Financial Risk Protection of Thailand Universal Health Coverage: results from series of national household surveys between 1996 and 2015.
Abstract Background Thailand, an upper-middle country, had demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country has achieved UHC since 2002 when the whole population was covered by the three public health insurance schemes. Prior studies do not provide long series of UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002.Methods We used data from a fifteen-year series of annual national household socioeconomic surveys between 1996 and 2015, which were conducted by the National Statistical Office. The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payment for health by households exceeding 10% and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by additional number of non-poor households falling below the national and international poverty lines after health payment.Results Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when 25% threshold was applied (from 1.8% to 0.4% in the same period). The incidence of impoverishment against national poverty line reduced considerably, from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was used, the incidence of impoverishment was 1.4% and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low.Conclusion The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design on the Thai UHC that provides comprehensive benefit package, zero co-payment at point of services. The well-founded healthcare delivery systems also play critical role in supporting and sustaining the function of the UHC.