Abstract
Studies from high-income countries observed that health outcomes among individual having access to care still differed based on their socio-economic status (SES). This led to a concern that performance-based payment introduced by National Health Security Office (NHSO) in Thailand would penalize healthcare facilities located in low SES areas where health outcomes would be worse compared to high SES areas, although same standard of care is provided. Patients with high SES would have better health outcomes because they could control themselves better. Those with high SES evidently had higher level of perceived control. Perceived control comprises two important parameters: health locus of control and self-efficacy. This cross-sectional study has been conducted to test whether SES affects health outcomes of Thais who are under the universal health coverage policy. Patients with diabetes (all having access to care) were used as an example. We found no association between SES and treatment outcomes and service-based indicators. CCM-related activities had strong association with health outcomes. SES was, however, associated with perceived control as found in previous studies. Those with high SES tended to have higher perceived control (high self-efficacy and internal locus of control). Perceived control had a tricky relationship with compliance. Those with high self-efficacy had better compliance to diet recommendation, but worse compliance to prescribed medicine. In contrast, those with internal locus of control had worse compliance to diet recommendation, but better compliance to prescribed medicine. The effects were cancelled out; overall, no association was found between perceived control and compliance.
