Applied Micro Economics Seminar: Universal Coverage on a Budget: The Impact on Health Care Utilization and Household Medical Expenditures in Thailand

In 2002, Thailand became the lowest income country yet to have achieved effective universal health insurance coverage. We estimate the impact of this major health reform on the utilization of public and private health care and on household medical expenditures. Identification is through comparison of changes in outcomes for groups to whom coverage was extended by the Universal Coverage Scheme (UCS) with those of public sector employees whose coverage did not change. The UCS is estimated to have reduced the probability of not being treated or being treated only by informal sector providers when sick by 3.2 percentage points from a baseline of 30%. The probability of receiving ambulatory care at a public facility was raised by 2.7 percentage points (baseline 55%) and the probability of an inpatient admission to a public hospital by 1 percentage point (baseline 5.6%). Impacts on utilization were strongest in the elderly population. UCS is estimated to have reduced the amount paid for an inpatient admission to a public hospital by 37% and to have reduced household total medical expenditure by up to 32%.

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Natascha Wagner