Financial protection and enabling access to care for Thai elderly: the role of public insurance

Improvement of health status and increased access to modem medical care among Thai elderly was apparent during the 1990s. Various factors explained this including improved socioeconomic conditions, availability of services, improved physical access, and expansion of health insurance. Nevertheless, differences in health status and access to care have persisted across socioeconomic groups and geographical areas. Despite the policy of free medical care for the elderly launched in Thailand in 1992, a substantial number of elderly were still uninsured in 2001, mainly among those residing in urban areas. In 2002, a universal coverage (UC) policy was introduced, to include the approximately 18 million Thais not covered by formal public insurance schemes. The UC scheme is tax funded, with a budget allocated to each province according to the number of beneficiaries (who must register for a UC card and at a primary health care unit). The aim of the study was to assess how effectively the UC scheme has been implemented, and performed the functions of financial protection and enabling access to care for the elderly across all socioeconomic groups and urban and rural geographical areas. Both quantitative and qualitative approaches were employed: document review, cross-sectional household survey, in-depth interviews, and focus group discussions. The study site was Yasothon province, one of the poorest provinces in the Northeast of Thailand. The main constraints in UC policy implementation included lack of appropriate health personnel to provide care in primary care units and lack of management capabilities in purchasing services. Registration of beneficiaries was almost 100%. Access to overall ambulatory care was quite equitable and was solely determined by health need. However, less emphasis was placed on services specific to the needs of the elderly. For hospitalization, urban respondents were admitted more frequently than rural respondents. Take-up of UC benefits was high among cardholding beneficiaries especially for hospitalization. A gradient of burden of out-of-pocket payment across income groups existed, due to the relatively high illness amongst the poor, their extremely low income, and the burden of non-medical expenditure. A few individuals experienced catastrophic payments as a result of non medical care expenditure, noncompliance with the requirements for accessing free care, and informal payments. The study concluded that the UC scheme was quite successful in its implementation; however, inequity in out-of-pocket payment remained and income inequity itself played a substantial role. To improve equity of access and financial protection, attention should be paid to primary geriatric care, non-medical care expenditure and physical access, insurance management and human resources, and the broader policy context relating to income inequity

Copayment and recommended strategies to mitigate its impacts on access to emergency medical services under universal health coverage: a case study from Thailand

Abstract Background Although bodies of evidence on copayment effects on access to care and quality of care in general have not been conclusive, allowing copayment in the case of emergency medical conditions might pose a high risk of delayed treatment leading to avoidable disability or death. Methods Using mixed-methods approach to draw evidence from multiple sources (over 40,000 records of administrative dataset of Thai emergency medical services, in-depth interviews, telephone survey of users and documentary review), we are were able to shed light on the existence of copayment and its related factors in the Thai healthcare system despite the presence of universal health coverage since 2001. Results The copayment poses a barrier of access to emergency care delivered by private hospitals despite the policy proclaiming free access and payment. The copayment differentially affects beneficiaries of the major 3 public-health insurance schemes hence inducing inequity of access. Conclusions We have identified 6 drivers of the copayment i.e., 1) perceived under payment, 2) unclear operational definitions of emergency conditions or 3) lack of criteria to justify inter-hospital transfer after the first 72 h of admission, 4) limited understanding by the service users of the policy-directed benefits, 5) weak regulatory mechanism as indicated by lack of information systems to trace private provider’s practices, and 6) ineffective arrangements for inter-hospital transfer. With demand-side perspectives, we addressed the reasons for bypassing gatekeepers or assigned local hospitals. These are the perception of inferior quality of care and age-related tendency to use emergency department, which indicate a deficit in the current healthcare systems under universal health coverage. Finally, we have discussed strategies to address these potential drivers of copayment and needs for further studies

Assessing system-based trainings for primary care teams and quality-of-life of patients with multimorbidity in Thailand: patient and provider surveys.

BACKGROUND: Strengthening primary care is considered a global strategy to address non-communicable diseases and their comorbidity. However, empirical evidence of the longer-term benefits of capacity building programmes for primary care teams contextualised for low- and middle-income countries is scanty. In Thailand, a series of system-based capacity building programmes for primary care teams have been implemented for a decade. An analysis of the relationship between these systems-based trainings in diverse settings of primary care and quantified patient outcomes was needed. METHODS: Facility-based and community-based cross-sectional surveys were used to obtain data on exposure of primary care team members to 11 existing training programmes in Thailand, and health profiles and health-related quality of life of their patients measured in EuroQol-5 Dimension (EQ-5D) scale. Using a multilevel modelling, the associations between primary care provider's training and patient's EQ-5D score were estimated by a generalized linear mixed model (GLMM). RESULTS: While exposure to training programmes varied among primary care teams nationwide, District Health Management Learning (DHML) and Contracting Unit of Primary Care (CUP) Leadership Training Programmes, which put more emphasis on bundling of competencies and contextualising of applying such competencies, were positively associated with better health-related quality of life of their multimorbid patients. CONCLUSIONS: Our report provides systematic feedback to a decade-long investment on system-based capacity building for primary care teams in Thailand, and can be considered as new evidence on the value of human resource development in primary care systems in low- and middle-income countries. Building multiple competencies helps members of primary care teams collaboratively manage district health systems and address complex health problems in different local contexts. Coupling contextualised training with ongoing programme implementation could be a key entity to the sustainable development of primary care teams in low and middle income countries which can then be a leverage for improving patients outcomes

Financial protection and enabling access to care for Thai elderly : the role of public insurance

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Acceptability and Willingness to Pay for Influenza Vaccination among Healthcare Professionals in Vietnam

Background: While Vietnam’s Expanded Program on Immunization does not cover influenza vaccines, people must pay out-of-pocket for influenza vaccination. Healthcare professionals have a high risk of contracting influenza, but their vaccination rate is low.  Objective: To examine the willingness to pay (WTP) for influenza vaccination among healthcare professionals in Vietnam. It also recommends financing sources for influenza vaccination among healthcare professionals and determines possible measures to expand vaccine coverage. Method: We interviewed 130 healthcare professionals in a national hospital in Hanoi in July 2021. We used Andersen’s behavioral Model (ABM) as an initial approach. The double-bounded dichotomous-choice questions were used to determine WTP for influenza vaccination among the target group. Collected responses were coded and analysed through IBM SPSS version 20 for descriptive, chi-square analyses.  Results: Most of the healthcare professionals who responded to this study were female with 75.4 % of the total 130 respondents. The mean age of participants was 34.08 years old. The average maximum WTP for influenza vaccination services was 357.57 VND (USD 15.3). Most of the participants reported that individuals should pay a part of the cost, and four-fifths reported they believed that the government and medical insurance should subsidize the service (80.8 % and 85.4 %). The Chi-square test showed that there was a significant association between perceived severity and history of influenza vaccination with the WTP, X2(1, N=130) = 4.18, p = 0.04 and X2 (1, N=130) = 7.81, p = 0.005, respectively. Conclusion: The WTP for influenza vaccination among healthcare professionals was found relatively high. Suggesting that price is not a primary barrier. The government and medical insurance were believed to be the potential agencies for improving vaccination uptake as these agencies were expected to be the subsidized actors. Other health interventions such as influenza literacy and communication methods are also needed to expand vaccine coverage. (*The paper was presented at The Hong Kong Polytechnic University’s College of Professional and Continuing Education (CPCE) Conference “Post-pandemic health and long-term care: A new paradigm”. September 2021