,679.5058.4519,030.3119,030,310,00023.01

Northeastern1,332.0546.0228,539.6328,539,630,00034.51

South1,183.0056.4010,139.1110,139,110,00012.26

East817.8953.462,059.572,059,574,0002.49

Total1,294.6023.9782,704.7382,704,731,000100.00

Geographical BIA

00

00

00

00

00

00

2001

2003

Regions

percent

Geographical distribution of net government health subsidies for ambulatory services and hospitalization in 2001 and 2003

Regional BIA

Net government health subsidies among different income quintiles in 2003 (using different regional costs)

quintileTotal gov sub for amb services (Baht)total gov subsidy for IP (Baht)overall government health subsidies (million Baht)percentaverage gov sub per capstandard error of mean95% CI2003 (national unit costs)2003 (regional BIA)

Q125368.6928.11,659.3960.992971,539.841,778.9531.328.1

Q217942.8219.91,376.4554.834191,268.961,483.9322.319.9

Q314794.3716.41,172.2145.301371,083.411,261.0114.716.4

Q414322.7715.91,300.9352.80861,197.421,404.4416.415.9

Q517870.2119.81,497.8767.542771,365.471,630.2615.319.8

Total90,298.86100.01,413.4725.485191,363.521,463.42100.0100.0

Regional BIA

00

00

00

00

00

Aggregated unit subsidies

Regional unit subsidies

income quintiles

percent

The distribution of net government health subsidies in 2003 between using aggregated and regional unit subsidies

Gender BIA

2001

gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent2003

Male803.9111.39781.58826.2325,185.0525,185,050,00042.3243.9

Female1,088.2312.401,063.931,112.5334,325.6234,325,620,00057.6856.1

Total946.558.44930.00963.1059,510.6759,510,670,000100.00100.0

2003

gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent20012003% changes

Male1,166.2233.971,099.641,232.8037,106.9837,106,980,00043.9male803.911,166.2245.07

Female1,481.3433.341,416.001,546.6947,501.3547,501,350,00056.1female1,088.231,481.3436.12

Total1,324.3923.791,277.761,371.0384,608.3484,608,340,000100.0total946.551,324.3939.92

0.724137931

1.380952381

1.2727272727

Gender BIA

00

00

2001

2003

gender

percent

The distribution of net government health subsidies between male and female in 2001 and 2003

The distribution of hospitalization among different income quintiles of Thais in 2001 and 2003, by types of health facilitiesConcentration indices of hospitalization among different types of health facilities in 2001 & 200320032001

Chart4

0.0360.05220.0064

0.02730.04740.0054

0.0190.04880.0073

0.01080.04810.0121

0.0050.03420.026

0.06310.0230.0054

0.04880.0330.0037

0.03410.0210.0101

0.02250.0180.008

0.01110.0120.022

district hospitals

prov / reg hospitals

private hospitals

Income quintiles

Hosptial admission per cap per year

The distribution of hospitalization among different income quintiles of Thais in 2001 and 2003

Sheet1

Average hospitalization

(admissions per capita per year)

Q1Q2Q3Q4Q5TotalConcentration indexQ1Q2Q3Q4Q5Q1Q2Q3Q4Q5

2001district hospitals0.0360.0270.0190.0110.0050.021-0.3157district hospitals0.0360.0270.0190.0110.0050.0630.0490.0340.0230.011

prov / reg hospitals0.0520.0470.0490.0480.0340.047-0.0691prov / reg hospitals0.0520.0470.0490.0480.0340.0230.0330.0210.0180.012

private hospitals0.0060.0050.0070.0120.0260.0110.3199private hospitals0.0060.0050.0070.0120.0260.0050.0040.0100.0080.022

2003district hospitals0.0630.0490.0340.0230.0110.037-0.2934

prov / reg hospitals0.0230.0330.0210.0180.0120.022-0.1375

private hospitals0.0050.0040.0100.0080.0220.0100.3160

Sheet1

0.0360.02730.0190.01080.005

0.05220.04740.04880.04810.0342

0.00640.00540.00730.01210.026

0.06310.04880.03410.02250.0111

0.0230.0330.0210.0180.012

0.00540.00370.01010.0080.022

Q1

Q2

Q3

Q4

Q5

Types of health facilities

Admission per cap per year

Distribution of hospitalization among different types of health facilities between the 2001 and 2003 HWS

Sheet2

district hospitals

prov / reg hospitals

private hospitals

Income quintiles

Hosptial admission per cap per year

The distribution of hospitalization among different income quintiles of Thais in 2001 and 2003

Sheet3

MBD00043790.xls

Chart1

1.1970.710.720.340.046

1.0110.570.620.370.054

0.7460.430.690.430.088

0.450.230.690.450.169

0.1370.160.610.560.365

1.91.840.390.710.139

1.291.270.40.610.092

0.710.890.330.620.145

0.570.660.390.730.186

0.20.250.260.620.626

Health centre

Community hospital

Provincial and regional hospital

Private clinic

Private hospital

Income quintiles

Ambulatory visits per cap per year

Distribution of hospitalization among different health facilities between the 2001 and 2003 HWS

insurance shift

health insurance scheme in 2003

H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotalA comparison of illness rate between 2001 and 2003 among different income quintiles

no h ins3,041,78626,7297,702221,2653,544,19627,0556,5903,0636,878,386inc quintile20012003% increase

