Abstract
Health Care Financing for Low Income Population in Thailand The present study investigated a current public health care policy for low income population in Thailand on the financing and expenditures as well as evaluated the post-policy implementation outcome of the current system of health financing for the low income population aiming at the satisfaction and perception of health care providers, the poor who have enrolled in the free medical care project (FMCP) and the poor who have not enrolled in the free medical care project (NFMCP), but received free care or paid partial expenses. The study also tested the hypothesis of differences on the satisfaction and perception between the FMCP in the provinces that have the highest utilization rate of free medical care enrollees at health centers and the FMCP in the provinces that have the lowest utilization rate of free medical care enrollees at health centers.The secondary data on number of free medical care project enrollees, budget and health care expenditures revealed that the increasing number of enrollees in each year did not correspond to the total number of the poor in the country. Although the budget allocation for each region harmonized with the number of the poor in each region, the ways the budget was set for every group in the government welfare programs together has not reflected the real expenditure for each group, especially for the poor. Each region and each level of health facilities also experienced different patterns of changes in the health expenditure for the FMCP. The health expenditure for the NFMCP was in a high level compared with that of the FMCP. However, unlike the FMCP, the inpatient expenditure of the NFMCP still increased. The analysis on primary data collecting from 10 provinces in the north, northeast, central, east and south regions showed that both providers and poor patients mostly satisfied with and agreed to the health policy for the poor. The assessment of the impact of the policy for the poor on the providers showed that most providers satisfied with the policy, practice, expenditure calculation in health facilities. The providers also mainly satisfied with the work and job related to the poor in the workplace. Nonetheless, most providers did not satisfied with the budget and the ways the budget was allocated in the provinces. Most providers also agreed that the poor should pay a proportion of total health expenses or a proportion of health expenses on some types of services. By assessing the satisfaction and attitude of the FMCP on the health policy for the poor, the results depicted that most FMCP satisfied with the policy and service received. However, some FMCP patients misunderstood or did not know about the right and benefits of being enrolled in the FMCP. Furthermore, most patients agreed that the poor should pay a proportion of total health expenses or a proportion of health expenses on some types of services. The hypothesis testing of differences on the satisfaction and perception between the FMCP in the provinces that have the highest utilization rate of free medical care enrollees at health centers and the FMCP in the provinces that have the lowest utilization rate of free medical care enrollees at health centers showed that the high (low) utilization resulted in lower (higher) patient satisfaction. By assessing the satisfaction and attitude of the NFMCP on the service received, the results revealed that most NFMCP satisfied with the services, providers and facilities. Some NFMCP were previous FMCP, but the free medical care cards had expired. Some NFMCP had requested for the free medical care cards, but they did not get the approval. Part of the NFMCP did not know about the free medical care project or knew about the project, but lack of some important document. Most NFMCP also agreed that the poor should pay a proportion of total health expenses or a proportion of health expenses on some types of services.
