Abstract
The Universal Health Care Coverage Program (known as the 30 Baht Program) has attracted tremendous attention from both public and private sectors since its initiation due to its widespread impacts on health care clients and providers. However, there have been only a few systematic studies on the impacts of the program. The purpose of this study is to apply econometric methods to study and evaluate the impacts of the Universal Health Care Coverage Program on both the demand for (i.e. patient visits) and the supply of health care (i.e. quality of health services). This study also provides some suggestions that may help reduce existing problems of the program so that it can be more successful and effective in order to offer true benefits to Thai people.
It is interesting to see that the impacts of the Universal Health Care Coverage Program on outpatients were dramatic during the first year of the program, and them faded away quick in the subsequent years. A possible explanation is that, during the first year, participating hospitals faced a sharp increase in the demand for health care while they were not ready to provide services with decent quality. This caused problems such as long waiting time for hospital visits, uneven quality of health care services provided to patients with different types of health insurance, and a lack of confidence in the quality of the services provided, As a result, some of the patients who looked for high-quality services and were able to afford private hospitals or clinics, though they were eligible for the Universal Health Care Coverage Program, decided to switch to those alternative. Moreover, since this process of adaptation takes time, we do not observe the decline immediately during the first year of the program, but in the later years.
At the micro level, individual level, we find that three hospitals in our study share a common important finding. After the program was implemented. Inpatients that had some types of coverage even before the program visit the hospitals more than those who never had any coverage until the program was introduced. Since impatient cares usually involve high treatment costs relatively to outpatient cares, Universal Health Care Coverage has relatively small budget compared to other coverage programs, it is possible that hospitals have incentives to allocate their resources unevenly across health care services provided as well as across patients under different coverage programs. The hospitals might have an incentive to provide more services to patients with other types of coverage programs than patients with Universal Health Care Coverage. However, with existing data, our empirical results cannot lead to a precise conclusion and we leave this issue to future studies.
It terms of the impacts of the Universal Health Care Coverage program on household’s expenditure on health and other categories, we find that household’s health expenditure decreased by 68% as compared to the period before the program (425 baht per month or 5,100 baht per year). In more details, we find that the impact from the program fades away over time. In 2545, household’s health expenditure dropped by 93% (as compared to the period before the program was implemented) while heath expenditure in 2549 was only 47% lower (as compared to the period before the program was implemented). Although the program helps households save on their health spending, we do not find and empirical support that suggests an in expenditures on education, or harmful items such as tobacco and alcoholic beverages.
Another interesting result from this study is that households that did not have any member eligible to health care before the Universal Health Care Coverage Program tend to have a smaller decrease in their health expenditure after the program, even though these households are the main target of the program. There are several possible explanations for this finding. These households voluntarily chose not to participate in the program, or there were some obstacles that prevent these households to exercise in the program, or there were households might not trust the quality of the health care or might not satisfy with the services provided, and therefore chose not to participate in the program. It could also be that some households were not able to afford the transportation costs to and from the participating hospitals.