CSMBS7,5695,537,3801,4054,72391,4133,4281,2730.05,647,19114.816.4433.89

employee benefit1,3925,921197,6226,56224,7423390.00.0236,57824.145.1524.40

SSS/WCS35,54120,07015,0005,308,700167,2466,94623425,3455,579,08233.913.951.02

30-Baht scheme0.048,654846108,97123,817,5860.00.00.023,976,05743.393.915.04

priv h insurance27,8374,97777752,626255,376602,1760.00.0943,76953.093.4611.97

VHCs65,20440,2302,282131,5727,354,1814,1683,74414,5467,615,927Total3.944.6818.78

Health volunteer3,2074,0650.01,7461,587,1600.00.00.01,596,178

LICs23,26832,32757122,83311,208,6404,65017,4586,08911,315,836

Other14,5480.00.02,99153,27416913,0810.084,063

Unknown0.00.00.00.010,3560.00.01,13211,488

Total3,220,3525,720,353226,2055,861,98948,114,170648,93142,38050,17563,884,555

health insurance scheme in 2003

H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal

no h ins94.460.473.403.777.374.1715.556.1010.77

CSMBS0.2496.800.620.080.190.533.000.008.84

employee benefit0.040.1087.360.110.050.050.000.000.37

SSS/WCS1.100.356.6390.560.351.070.5550.518.73

30-Baht scheme0.000.850.371.8649.500.000.000.0037.53

priv h insurance0.860.090.340.900.5392.800.000.001.48

VHCs2.020.701.012.2415.280.648.8328.9911.92

Health volunteer0.100.070.000.033.300.000.000.002.50

LICs0.720.570.250.3923.300.7241.1912.1417.71

Other0.450.000.000.050.110.0330.870.000.13

Unknown0.000.000.000.000.020.000.002.260.02

Total100.00100.00100.00100.00100.00100.00100.00100.00100.00

health insurance scheme in 2003

H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal

no h ins44.20.40.13.251.50.40.10.0100.0

CSMBS0.198.10.00.11.60.10.00.0100.0

employee benefit0.62.583.52.810.50.10.00.0100.0

SSS/WCS0.60.40.395.23.00.10.00.5100.0

30-Baht scheme0.00.20.00.599.30.00.00.0100.0

priv h insurance2.90.50.15.627.163.80.00.0100.0

VHCs0.90.50.01.796.60.10.00.2100.0

Health volunteer0.20.30.00.199.40.00.00.0100.0

LICs0.20.30.00.299.10.00.20.1100.0

Other17.30.00.03.663.40.215.60.0100.0

Unknown0.00.00.00.090.10.00.09.9100.0

Total5.09.00.49.275.31.00.10.1100.0

insurance shift

51.5265645167

1.6187339865

10.4582843713

2.9977333189

27.059163842

96.5631760914

99.435025417

99.0526904066

63.3738981478

90.1462395543

Health insurance scheme in 2001

percent

Percent of beneficiaries in different health insurance schemes in 2001 transfering to the 30-Baht scheme in 2003

amb rate 01&03

Health facilitiesYear and percent changeAverage ambulatory services utilizationConcentration index

(visits per capita per year)

Q1Q2Q3Q4Q5Total

Health centre20011.1971.0110.7460.450.1370.749-0.29442

20031.91.290.710.570.20.99-0.36497

Change58.727.6-4.826.746.032.2---

Community hospital20010.710.570.430.230.160.44-0.26983

20031.841.270.890.660.251.03-0.32

Change159.2122.8107.0187.056.3133.6---

Provincial and regional hospital20010.720.620.690.690.610.67-0.03657

20030.390.40.330.390.260.356-0.08019

Change-45.8-35.5-52.2-43.5-57.4-46.9---

Private clinic20010.340.370.430.450.560.420.09307

20030.710.610.620.730.620.66-0.014018

Change108.864.944.262.210.757.1---

Private hospital20010.0460.0540.0880.1690.3650.1350.43131

20030.1390.0920.1450.1860.6260.230.348354

Change202.270.464.810.171.570.4---

Q1Q2Q3Q4Q5Total

2001HC1.1971.0110.7460.450.1370.749

Com Hosp0.710.570.430.230.160.44

Prov/reg Hosp0.720.620.690.690.610.672001

Priv clinic0.340.370.430.450.560.42

Priv hosp0.0460.0540.0880.1690.3650.135

Total3.0132.6252.3841.9891.8322.414

Q1Q2Q3Q4Q5Total

2003HC1.91.290.710.570.20.99

Com Hosp1.841.270.890.660.251.028

Prov/reg Hosp0.390.40.330.390.260.356

Priv clinic0.710.610.620.730.620.66

Priv hosp0.1390.0920.1450.1860.6260.23

Total4.9793.6622.6952.5361.9563.264

amb rate 01&03

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

Health centre

Community hospital

Provincial and regional hospital

Private clinic

Private hospital

Income quintiles

Ambulatory visits per cap per year

Distribution of ambulatory services at different health facilities between the 2001 and 2003 HWS

hosp rate 01&03

hosptialization rate between 2001 & 2003

20012003

Q10.09480.104810.5

Q20.08070.093315.6

yearAverage hospitalizationConcentration indexQ30.07570.07863.8

(admissions per capita per year)Q40.07170.0683-4.7

Q1Q2Q3Q4Q5TotalQ50.06590.0598-9.3

district hospitals20010.03600.02730.01900.01080.0050.0209-0.315744Total0.07890.08234.3

20030.06310.04880.03410.02250.01110.0374-0.2934

prov / reg hospitals20010.05220.04740.04880.04810.03420.0466-0.069053

20030.0230.0330.0210.0180.0120.0216-0.1375

private hospitals20010.00640.00540.00730.01210.02600.01090.319934

20030.00540.00370.01010.0080.02200.00950.316

Income quintileNet government health subsidy for ambulatory and in-patient services (million Baht)% increase

