The Effects of the Health Insurance Card Scheme on Out-of-Pocket Expenditure Among Migrants in Ranong Province, Thailand

Figures & data

Figure 1 Top-ten provinces with the largest proportion (%) of insured migrants to Thai citizens.

Notes: Data from Health Insurance Group, Office of the Permanent Secretary, the MOPH and National Statistical Office of Thailand.^12,29

Table 1 Overview of the Data in Each Health Facility Used for the Analysis

Data	Mueang		Kraburi		Year
	Ranong Hospital	Heath Center A	Kraburi Hospital	Health Center B
Inpatient	Not available	Not available	✓	Not available	2011–2015
Outpatient	✓	✓	✓	✓	2012–2015

Table 2 Baseline Characteristics of the HICS Insurees and the Uninsured for IP Admissions

Variable—n (%)	Uninsured (N= 1733)	HICS (N= 2122)	P for Chi-Square Test
Sex			<0.001
Male	648 (37.4)	512 (24.1)
Female	1085 (62.6)	1610 (75.9)
Illness			0.689
Non-severe	1597 (92.2)	1960 (92.5)
Severe	136 (7.8)	159 (7.5)
Domicile			0.016
Non-proximity	69 (4.9)	36 (3.0)
Proximity	1349 (95.1)	1158 (97.0)
Time			<0.001
Pre-2013	1123 (64.8)	1214 (57.2)
Post-2013	610 (35.2)	908 (42.8)
Age group in years			<0.001
0–7	557 (32.2)	70 (3.3)
8–15	97 (5.6)	7 (0.3)
16–30	638 (36.8)	1259 (59.3)
31–60	397 (22.9)	766 (36.1)
>60	43 (2.5)	20 (1.0)

Note: Missing data not shown.

Figure 2 Mean IP OOP per admission by insurance schemes across years.

Table 3 Summary of Descriptive Statistics of IP OOP per Admission (in Baht) by Insurance Schemes

Beneficiary	N—visits	Mean (Standard Deviation)	Median (Interquartile Range)	Min-Max
Uninsured	1733	2460.5 (1556.3)	2388 (1968)	0–17,100
HICS	2122	34.2 (101.8)	30 (0)	0–3230

Table 4 Comparing IP OOP (in Baht) by Personal Attributes and Insurance Schemes

Variable	Mean	Standard Deviation	P for Student’s t-Test or ANOVA	P for Wilcoxon Rank-Sum Test or Kruskal–Wallis Test
Insurance			<0.001	<0.001
Uninsured	2460.5	1556.3
HICS	34.2	101.8
Sex			<0.001	<0.001
Male	1299.7	1770.4
Female	1049.8	1510.9
Illness			0.001	0.133
Non-severe	1101.8	1545.2
Severe	1415.2	2112.6
Domicile			0.023	0.013
Non-proximity	1689.2	1742.1
Proximity	1316.6	1638.4
Time			<0.001	<0.001
Pre-2013	1235.5	1642.7
Post-2013	954.8	1509.6
Age group in years			<0.001	<0.001
0–7	1803.5	1559.6
8–15	2194.5	1325.4
16–30	963.2	1522.6
31–60	905.2	1592.7
>60	1547	2053.8

