IDEAS home Printed from https://ideas.repec.org/a/wly/jintdv/v21y2009i2p291-308.html
   My bibliography  Save this article

The implications of benefit package design: the impact on poor Thai households of excluding renal replacement therapy

Author

Listed:
  • Phusit Prakongsai

    (Ministry of Public Health, Nonthaburi Province, Thailand)

  • Natasha Palmer

    (London School of Hygiene and Tropical Medicine, UK)

  • Preecha Uay-Trakul

    (Nakorn Ratchasima Rajchabhat University, Nakorn Ratchasima Province, Thailand)

  • Viroj Tangcharoensathien

    (Ministry of Public Health, Nonthaburi Province, Thailand)

  • Anne Mills

    (London School of Hygiene and Tropical Medicine, UK)

Abstract

When the Thai universal coverage (UC) scheme was established, the government decided to exclude renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients from the benefit package, though RRT was included in two other public health insurance schemes. Access to RRT for UC members thus depended on the ability to pay. This study assessed the economic impact of RRT costs on Thai households of different economic status focusing on three issues: (1) the use of RRT; (2) the financial burden of health care payments and (3) household strategies for coping with RRT costs. In-depth case studies of 20 households covered by the UC scheme and having ESRD patients were undertaken using three qualitative data collection approaches: semi-structured and in-depth interviews, and direct observation. Poorer and richer households in urban and rural areas of Nakorn Ratchasima province, a large province in the Northeast where more than 20 per cent of households live below the national poverty line, were purposively selected. The study was conducted in early 2005 and households were visited every 2 weeks for 3 months. Interviews were transcribed and analysed using a thematic approach. The decision to exclude RRT from the UC benefit package created financial barriers to RRT and had a substantial economic impact on poorer ESRD patients. Inadequate dialyses and erythropoietin injections to correct anaemia appeared to be a major cause of death for poorer patients. Household expenditure on RRT took 25-68 per cent of total income or 31-52 per cent of total expenditure, which meant all poorer patients faced catastrophic health spending. In contrast, richer patients had adequate dialyses, resulting in a higher survival rate and quality of life than poorer counterparts. Various coping strategies were employed by poorer patients; these included reducing frequency of dialyses, reducing food consumption, using public transportation to hospitals and taking high interest loans. The RRT cost burden not only impacted patients but also their household members and relatives who provided financial support. Given the two UC policy objectives of equitable access to health care and financial risk protection, the catastrophic impact of RRT costs on poorer households questions the appropriateness of excluding RRT from the UC benefit package. This issue requires further serious attention by the Thai government. Copyright © 2009 John Wiley & Sons, Ltd.

Suggested Citation

  • Phusit Prakongsai & Natasha Palmer & Preecha Uay-Trakul & Viroj Tangcharoensathien & Anne Mills, 2009. "The implications of benefit package design: the impact on poor Thai households of excluding renal replacement therapy," Journal of International Development, John Wiley & Sons, Ltd., vol. 21(2), pages 291-308.
  • Handle: RePEc:wly:jintdv:v:21:y:2009:i:2:p:291-308
    DOI: 10.1002/jid.1553
    as

    Download full text from publisher

    File URL: http://hdl.handle.net/10.1002/jid.1553
    File Function: Link to full text; subscription required
    Download Restriction: no