200120032003

(in 2001 value)20012003

Q116,494.2625,874.6325,240.445328.131.3

Q211,865.6318,442.2917,990.275220.222.3

Q39,899.0812,169.3111,871.042016.914.7

Q410,195.0413,592.6413,259.483017.416.4

Q510,278.9412,625.8512,316.392017.515.3

Total58,732.9582,704.7280,677.6137100.0100.0

quintiles200120022003

Q125,240.4425,417.1225,874.63

Q217,990.2718,116.2018,442.29

Q311,871.0411,954.1412,169.31

Q413,259.4813,352.3013,592.64

Q512,316.3912,402.6012,625.85

Total80,677.6181,242.3682,704.72

CPI1.60.71.8

hosp rate 01&03

00

00

00

00

00

2001

2003

Income quintile

percent

A comparison of percent distribution of net government health subsidies among different income quintiles in 2001 and 2003

asset index_2003

Net government health subsidies for amb services and hospitalization among different asset quintiles in 2003

qfactor1meanse(mean)sum (million Baht)total amount (Baht)percentincome quintile

11,479.4855.787824,569.1824,569,180,0003031

21,210.6243.167216,985.3316,985,330,0002122

31,299.5856.363916,547.6016,547,600,0002015

41,218.1549.126712,924.9912,924,990,0001616

51,179.0563.366111,677.6311,677,630,0001415

Total1,294.6023.974282,704.7382,704,730,000100100

asset index_2003

00

00

00

00

00

asset quintile

income quintile

asset and income quintiles

percent

A comparison of percent distribution of net government health subsidies between using income and asset quintiles in 2003

Geographical BIA

2001

regmeanse(mean)sum (million Baht)total amountpercent2003

BKK613.1833.064,752.514,752,510,0008.099.43

Central (excl. BKK)960.6218.7111,075.3111,075,310,00018.8618.31

North995.6418.5011,254.1711,254,170,00019.1623.01

Northeastern970.7115.4320,559.3420,559,340,00035.0034.51

South1,066.5922.388,972.258,972,253,00015.2812.26

East786.1832.842,119.362,119,361,0003.612.49

Total934.188.4458,732.9458,732,944,000100.00100.00

2003

regmeanse(mean)sum (million Baht)total amountpercent

BKK970.87105.067,795.597,795,587,0009.43

Central (excl. BKK)1,260.6749.4515,140.5215,140,520,00018.31

North1,679.5058.4519,030.3119,030,310,00023.01

Northeastern1,332.0546.0228,539.6328,539,630,00034.51

South1,183.0056.4010,139.1110,139,110,00012.26

East817.8953.462,059.572,059,574,0002.49

Total1,294.6023.9782,704.7382,704,731,000100.00

Geographical BIA

00

00

00

00

00

00

2001

2003

Regions

percent

Geographical distribution of net government health subsidies for ambulatory services and hospitalization in 2001 and 2003

Regional BIA

Net government health subsidies among different income quintiles in 2003 (using different regional costs)

quintileTotal gov sub for amb services (Baht)total gov subsidy for IP (Baht)overall government health subsidies (million Baht)percentaverage gov sub per capstandard error of mean95% CI2003 (national unit costs)2003 (regional BIA)

Q125368.6928.11,659.3960.992971,539.841,778.9531.328.1

Q217942.8219.91,376.4554.834191,268.961,483.9322.319.9

Q314794.3716.41,172.2145.301371,083.411,261.0114.716.4

Q414322.7715.91,300.9352.80861,197.421,404.4416.415.9

Q517870.2119.81,497.8767.542771,365.471,630.2615.319.8

Total90,298.86100.01,413.4725.485191,363.521,463.42100.0100.0

Regional BIA

00

00

00

00

00

Aggregated unit subsidies

Regional unit subsidies

income quintiles

percent

The distribution of net government health subsidies in 2003 between using aggregated and regional unit subsidies

Gender BIA

2001

gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent2003

Male803.9111.39781.58826.2325,185.0525,185,050,00042.3243.9

Female1,088.2312.401,063.931,112.5334,325.6234,325,620,00057.6856.1

Total946.558.44930.00963.1059,510.6759,510,670,000100.00100.0

2003

gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent20012003% changes

Male1,166.2233.971,099.641,232.8037,106.9837,106,980,00043.9male803.911,166.2245.07

Female1,481.3433.341,416.001,546.6947,501.3547,501,350,00056.1female1,088.231,481.3436.12

Total1,324.3923.791,277.761,371.0384,608.3484,608,340,000100.0total946.551,324.3939.92

0.724137931

1.380952381

1.2727272727

Gender BIA

00

00

2001

2003

gender

percent

The distribution of net government health subsidies between male and female in 2001 and 2003

Percent distribution of net government health subsidies among different income quintiles in 2001 and 2003Note: Overall net government health subsidies in 2001 were approximately 58,733 million Baht, and in 2003 were 80,678 million Baht (in 2001-value) The concentration index of government health subsidies in 2001 was -0.044 and in 2003 was -0.123

Benefit incidence in 2003 between using aggregate and regional unit subsidiesBenefit incidence in 2003 between using household income per capita and an asset index to rank individuals

Chart2

31.285554198128.0941420523

22.29895947919.8704834147

14.714168671416.3837838041

16.435138163815.8615180745

15.266179487719.7900726543

Aggregated unit subsidies

Regional unit subsidies

income quintiles

percent

The distribution of net government health subsidies in 2003 between using aggregated and regional unit subsidies

insurance shift

health insurance scheme in 2003

H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotalA comparison of illness rate between 2001 and 2003 among different income quintiles

no h ins3,041,78626,7297,702221,2653,544,19627,0556,5903,0636,878,386inc quintile20012003% increase

