Analysis of Composition Change of Public Facility Care Users After the Universal Coverage Scheme in Thailand

This study conducted a preliminary analysis to examine the impact of Thailand’s Universal Coverage Scheme (UCS) on health care use. In contrast with our expectation, no significant increase was found in the use of public facility care (i.e., use of the UCS services) after the UCS because the UCS increased the use of public facility care for the previously uninsured, but at the same time, it similarly decreased the previously insured who were previous public facility care users. Based on a view of this situation as a composition change of public facility care users, this study investigated where and discussed why the composition change occurred. By classifying health care use into four types (no care, informal care, public facility care, and private facility care), descriptive analysis and pooled logistic regression analysis were performed with data from the Health and Welfare Survey 2001 and 2003 to 2005. The study results showed that the UCS largely increased the use of public facility care for the previous uninsured people. In addition, the degree of the increase was relatively larger in lower income, older, younger, female, and rural people. Meanwhile, the UCS decreased the use of public facility care for previous public facility care users, especially those in higher income, middle-aged (mostly age 20–39 years), male, and urban people. This was probably due to an imbalance between the scaled-up UCS implementation and the resources allocated for improving the capacity of public facilities. This may have created circumstances that did not serve the needs of users (e.g., long waiting time) and pushed those previous users to the private sector.