We estimate the impact on health care utilization and out-of-pocket (OOP) expenditures of a major reform in Thailand that extended health insurance to one-quarter of the population to achieve universal coverage while keeping health spending below 4% of GDP. Identification is through comparison of changes in outcomes of groups to whom coverage was extended with those of public sector employees and their dependents whose coverage was not affected. The reform is estimated to have reduced the probability that a sick person goes without formal treatment by 3.2 percentage points (11%). It increased the probability of receiving public ambulatory care by 2.7 ppt (5%) and of admission to a public hospital by 1 ppt (18%). OOP expenditures were reduced by one-third on average, as was the probability of spending more than 10% of the household budget on health care, while spending at the very top of the OOP distribution was reduced by one-half representing substantial reductio ns in exposure to medical expenditure risk. Supply-side measures implemented with the coverage extension are likely to have helped realize these effects from an increased, but still very tight, budget.

Thailand, health insu, medical expenditures, universal coverage
Publicly Provided Private Goods (jel H42), Government Expenditures and Health (jel H51), Government Policy; Regulation; Public Health (jel I18)
Tinbergen Institute
Tinbergen Institute Discussion Paper Series
Discussion paper / Tinbergen Institute
This work was funded by the European Commission 7th Framework Programme; grant id fp7/223166 - Health Equity and Financial Protection in Asia (HEFPA)
Erasmus School of Economics

Limwattananon, S, Neelsen, S, O'Donnell, O.A, Prakongsai, P, Tangcharoensathien, V, & van Doorslaer, E.K.A. (2013). Universal Coverage on a Budget: Impacts on Health Care Utilization and Out-Of-Pocket Expenditures in Thailand (No. TI 13-067/V). Discussion paper / Tinbergen Institute (pp. 1–36). Tinbergen Institute. Retrieved from http://hdl.handle.net/1765/40406