CSMBS7,5695,537,3801,4054,72391,4133,4281,2730.05,647,19114.816.4433.89

employee benefit1,3925,921197,6226,56224,7423390.00.0236,57824.145.1524.40

SSS/WCS35,54120,07015,0005,308,700167,2466,94623425,3455,579,08233.913.951.02

30-Baht scheme0.048,654846108,97123,817,5860.00.00.023,976,05743.393.915.04

priv h insurance27,8374,97777752,626255,376602,1760.00.0943,76953.093.4611.97

VHCs65,20440,2302,282131,5727,354,1814,1683,74414,5467,615,927Total3.944.6818.78

Health volunteer3,2074,0650.01,7461,587,1600.00.00.01,596,178

LICs23,26832,32757122,83311,208,6404,65017,4586,08911,315,836

Other14,5480.00.02,99153,27416913,0810.084,063

Unknown0.00.00.00.010,3560.00.01,13211,488

Total3,220,3525,720,353226,2055,861,98948,114,170648,93142,38050,17563,884,555

health insurance scheme in 2003

H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal

no h ins94.460.473.403.777.374.1715.556.1010.77

CSMBS0.2496.800.620.080.190.533.000.008.84

employee benefit0.040.1087.360.110.050.050.000.000.37

SSS/WCS1.100.356.6390.560.351.070.5550.518.73

30-Baht scheme0.000.850.371.8649.500.000.000.0037.53

priv h insurance0.860.090.340.900.5392.800.000.001.48

VHCs2.020.701.012.2415.280.648.8328.9911.92

Health volunteer0.100.070.000.033.300.000.000.002.50

LICs0.720.570.250.3923.300.7241.1912.1417.71

Other0.450.000.000.050.110.0330.870.000.13

Unknown0.000.000.000.000.020.000.002.260.02

Total100.00100.00100.00100.00100.00100.00100.00100.00100.00

health insurance scheme in 2003

H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal

no h ins44.20.40.13.251.50.40.10.0100.0

CSMBS0.198.10.00.11.60.10.00.0100.0

employee benefit0.62.583.52.810.50.10.00.0100.0

SSS/WCS0.60.40.395.23.00.10.00.5100.0

30-Baht scheme0.00.20.00.599.30.00.00.0100.0

priv h insurance2.90.50.15.627.163.80.00.0100.0

VHCs0.90.50.01.796.60.10.00.2100.0

Health volunteer0.20.30.00.199.40.00.00.0100.0

LICs0.20.30.00.299.10.00.20.1100.0

Other17.30.00.03.663.40.215.60.0100.0

Unknown0.00.00.00.090.10.00.09.9100.0

Total5.09.00.49.275.31.00.10.1100.0

insurance shift

51.5265645167

1.6187339865

10.4582843713

2.9977333189

27.059163842

96.5631760914

99.435025417

99.0526904066

63.3738981478

90.1462395543

Health insurance scheme in 2001

percent

Percent of beneficiaries in different health insurance schemes in 2001 transfering to the 30-Baht scheme in 2003

amb rate 01&03

Health facilitiesYear and percent changeAverage ambulatory services utilizationConcentration index

(visits per capita per year)

Q1Q2Q3Q4Q5Total

Health centre20011.1971.0110.7460.450.1370.749-0.29442

20031.91.290.710.570.20.99-0.36497

Change58.727.6-4.826.746.032.2---

Community hospital20010.710.570.430.230.160.44-0.26983

20031.841.270.890.660.251.03-0.32

Change159.2122.8107.0187.056.3133.6---

Provincial and regional hospital20010.720.620.690.690.610.67-0.03657

20030.390.40.330.390.260.356-0.08019

Change-45.8-35.5-52.2-43.5-57.4-46.9---

Private clinic20010.340.370.430.450.560.420.09307

20030.710.610.620.730.620.66-0.014018

Change108.864.944.262.210.757.1---

Private hospital20010.0460.0540.0880.1690.3650.1350.43131

20030.1390.0920.1450.1860.6260.230.348354

Change202.270.464.810.171.570.4---

Q1Q2Q3Q4Q5Total

2001HC1.1971.0110.7460.450.1370.749

Com Hosp0.710.570.430.230.160.44

Prov/reg Hosp0.720.620.690.690.610.672001

Priv clinic0.340.370.430.450.560.42

Priv hosp0.0460.0540.0880.1690.3650.135

Total3.0132.6252.3841.9891.8322.414

Q1Q2Q3Q4Q5Total

2003HC1.91.290.710.570.20.99

Com Hosp1.841.270.890.660.251.028

Prov/reg Hosp0.390.40.330.390.260.356

Priv clinic0.710.610.620.730.620.66

Priv hosp0.1390.0920.1450.1860.6260.23

Total4.9793.6622.6952.5361.9563.264

amb rate 01&03

Health centre

Community hospital

Provincial and regional hospital

Private clinic

Private hospital

Income quintiles

Amb visits per cap per year

Distribution of ambulatory services at different health facilities between the 2001 and 2003 HWS

hosp rate 01&03

hosptialization rate between 2001 & 2003

20012003

Q10.09480.104810.5

Q20.08070.093315.6

Health facilitiesyearAverage hospitalizationConcentration indexQ30.07570.07863.8

(admissions per capita per year)Q40.07170.0683-4.7

Q1Q2Q3Q4Q5TotalQ50.06590.0598-9.3

Community hospital20010.03600.02730.01900.01080.0050.0209-0.315744Total0.07890.08234.3

20030.06310.04880.03410.02250.01110.0374-0.2934

Diff.75.378.879.5108.3113.578.9---

Provincial and regional hospital20010.05220.04740.04880.04810.03420.0466-0.069053

20030.0230.0330.0210.0180.0120.0216-0.1375

Diff.-55.9-30.4-57.0-62.6-64.9-53.6---

Private hospital20010.00640.00540.00730.01210.02600.01090.319934

20030.00540.00370.01010.0080.02200.00950.316

Diff.-15.6-31.538.4-33.9-15.4-12.8---

Income quintileNet government health subsidy for ambulatory and in-patient services (million Baht)% increase

