The impact of universal health coverage and COVID-19 pandemic on out-of-pocket expenses in Thailand: an analysis of household survey from 1994 to 2021

ABSTRACT

Objectives

After Thailand achieved Universal Health Coverage (UHC) in 2002, the extent of financial risk protection has not been assessed in the long term, especially after the COVID-19 pandemic. Therefore, this study aims to revisit the impact of UHC on out-of-pocket expenses (OOPE) for health and to descriptively explore the impact of COVID-19 on OOPE.

Methods

This study was a secondary data analysis and used data from the Socio-Economic Survey from 1994 to 2021 in Thailand. The effect of UHC on the percentage of OOPE in total health expenditures (THE) from 1994 to 2019 was investigated with an interrupted time-series analysis. Descriptive analyses of OOPE in absolute value during the COVID-19 were conducted.

Results

The percentage of OOPE in THE significantly decreased both before (β −2.02%; 95% CI: −2.70% to − 1.33%) and during (β 1.41%; 95% CI: 0.70% to 2.11%) the UHC period. During the pandemic, total household OOPE for medical equipment was found to have rapidly increased from 643 million THB in 2019 to 9.4 billion THB in 2020.

Conclusions

The trend of providing financial risk protection (measured by OOPE/THE) in Thailand continues until 2019. Providing medical equipment in sufficient and equally accessible manners should be prioritized during the future pandemic.

KEYWORDS:

• COVID-19
• health expenditure
• interrupted time-series
• out-of-pocket expenses
• Thailand
• Universal health coverage

List of abbreviations

OOPE	=	Out-of-pocket expenses
SES	=	Socio-Economic Survey
THB	=	Thai Baht
USD	=	United States Dollar
THE	=	Total health expenditure
UCS	=	Universal Coverage Scheme
UHC	=	Universal Health Coverage

Acknowledgments

We would like to thank the National Statistical Office (NSO) of Thailand for providing the Socio-Economic Survey (SES) data, as well as Mr. Suradech Doungthipsirikul and Mr. Suppawat Permpolsuk for preparing the data for this study. We would also like to extend our gratitude to Ms. Shaheda Viriyathorn from the International Health Policy Program for providing information on the National Health Accounts (NHA) in Thailand.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

S Dabak, R Butchon, and Y Teerawattananon contributed to study conception and design. R Butchon and P Karunayawong involved in acquisition of data. J Sukmanee and R Butchon performed statistical analyses and interpretation of results. J Sukmanee, P Karunayawong, W Isaranuwatchai, R Butchon, and S Dabak wrote the first draft of the manuscript. Y Teerawattananon, W Isaranuwatchai and S Dabak contributed to the revision of the manuscript. All authors reviewed the draft and approved the final version of the manuscript to be published.

Data availability statement

The data on total household out-of-pocket expenses and total health expenditures during the study period, which were used to create Figures 1–3, are provided in Supplementary Tables 3–6. The household-level data cannot be shared due to the non-disclosure agreement with the data custodian, but general information on the database is available from the corresponding author on reasonable request https://doi.org/10.1080/14737167.2023.2219447.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2219447.

Additional information

Funding

This paper was not funded. Nevertheless, the authors were supported by the Health Intervention and Technology Assessment Program (HITAP), which is a semi-autonomous research unit in the Ministry of Public Health, Thailand, and supports evidence-informed priority-setting and decision-making for healthcare. HITAP is funded by national and international public funding agencies. HITAP is supported by the Access and Delivery Partnership, which is hosted by the United Nations Development Programme and funded by the Government of Japan, the Rockefeller Foundation and the Health Systems Research Institute (HSRI), among others. The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The findings, interpretations, and conclusions expressed in this article do not necessarily reflect the views of the funding agencies.