<br><span class="gmail_quote">From: <b class="gmail_sendername">Ruggiero, Mrs. Ana Lucia (WDC)</b> <<a href="mailto:ruglucia@paho.org">ruglucia@paho.org</a>><br>crossposted from: <a href="mailto:EQUIDAD@listserv.paho.org">EQUIDAD@listserv.paho.org</a><br>
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<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="maroon" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 11pt; COLOR: maroon; FONT-FAMILY: Arial">Which Households Are At Risk Of Catastrophic Health Spending:<br>
 Experience In Thailand After Universal Coverage</span></font></b></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><i><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-STYLE: italic; FONT-FAMILY: Arial">Exploring the reasons why some households still incur high levels of spending--even under universal coverage--</span></font></i></p>

<p style="MARGIN-LEFT: 0.5in"><i><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-STYLE: italic; FONT-FAMILY: Arial">can help policymakers devise solutions.</span></font></i></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Tewarit Somkotra, a lecturer on the faculty of dentistry at Chulalongkorn University in Bangkok, Thailand. <br>
Leizel Lagrada is in the Department of Health Policy Sciences at Tokyo Medical and Dental University in Tokyo, Japan.</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">HEALTH AFFAIRS - Web Exclusive – March 31, 2009</span></font></b></p>

<p style="MARGIN-BOTTOM: 12pt; MARGIN-LEFT: 0.5in; MARGIN-RIGHT: 0in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">Project HOPE–The People-to-People Health Foundation, Inc</span></font><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"></span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Available online at: <a onclick="return top.js.OpenExtLink(window,event,this)" href="http://content.healthaffairs.org/cgi/content/full/hlthaff.28.3.w467/DC1" target="_blank"><font color="navy"><span style="COLOR: navy">http://content.healthaffairs.org/cgi/content/full/hlthaff.28.3.w467/DC1</span></font></a> </span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">“………………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. </span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">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. </span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">[Health Affairs 28, no. 3 (2009): w467-w478 (published online 31 March 2009; 10.1377/hlthaff.28.3.w467)]</span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="maroon" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 11pt; COLOR: maroon; FONT-FAMILY: Arial">Early Results From Thailand's 30 Baht Health Reform: Something To Smile About </span></font></b></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">Kannika Damrongplasit,postdoctoral research fellow in health services at the School of Public Health, University of California, Los Angeles, and the RAND Corp.</span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">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.</span></font></p>

<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">HEALTH AFFAIRS - Web Exclusive – March 31, 2009</span></font></b></p>

<p style="MARGIN-BOTTOM: 12pt; MARGIN-LEFT: 0.5in; MARGIN-RIGHT: 0in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">Project HOPE–The People-to-People Health Foundation, Inc</span></font><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"></span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Available online at: <a onclick="return top.js.OpenExtLink(window,event,this)" href="http://content.healthaffairs.org/cgi/content/full/hlthaff.28.3.w457/DC1" target="_blank"><font color="navy"><span style="COLOR: navy">http://content.healthaffairs.org/cgi/content/full/hlthaff.28.3.w457/DC1</span></font></a> </span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">“……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. </span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">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. </span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">[Health Affairs 28, no. 3 (2009): w457-w466 (published online 31 March 2009; 10.1377/hlthaff.28.3.w457)]<br>
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