200120032003

(in 2001 value)20012003

Q116,494.2625,874.6325,240.445328.131.3

Q211,865.6318,442.2917,990.275220.222.3

Q39,899.0812,169.3111,871.042016.914.7

Q410,195.0413,592.6413,259.483017.416.4

Q510,278.9412,625.8512,316.392017.515.3

Total58,732.9582,704.7280,677.6137100.0100.0

quintiles200120022003

Q125,240.4425,417.1225,874.63

Q217,990.2718,116.2018,442.29

Q311,871.0411,954.1412,169.31

Q413,259.4813,352.3013,592.64

Q512,316.3912,402.6012,625.85

Total80,677.6181,242.3682,704.72

CPI1.60.71.8

hosp rate 01&03

2001

2003

Income quintile

percent

A comparison of percent distribution of net government health subsidies among different income quintiles in 2001 and 2003

asset index_2003

Net government health subsidies for amb services and hospitalization among different asset quintiles in 2003

qfactor1meanse(mean)sum (million Baht)total amount (Baht)percentincome quintile

11,479.4855.787824,569.1824,569,180,0003031

21,210.6243.167216,985.3316,985,330,0002122

31,299.5856.363916,547.6016,547,600,0002015

41,218.1549.126712,924.9912,924,990,0001616

51,179.0563.366111,677.6311,677,630,0001415

Total1,294.6023.974282,704.7382,704,730,000100100

asset index_2003

Q1Q1

Q2Q2

Q3Q3

Q4Q4

Q5Q5

asset quintile

income quintile

asset and income quintiles

percent

A comparison of percent distribution of net government health subsidies between using income and asset quintiles in 2003

Geographical BIA

2001

regmeanse(mean)sum (million Baht)total amountpercent2003

BKK613.1833.064,752.514,752,510,0008.099.43

Central (excl. BKK)960.6218.7111,075.3111,075,310,00018.8618.31

North995.6418.5011,254.1711,254,170,00019.1623.01

Northeastern970.7115.4320,559.3420,559,340,00035.0034.51

South1,066.5922.388,972.258,972,253,00015.2812.26

East786.1832.842,119.362,119,361,0003.612.49

Total934.188.4458,732.9458,732,944,000100.00100.00

2003

regmeanse(mean)sum (million Baht)total amountpercent

BKK970.87105.067,795.597,795,587,0009.43

Central (excl. BKK)1,260.6749.4515,140.5215,140,520,00018.31

North1,679.5058.4519,030.3119,030,310,00023.01

Northeastern1,332.0546.0228,539.6328,539,630,00034.51

South1,183.0056.4010,139.1110,139,110,00012.26

East817.8953.462,059.572,059,574,0002.49

Total1,294.6023.9782,704.7382,704,731,000100.00

Geographical BIA

2001

2003

Regions

percent

Geographical distribution of net government health subsidies for ambulatory services and hospitalization in 2001 and 2003

Regional BIA

Net government health subsidies among different income quintiles in 2003 (using different regional costs)

quintileTotal gov sub for amb services (Baht)total gov subsidy for IP (Baht)overall government health subsidies (million Baht)percentaverage gov sub per capstandard error of mean95% CI2003 (national unit costs)2003 (regional BIA)

Q125368.6928.11,659.3960.992971,539.841,778.9531.328.1

Q217942.8219.91,376.4554.834191,268.961,483.9322.319.9

Q314794.3716.41,172.2145.301371,083.411,261.0114.716.4

Q414322.7715.91,300.9352.80861,197.421,404.4416.415.9

Q517870.2119.81,497.8767.542771,365.471,630.2615.319.8

Total90,298.86100.01,413.4725.485191,363.521,463.42100.0100.0

Regional BIA

Aggregated unit subsidies

Regional unit subsidies

income quintiles

percent

The distribution of net government health subsidies in 2003 between using aggregated and regional unit subsidies

Gender BIA

2001

gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent2003

Male803.9111.39781.58826.2325,185.0525,185,050,00042.3243.9

Female1,088.2312.401,063.931,112.5334,325.6234,325,620,00057.6856.1

Total946.558.44930.00963.1059,510.6759,510,670,000100.00100.0

2003

gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent20012003% changes

Male1,166.2233.971,099.641,232.8037,106.9837,106,980,00043.9male803.911,166.2245.07

Female1,481.3433.341,416.001,546.6947,501.3547,501,350,00056.1female1,088.231,481.3436.12

Total1,324.3923.791,277.761,371.0384,608.3484,608,340,000100.0total946.551,324.3939.92

0.724137931

1.380952381

1.2727272727

Gender BIA

00

00

2001

2003

gender

percent

The distribution of net government health subsidies between male and female in 2001 and 2003

Chart1

29.707103813831.2855541981

20.537313887622.298959479

20.008045489114.7141686714

15.627872795216.4351381638

14.119664014415.2661794877

asset quintile

income quintile

asset and income quintiles

percent

A comparison of percent distribution of net government health subsidies between using income and asset quintiles in 2003

insurance shift

health insurance scheme in 2003

H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotalA comparison of illness rate between 2001 and 2003 among different income quintiles

no h ins3,041,78626,7297,702221,2653,544,19627,0556,5903,0636,878,386inc quintile20012003% increase