    File URL: https://libkey.io/10.1002/jid.1553?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Hammer, Jeffrey S. & Berman, Peter, 1995. "Ends and means in public health policy in developing countries," Health Policy, Elsevier, vol. 32(1-3), pages 29-45.
    2. Mark A. Miller & Laura McCann, 2000. "Policy analysis of the use of hepatitis B, Haemophilus influenzae type b‐, Streptococcus pneumoniae‐conjugate and rotavirus vaccines in national immunization schedules," Health Economics, John Wiley & Sons, Ltd., vol. 9(1), pages 19-35, January.
    3. Md. Azmal Kabir & Ataur Rahman & Sarah Salway & Jane Pryer, 2000. "Sickness among the urban poor: a barrier to livelihood security," Journal of International Development, John Wiley & Sons, Ltd., vol. 12(5), pages 707-722.
    4. Drummond, Michael & Torrance, George & Mason, James, 1993. "Cost-effectiveness league tables: More harm than good?," Social Science & Medicine, Elsevier, vol. 37(1), pages 33-40, July.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Pal, Rama, 2010. "Borrowing for hospitalization in India," MPRA Paper 29404, University Library of Munich, Germany.
    2. Kutzin, Joseph, 2001. "A descriptive framework for country-level analysis of health care financing arrangements," Health Policy, Elsevier, vol. 56(3), pages 171-204, June.
    3. Kuangnan Fang & Yefei Jiang & BenChang Shia & Shuangge Ma, 2012. "Impact of Illness and Medical Expenditure on Household Consumptions: A Survey in Western China," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-8, December.
    4. Tappenden, P & Brazier, J & Ratcliffe, J, 2006. "Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A," MPRA Paper 29772, University Library of Munich, Germany.
    5. Rutten, Frans, 1996. "Economic evaluation and health care decision-making," Health Policy, Elsevier, vol. 36(3), pages 215-229, June.
    6. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    7. Wolfgang C. Winkelmayer & Milton C. Weinstein & Murray A. Mittleman & Robert J. Glynn & Joseph S. Pliskin, 2002. "Health Economic Evaluations: The Special Case of End-Stage Renal Disease Treatment," Medical Decision Making, , vol. 22(5), pages 417-430, October.
    8. Cookson, Richard & Hutton, John, 2003. "Regulating the economic evaluation of pharmaceuticals and medical devices: a European perspective," Health Policy, Elsevier, vol. 63(2), pages 167-178, February.
    9. Salem Deenadayalan Vaishnavi & Umakant Dash, 2009. "Catastrophic payments for health care among households in urban Tamil Nadu, India," Journal of International Development, John Wiley & Sons, Ltd., vol. 21(2), pages 169-184.
    10. Tom Jefferson & Miranda Mugford & Alastair Gray & Vittorio Demicheli, 1996. "An exercise on the feasibility of carrying out secondary economic analyses," Health Economics, John Wiley & Sons, Ltd., vol. 5(2), pages 155-165, March.
    11. Navneet Manchanda & Dil Bahadur Rahut, 2021. "Inpatient Healthcare Financing Strategies: Evidence from India," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 33(6), pages 1729-1767, December.
    12. Lindholm, Lars & Rosen, Mans & Emmelin, Maria, 1996. "An epidemiological approach towards measuring the trade-off between equity and efficiency in health policy," Health Policy, Elsevier, vol. 35(3), pages 205-216, March.
    13. David W. Hutton & Margaret L. Brandeau, 2013. "Too Much of a Good Thing? When to Stop Catch-Up Vaccination," Medical Decision Making, , vol. 33(7), pages 920-936, October.
    14. Joakim Ramsberg, 2002. "When should expenditure per life saved vary?," Journal of Risk Research, Taylor & Francis Journals, vol. 5(3), pages 249-263, July.
    15. Diana Mitlin, 2008. "GATS and water services," Progress in Development Studies, , vol. 8(1), pages 31-44, January.
    16. Hammer, Jeffrey S, 1997. "Economic Analysis for Health Projects," The World Bank Research Observer, World Bank, vol. 12(1), pages 47-71, February.
    17. Gonzalez Block, Miguel Angel, 1997. "Comparative research and analysis methods for shared learning from health system reforms," Health Policy, Elsevier, vol. 42(3), pages 187-209, December.
    18. Raymond C.W. Hutubessy & Rob M.P.M. Baltussen & David B. Evans & Jan J. Barendregt & Christopher J.L. Murray, 2001. "Stochastic league tables: communicating cost‐effectiveness results to decision‐makers," Health Economics, John Wiley & Sons, Ltd., vol. 10(5), pages 473-477, July.
    19. Jacob M. Puliyel & Mark Miller, 2004. "Letter to the editor," Health Economics, John Wiley & Sons, Ltd., vol. 13(11), pages 1147-1148, November.
    20. Gafni, Amiram & Birch, Stephen, 2006. "Incremental cost-effectiveness ratios (ICERs): The silence of the lambda," Social Science & Medicine, Elsevier, vol. 62(9), pages 2091-2100, May.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:jintdv:v:21:y:2009:i:2:p:291-308. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/journal/5102/home .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.