Universal coverage scheme in Thailand: Analysis of factors associated with and reasons for underutilization

Abstract

© 2020 by De La Salle University. Despite nearly free health services offered by the Universal Coverage Scheme (UCS), the UCS services have been found to be underutilized. Thus, this study, employing the concept of unmet health needs, investigated factors and reasons for the underutilization. Specifically, performing logistic models with the national health survey of 2015, we analyzed who and why did not utilize the UCS services in availability, accessibility, and acceptability perspectives of the services. The study results indicated that among UCS beneficiaries who needed care, about 45% and 7% did not utilize the UCS outpatient and inpatient services, respectively. These non-users had a relatively higher socioeconomic status. Specifically, they were more likely to be high-income, employed, not chronically-ill, or urban people. Availability-related (e.g., long wait-time and unavailability due to emergencies) and acceptability-related reasons (e.g., time constraints and uncertainty of service quality) were major barriers of access to the UCS services. Although the UCS, by this study, was found to work better for socially vulnerable people, there are still concerns that some people, who actually wanted to use the UCS services, might be ultimately forced to use other private services due to such barriers. Particularly, employed people who have time constraints during daytime and people who need inpatient services due to emergencies are our main concerns. In the short term, the public-private partnership should be strengthened to support the urgent needs of emergency cases. In the long term, the expansion of the UCS services boundary should be continued by the National Health Development Plan.