CSMBS7,5695,537,3801,4054,72391,4133,4281,2730.05,647,19114.816.4433.89

employee benefit1,3925,921197,6226,56224,7423390.00.0236,57824.145.1524.40

SSS/WCS35,54120,07015,0005,308,700167,2466,94623425,3455,579,08233.913.951.02

30-Baht scheme0.048,654846108,97123,817,5860.00.00.023,976,05743.393.915.04

priv h insurance27,8374,97777752,626255,376602,1760.00.0943,76953.093.4611.97

VHCs65,20440,2302,282131,5727,354,1814,1683,74414,5467,615,927Total3.944.6818.78

Health volunteer3,2074,0650.01,7461,587,1600.00.00.01,596,178

LICs23,26832,32757122,83311,208,6404,65017,4586,08911,315,836

Other14,5480.00.02,99153,27416913,0810.084,063

Unknown0.00.00.00.010,3560.00.01,13211,488

Total3,220,3525,720,353226,2055,861,98948,114,170648,93142,38050,17563,884,555

health insurance scheme in 2003

H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal

no h ins94.460.473.403.777.374.1715.556.1010.77

CSMBS0.2496.800.620.080.190.533.000.008.84

employee benefit0.040.1087.360.110.050.050.000.000.37

SSS/WCS1.100.356.6390.560.351.070.5550.518.73

30-Baht scheme0.000.850.371.8649.500.000.000.0037.53

priv h insurance0.860.090.340.900.5392.800.000.001.48

VHCs2.020.701.012.2415.280.648.8328.9911.92

Health volunteer0.100.070.000.033.300.000.000.002.50

LICs0.720.570.250.3923.300.7241.1912.1417.71

Other0.450.000.000.050.110.0330.870.000.13

Unknown0.000.000.000.000.020.000.002.260.02

Total100.00100.00100.00100.00100.00100.00100.00100.00100.00

health insurance scheme in 2003

H ins in 2001no h insCSMBSemployee's benefitSSS/WCS30-Baht schemepriv health insotherunknownTotal

no h ins44.20.40.13.251.50.40.10.0100.0

CSMBS0.198.10.00.11.60.10.00.0100.0

employee benefit0.62.583.52.810.50.10.00.0100.0

SSS/WCS0.60.40.395.23.00.10.00.5100.0

30-Baht scheme0.00.20.00.599.30.00.00.0100.0

priv h insurance2.90.50.15.627.163.80.00.0100.0

VHCs0.90.50.01.796.60.10.00.2100.0

Health volunteer0.20.30.00.199.40.00.00.0100.0

LICs0.20.30.00.299.10.00.20.1100.0

Other17.30.00.03.663.40.215.60.0100.0

Unknown0.00.00.00.090.10.00.09.9100.0

Total5.09.00.49.275.31.00.10.1100.0

insurance shift

51.5265645167

1.6187339865

10.4582843713

2.9977333189

27.059163842

96.5631760914

99.435025417

99.0526904066

63.3738981478

90.1462395543

Health insurance scheme in 2001

percent

Percent of beneficiaries in different health insurance schemes in 2001 transfering to the 30-Baht scheme in 2003

amb rate 01&03

Health facilitiesYear and percent changeAverage ambulatory services utilizationConcentration index

(visits per capita per year)

Q1Q2Q3Q4Q5Total

Health centre20011.1971.0110.7460.450.1370.749-0.29442

20031.91.290.710.570.20.99-0.36497

Change58.727.6-4.826.746.032.2---

Community hospital20010.710.570.430.230.160.44-0.26983

20031.841.270.890.660.251.03-0.32

Change159.2122.8107.0187.056.3133.6---

Provincial and regional hospital20010.720.620.690.690.610.67-0.03657

20030.390.40.330.390.260.356-0.08019

Change-45.8-35.5-52.2-43.5-57.4-46.9---

Private clinic20010.340.370.430.450.560.420.09307

20030.710.610.620.730.620.66-0.014018

Change108.864.944.262.210.757.1---

Private hospital20010.0460.0540.0880.1690.3650.1350.43131

20030.1390.0920.1450.1860.6260.230.348354

Change202.270.464.810.171.570.4---

Q1Q2Q3Q4Q5Total

2001HC1.1971.0110.7460.450.1370.749

Com Hosp0.710.570.430.230.160.44

Prov/reg Hosp0.720.620.690.690.610.672001

Priv clinic0.340.370.430.450.560.42

Priv hosp0.0460.0540.0880.1690.3650.135

Total3.0132.6252.3841.9891.8322.414

Q1Q2Q3Q4Q5Total

2003HC1.91.290.710.570.20.99

Com Hosp1.841.270.890.660.251.028

Prov/reg Hosp0.390.40.330.390.260.356

Priv clinic0.710.610.620.730.620.66

Priv hosp0.1390.0920.1450.1860.6260.23

Total4.9793.6622.6952.5361.9563.264

amb rate 01&03

Health centre

Community hospital

Provincial and regional hospital

Private clinic

Private hospital

Income quintiles

Amb visits per cap per year

Distribution of ambulatory services at different health facilities between the 2001 and 2003 HWS

hosp rate 01&03

hosptialization rate between 2001 & 2003

20012003

Q10.09480.104810.5

Q20.08070.093315.6

Health facilitiesyearAverage hospitalizationConcentration indexQ30.07570.07863.8

(admissions per capita per year)Q40.07170.0683-4.7

Q1Q2Q3Q4Q5TotalQ50.06590.0598-9.3

Community hospital20010.03600.02730.01900.01080.0050.0209-0.315744Total0.07890.08234.3

20030.06310.04880.03410.02250.01110.0374-0.2934

Diff.75.378.879.5108.3113.578.9---

Provincial and regional hospital20010.05220.04740.04880.04810.03420.0466-0.069053

20030.0230.0330.0210.0180.0120.0216-0.1375

Diff.-55.9-30.4-57.0-62.6-64.9-53.6---

Private hospital20010.00640.00540.00730.01210.02600.01090.319934

20030.00540.00370.01010.0080.02200.00950.316

Diff.-15.6-31.538.4-33.9-15.4-12.8---

Income quintileNet government health subsidy for ambulatory and in-patient services (million Baht)% increase