Table 5 Multivariable Regression of IP OOP (in Baht) by the TPM

Variable		Coef	SE	P	95% Confidence Interval
Part 1	Insurance (v uninsured)	−7.649	0.399	<0.001	−8.431	−6.866
	Severe illness (v not having)	−1.076	0.378	0.004	−1.817	−0.334
	Insurance## Severe illness	1.496	0.835	0.073	−0.140	3.133
	Post-2013 (v pre-2013)	−0.792	0.292	0.007	−1.364	−0.221
	Insurance##Post-2013	0.539	0.505	0.286	−0.451	1.530
	Female (v male)	0.782	0.344	0.023	0.109	1.456
	Age group (v ≤7 yr)
	8–15	−0.539	0.643	0.402	−1.798	0.721
	16–30	−0.850	0.368	0.021	−1.572	−0.128
	31–60	−1.105	0.427	0.010	−1.941	−0.268
	>60	−2.612	0.542	<0.001	−3.675	−1.549
	Proximity (v non-proximity)	−0.672	0.557	0.228	−1.765	0.420
	Constant	4.736	0.640	<0.001	3.481	5.990
Part 2	Insurance (v uninsured)	−3.047	0.545	<0.001	−4.115	−1.980
	Severe illness (v not having)	0.345	0.070	<0.001	0.209	0.482
	Insurance## Severe illness	−1.241	0.548	0.024	−2.315	−0.167
	Post-2013 (v pre-2013)	−0.075	0.036	0.039	−0.146	−0.004
	Insurance##Post-2013	0.880	0.932	0.345	−0.947	2.707
	Female (v male)	0.016	0.043	0.711	−0.069	0.101
	Age group (v ≤7 yr)
	8–15	0.121	0.062	0.050	0.000	0.242
	16–30	0.336	0.044	<0.001	0.249	0.422
	31–60	0.223	0.054	<0.001	0.117	0.329
	>60	0.275	0.189	0.145	−0.095	0.644
	Proximity (v non-proximity)	−0.016	0.082	0.845	−0.177	0.145
	Constant	7.632	0.092	<0.001	7.452	7.813
Both parts	Insurance (v uninsured)	−2470.710	45.185	<0.001	−2559.271	−2382.150
	Severe illness (v not having)	425.963	126.616	0.001	177.800	674.126
	Post-2013 (v pre-2013)	−136.234	48.277	0.005	−230.855	−41.613
	Female (v male)	60.860	58.909	0.302	−54.600	176.320
	Age group (v ≤7 yr)
	8–15	124.222	77.126	0.107	−26.941	275.385
	16–30	400.856	57.477	<0.001	288.203	513.508
	31–60	224.493	70.437	0.001	86.439	362.546
	>60	94.868	244.645	0.698	−384.628	574.364
	Proximity (v non-proximity)	−55.321	110.728	0.617	−272.344	161.702

Abbreviations: Coef, coefficient; SE, standard error.

Table 6 Baseline Characteristics of the HICS Insurees and the Uninsured for OP Visits

Variable—n (%)	Uninsured (N= 59,648)	HICS (N= 96,695)	P for Chi-Square Test
Sex			<0.001
Male	28,949 (48.5)	40,033 (41.4)
Female	30,695 (51.5)	56,662 (58.6)
Illness			<0.001
Non-specific	26,209 (44.0)	50,663 (52.4)
Z-group	27,163 (45.5)	26,190 (27.1)
ACSC	6276 (10.5)	19,842 (20.5)
Facility level			<0.001
Health centres	4939 (8.3)	7311 (7.6)
District hospital	17,163 (28.8)	9756 (10.1)
Provincial hospital	37,546 (62.9)	79,628 (82.3)
Domicile			<0.001
Non-proximity	17,663 (32.8)	8580 (9.6)
Proximity	36,224 (67.2)	81,168 (90.4)
Time			<0.001
Pre-2013	38,481 (64.5)	52,724 (54.5)
Post-2013	21,167 (35.5)	43,971 (45.5)
Age group in years			<0.001
0–7	14,632 (24.5)	4731 (4.9)
8–15	4228 (7.1)	2043 (2.1)
16–30	19,453 (32.6)	30,274 (31.3)
31–60	18,224 (30.6)	49,916 (51.6)
>60	3111 (5.2)	9730 (10.1)

Note: Missing data not shown.

Figure 3 Mean OP OOP per visit by insurance schemes across years.

Table 7 Summary of Descriptive Statistics of OP OOP per Visit (in Baht) by Insurance Schemes

Beneficiary	N—Visits	Mean (Standard Deviation)	Median (Interquartile Range)	Min–Max
Uninsured	59,648	420.2 (805.9)	100 (383)	0–24,130
HICS	96,695	22.2 (147.4)	30 (0)	0–16,000

Table 8 Comparing OP OOP (in Baht) by Personal Attributes and Insurance Schemes

Variable	Mean	Standard Deviation	P for Student’s t-Test or ANOVA	P for Wilcoxon Rank-Sum Test or Kruskal–Wallis
Insurance			<0.001	<0.001
Uninsured	420.2	805.9
HICS	22.2	147.4
Sex			<0.001	<0.001
Male	222.4	593.8
Female	135.9	502.7
Illness			<0.001	<0.001
Non-specific	144.4	520.3
Z-group	256.1	620.0
ACSC	93.7	427.5
Facility level			<0.001	<0.001
Health centres	64.4	130.2
District hospital	677.6	1069.6
Provincial hospital	69.8	251.9
Domicile			<0.001	<0.001
Non-proximity	671.0	1055.2
Proximity	69.9	270.1
Time			<0.001	<0.001
Pre-2013	222.0	633.4
Post-2013	106.9	383.7
Age group in years			<0.001	<0.001
0–7	158.5	435.2
8–15	220.5	473.5
16–30	220.0	615.8
31–60	152.9	537.7
>60	108.8	471.1

