PHA-Exch> Which Households Are At Risk Of Catastrophic Health Spending: Experience In Thailand After Universal Coverage

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org

 *Which Households Are At Risk Of Catastrophic Health Spending:
 Experience In Thailand After Universal Coverage*



*Exploring the reasons why some households still incur high levels of
spending--even under universal coverage--*

*can help policymakers devise solutions.*



Tewarit Somkotra, a lecturer on the faculty of dentistry at Chulalongkorn
University in Bangkok, Thailand.
Leizel Lagrada is in the Department of Health Policy Sciences at Tokyo
Medical and Dental University in Tokyo, Japan.

*HEALTH AFFAIRS - Web Exclusive – March 31, 2009*

Project HOPE–The People-to-People Health Foundation, Inc



Available online at:
http://content.healthaffairs.org/cgi/content/full/hlthaff.28.3.w467/DC1



“………………The impact of the universal coverage policy implementation in
Thailand is demonstrated by the declining incidence of catastrophic health
spending among Thai households--particularly among the poor.



The households that remain at risk of catastrophe, as defined here, are
better-off households, because of their preference for using private
facilities. Others with increased likelihood of incurring catastrophic
health expenditures are households with a greater proportion of elderly
members, those having a member with a chronic illness or disability, and
those having a member who experienced hospitalization. These determinants
should prompt policy concerns to protect such households from financial
catastrophe. [Health Affairs 28, no. 3 (2009): w467-w478 (published online
31 March 2009; 10.1377/hlthaff.28.3.w467)]





*Early Results From Thailand's 30 Baht Health Reform: Something To Smile
About *



Kannika Damrongplasit,postdoctoral research fellow in health services at the
School of Public Health, University of California, Los Angeles, and the RAND
Corp.

Glenn Melnick, professor and Blue Cross of California Chair of Health Care
Finance at the University of Southern California in Los Angeles, and a
senior economist with RAND in Santa Monica.

*HEALTH AFFAIRS - Web Exclusive – March 31, 2009*

Project HOPE–The People-to-People Health Foundation, Inc

Available online at:
http://content.healthaffairs.org/cgi/content/full/hlthaff.28.3.w457/DC1



“……Efforts by countries to attain universal coverage are often hampered by
supply constraints that can reduce access to care for those already in the
system and, in many Asian and developing countries, by the emergence of
informal payment systems that extract under-the-table payments from
patients.



In 2001, Thailand extended government-financed coverage to all uninsured
people with little or no cost sharing. We found that Thailand has added
nearly fourteen million people to the system and achieved near-universal
coverage without compromising access for those with prior coverage; we also
found that, to date, no informal payment system has emerged. [Health Affairs
28, no. 3 (2009): w457-w466 (published online 31 March 2009;
10.1377/hlthaff.28.3.w457)]
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