200120032003

(in 2001 value)20012003

Q116,494.2625,874.6325,240.445328.131.3

Q211,865.6318,442.2917,990.275220.222.3

Q39,899.0812,169.3111,871.042016.914.7

Q410,195.0413,592.6413,259.483017.416.4

Q510,278.9412,625.8512,316.392017.515.3

Total58,732.9582,704.7280,677.6137100.0100.0

quintiles200120022003

Q125,240.4425,417.1225,874.63

Q217,990.2718,116.2018,442.29

Q311,871.0411,954.1412,169.31

Q413,259.4813,352.3013,592.64

Q512,316.3912,402.6012,625.85

Total80,677.6181,242.3682,704.72

CPI1.60.71.8

hosp rate 01&03

2001

2003

Income quintile

percent

A comparison of percent distribution of net government health subsidies among different income quintiles in 2001 and 2003

asset index_2003

Net government health subsidies for amb services and hospitalization among different asset quintiles in 2003

qfactor1meanse(mean)sum (million Baht)total amount (Baht)percentincome quintile

11,479.4855.787824,569.1824,569,180,0003031

21,210.6243.167216,985.3316,985,330,0002122

31,299.5856.363916,547.6016,547,600,0002015

41,218.1549.126712,924.9912,924,990,0001616

51,179.0563.366111,677.6311,677,630,0001415

Total1,294.6023.974282,704.7382,704,730,000100100

asset index_2003

Q1Q1

Q2Q2

Q3Q3

Q4Q4

Q5Q5

asset quintile

income quintile

asset and income quintiles

percent

A comparison of percent distribution of net government health subsidies between using income and asset quintiles in 2003

Geographical BIA

2001

regmeanse(mean)sum (million Baht)total amountpercent2003

BKK613.1833.064,752.514,752,510,0008.099.43

Central (excl. BKK)960.6218.7111,075.3111,075,310,00018.8618.31

North995.6418.5011,254.1711,254,170,00019.1623.01

Northeastern970.7115.4320,559.3420,559,340,00035.0034.51

South1,066.5922.388,972.258,972,253,00015.2812.26

East786.1832.842,119.362,119,361,0003.612.49

Total934.188.4458,732.9458,732,944,000100.00100.00

2003

regmeanse(mean)sum (million Baht)total amountpercent

BKK970.87105.067,795.597,795,587,0009.43

Central (excl. BKK)1,260.6749.4515,140.5215,140,520,00018.31

North1,679.5058.4519,030.3119,030,310,00023.01

Northeastern1,332.0546.0228,539.6328,539,630,00034.51

South1,183.0056.4010,139.1110,139,110,00012.26

East817.8953.462,059.572,059,574,0002.49

Total1,294.6023.9782,704.7382,704,731,000100.00

Geographical BIA

8.09172787259.4258053992

18.857065976518.3067157307

19.161596939523.009941233

35.004783686634.5078566304

15.276354953412.259407506

3.60847057152.4902735008

2001

2003

Regions

percent

Geographical distribution of net government health subsidies for ambulatory services and hospitalization in 2001 and 2003

Regional BIA

Net government health subsidies among different income quintiles in 2003 (using different regional costs)

quintileTotal gov sub for amb services (Baht)total gov subsidy for IP (Baht)overall government health subsidies (million Baht)percentaverage gov sub per capstandard error of mean95% CI2003 (national unit costs)2003 (regional BIA)

Q125368.6928.11,659.3960.992971,539.841,778.9531.328.1

Q217942.8219.91,376.4554.834191,268.961,483.9322.319.9

Q314794.3716.41,172.2145.301371,083.411,261.0114.716.4

Q414322.7715.91,300.9352.80861,197.421,404.4416.415.9

Q517870.2119.81,497.8767.542771,365.471,630.2615.319.8

Total90,298.86100.01,413.4725.485191,363.521,463.42100.0100.0

Regional BIA

00

00

00

00

00

Aggregated unit subsidies

Regional unit subsidies

income quintiles

percent

The distribution of net government health subsidies in 2003 between using aggregated and regional unit subsidies

Gender BIA

2001

gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent2003

Male803.9111.39781.58826.2325,185.0525,185,050,00042.3243.9

Female1,088.2312.401,063.931,112.5334,325.6234,325,620,00057.6856.1

Total946.558.44930.00963.1059,510.6759,510,670,000100.00100.0

2003

gendermeanse(mean)95% CIsum (million Baht)total amount (Baht)percent20012003% changes

Male1,166.2233.971,099.641,232.8037,106.9837,106,980,00043.9male803.911,166.2245.07

Female1,481.3433.341,416.001,546.6947,501.3547,501,350,00056.1female1,088.231,481.3436.12

Total1,324.3923.791,277.761,371.0384,608.3484,608,340,000100.0total946.551,324.3939.92

0.724137931

1.380952381

1.2727272727

Gender BIA

00

00

2001

2003

gender

percent

The distribution of net government health subsidies between male and female in 2001 and 2003

The incidence of catastrophic health payments in 2000, 2002, and 2004 Note: Catastrophic health expenditure refers to household out-of-pocket payments for health over 10% of total household consumption

Conclusions (1)The UC policy has improved equity in access to and utilization of health services in Thailand through four strategies:The expansion of public health insurance to nearly universal coverageThe removal of financial barriers to essential health services The comprehensive benefit package of the schemeThe promotion of primary care use as the main contracting unit

The distribution of government health subsidies in Thailand was pro-poor before UC, and the re-distributive effect is getting better after implementation of the UC policy.

Health services at primary and secondary care levels were more pro-poor than health services at tertiary care and private facilities.