Table 9 Multivariable Analysis of OP OOP (in Baht) by the TPM

	Variable	Coef	SE	P	95% Confidence Interval
Part 1	Insurance (v uninsured)	−5.037	0.061	<0.001	−5.157	−4.917
	Disease level (v non-specific diseases)
	Z-group	−0.823	0.036	<0.001	−0.894	−0.752
	ACSC	0.652	0.051	<0.001	0.552	0.753
	Insurance##Disease level
	HICS##Z-group	0.863	0.087	<0.001	0.691	1.034
	HICS##ACSC	−0.012	0.115	0.916	−0.239	0.214
	Female (v male)	−0.405	0.037	<0.001	−0.478	−0.333
	Post-2013 (v pre-2013)	−0.497	0.043	<0.001	−0.581	−0.414
	HICS##Post-2013	1.141	0.085	<0.001	0.974	1.308
	Age group (v ≤7 yr)
	8–15	0.921	0.074	<0.001	0.775	1.067
	16–30	0.442	0.048	<0.001	0.348	0.537
	31–60	0.682	0.054	<0.001	0.575	0.788
	>60	0.484	0.099	<0.001	0.289	0.679
	Proximity (v non-proximity)	−0.602	0.055	<0.001	−0.710	−0.493
	Facility-level (v health centers)
	District hospital	−0.344	0.113	0.002	−0.566	−0.122
	Provincial hospital	−2.048	0.121	<0.001	−2.286	−1.811
	Constant	2.681	0.108	<0.001	2.469	2.893
Part 2	Insurance (v uninsured)	−0.677	0.186	<0.001	−1.041	−0.313
	Disease level (v non-specific diseases)
	Z-group	0.029	0.025	0.241	−0.020	0.078
	ACSC	−0.292	0.039	<0.001	−0.370	−0.215
	Insurance##Disease level
	HICS##Z-group	0.423	0.116	<0.001	0.196	0.650
	HICS##ACSC	0.573	0.137	<0.001	0.304	0.842
	Female (v male)	−0.091	0.025	<0.001	−0.140	−0.042
	Post-2013 (v pre-2013)	−0.192	0.031	<0.001	−0.253	−0.131
	HICS##Post-2013	0.174	0.130	0.180	−0.080	0.428
	Age group (v ≤7 yr)
	8–15	0.179	0.046	<0.001	0.088	0.270
	16–30	0.576	0.032	<0.001	0.512	0.639
	31–60	0.627	0.035	<0.001	0.558	0.696
	>60	0.804	0.090	<0.001	0.627	0.981
	Proximity (v non-proximity)	−0.450	0.049	<0.001	−0.546	−0.354
	Facility-level (v health centers)
	District hospital	1.667	0.050	<0.001	1.570	1.764
	Provincial hospital	0.841	0.058	<0.001	0.727	0.955
	Constant	4.995	0.050	<0.001	4.897	5.094
Both parts	Insurance (v uninsured)	−293.489	6.026	<0.001	−305.300	−281.677
	Disease level (v non-specific diseases)
	Z-group	−18.274	4.168	<0.001	−26.444	−10.105
	ACSC	−22.301	5.838	<0.001	−33.743	−10.859
	Female (v male)	−30.104	4.191	<0.001	−38.317	−21.891
	Post-2013 (v pre-2013)	−37.670	4.330	<0.001	−46.156	−29.184
	Age group (v ≤7 yr)
	8–15	42.301	5.818	<0.001	30.897	53.704
	16–30	86.353	3.994	<0.001	78.525	94.181
	31–60	105.692	5.352	<0.001	95.202	116.182
	>60	132.951	19.697	<0.001	94.345	171.557
	Proximity (v non-proximity)	−95.033	8.555	<0.001	−111.801	−78.265
	Facility-level (v health centers)
	District hospital	236.955	9.064	<0.001	219.191	254.720
	Provincial hospital	14.938	4.110	<0.001	6.883	22.992

Abbreviations: Coef, coefficient; SE, standard error.

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