Conclusions (2)Using different figures of government unit subsidies (aggregated vs regional unit subsidies) and different measures to categorize individual socio-economic status (income and asset index) does not provide different pictures of improvements in health care use and the distribution of government health subsidies in Thailand.

The incidence of catastrophic health expenditure after UC is better than the situation before UC, particularly in poorer quintiles, but some expensive health services such as RRT for end-stage renal disease patients is still excluded from the UC benefit package and causes households to be financially catastrophic.

Changes in the allocation method of government health resource and health financing mechanisms appear to be a key factor in the success of UC in improving equity in the Thai health care system.

Limitations of the studyDifferences in questions and answer choices between the 2001 and 2003 HWS questionnaires,Lack of rigorous welfare indicators to categorize individuals into different socio-economic status,Variations of unit government subsidies among different regions and health care levels,The estimates of unit subsidies for CSMBS and SSS beneficiaries,Limitations in identifying UC members before implementation of the UC policy.

AcknowledgementsNational Statistical Office of Thailand (NSO)Ministry of Public Health (MOPH)Thailand Research Fund (TRF)Health Systems Research Institute (HSRI)World Health Organization (WHO)

We analyzed two nationally representative household surveys in 2001 and 2003 by using financial and benefit incidence analyses. We found that after implementation of the UC policy in 2001, the proportion of Thai population covered by a public or a private health insurance scheme increased from 71% in 2001 to 95% in 2003, and approximately 5% of Thais were still uninsured. The UC scheme covers approximately 75% of the population, while the CSMBS and SSS covered only 9 and 10%, respectively.

When beneficiaries of each health insurance scheme were categorized into different income quintiles, we found that around 53% of the UC beneficiaries were in the first and second quintiles, while 45% of the SSS beneficiaries and 53% of the CSMBS beneficiaries were in the richest category. The analysis of health service use in the 2001 and 2003 HWS indicates that after UC, ambulatory service use of the first and second quintiles increased significantly, especially at health centers and community hospitals. The concentration indexes show the more pro-poor nature of ambulatory service use at health centre, community, and regional hospitals; while the concentration indexes of private hospitals reveal the pro-rich nature of ambulatory service use both situations of before and after UC. Similar to ambulatory service use, the analysis of hospitalization in the 2001 and 2003 HWS indicates that the proportion of hospitalization at the community hospitals increased significantly at the first and second quintiles, while hospitalization at regional and provincial hospitals decreased in all income quintiles after UC. The increase in hospitalization of the first and the second quintiles at community hospitals reflected the success in promoting the close-to-client policy of the UC policy and the strategy to use primary care as a gate-keeper. In addition, the concentration indexes of hospitalization show the pro-poor nature of community, and regional hospitals; while the concentration indexes of private hospitals reveal the pro-rich nature both situations of before and after UC. It should be noted that the negative value of the concentration index of community hospitals decreased after UC because of an increase in hospitalization of richer quintiles at the community hospitals. When we analyzed the benefit incidence before and after UC by combining health service use with unit government subsidies, we found that in 2003, the first and second quintiles gained higher percentage of net government health subsidies, compared to the situation before UC. In contrast, the proportion of the net government health subsidies in the third to the fifth quintiles decreased after implementation of universal coverage. The concentration indexes of the net government health subsidies in 2003 had a higher negative value than the subsidy in 2001, which means the poorer gained more government health subsidies in 2003 than the situation before UC. A comparison of benefit incidence in 2001 and 2003 between using aggregate and regional unit subsidies and between using household income per capita and asset index to categorize individuals into different socio-economic groups show no significant difference in the distribution of the net government health subsidies before and after UC.

We also analyzed the incidence of catastrophic health expenditure which refers to the level of household out-of-pocket payments for health care over 10% of total household expenditure. The incidence of catastrophic health expenditure decreased from 5.4% in 2000 to 3.3% and 2.8% in 2002 and 2004, respectively. The decrease of catastrophic health expenditure was greater in poorer quintiles because most of them are covered by the UC scheme, while those is richer quintiles are beneficiaries of SSS and CSMBS. From these research findings, we can conclude that the UC policy has improved equity in access to and utilization of health services in Thailand through four strategies, which are 1) the expansion of public health insurance to nearly universal coverage; 2) the removal of financial barriers to essential health services; 3) the comprehensive benefit package of the scheme; and 4) the promotion of primary care use as the main contracting unit.

The distribution of government health subsidies in Thailand was pro-poor before UC, and the re-distribution is getting better after implementation of the policy. From our analyses, we also found that health service use at primary and secondary care levels were more pro-poor than health service use at tertiary care and private facilities. Another finding of this study is that using different figures of government unit subsidies (aggregated vs regional unit subsidies) and different measures to categorize individual socio-economic status (income and asset index) does not provide different pictures of improvements in health care use and the distribution of government health subsidies in Thailand.

For health financing perspective, the incidence of catastrophic health expenditure after UC is better than the situation before UC, particularly in poorer quintiles, but it should be noted that some expensive health services such as RRT for end-stage renal disease patients is still excluded from the UC benefit package and this may cause households to be financially catastrophic.

Finally, changes in the allocation methods of government health resources and health financing mechanisms appear to be a key factor in the success of the UC policy in improving health equity of the Thai health care system.We would like to note limitations of this study which comprise five areas of limitations. The first one is differences in questions and answer choices between the 2001 and 2003 HWS questionnaires, which interviewed period on illness, and . The second issue is a lack of rigorous welfare indicators to categorize individuals into different socio-economic status in the HWS. The third one is variations in unit subsidies among different regions and health care levels which pose an uncertainty of the benefit incidence analysis. Difficulties in the estimates of unit subsidies for CSMBS and SSS beneficiaries and limitations in identifying UC members before implementation of the UC policy are two other limitations of this study.