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The poor pay more: Health-related inequality in Thailand

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  • Pannarunothai, Supasit
  • Mills, Anne
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    Abstract

    This paper examines the equality of utilization for equal need and equity of out-of-pocket expenditure for health services in a large urban area in Thailand. Data from a household health interview survey were used to explore patterns of perceived morbidity, utilization of various treatment sources, and out-of-pocket payment. Financial access to health care, as reflected in medical benefit/insurance cover, appeared to influence reported illness and hospitalization rates. Gross lack of access to health care amongst lower socio-economic groups was not the main problem in this densely populated urban area because people could choose and use alternative health services according to their ability and willingness to pay. The corollary, however, was an inequitable pattern of out-of-pocket health expenditure by income quintile and per capita. The underprivileged were more likely to pay out of their own pocket for their health problems, and to pay out of proportion to their household income when compared with more privileged groups. Furthermore, the underprivileged were least likely to be covered by government health benefit schemes, in contrast in particular to civil servants, who paid less out of pocket and did not contribute to their medical benefit fund. The private health sector (private clinics and private hospitals) was the major provider of health care to urban dwellers for both outpatient and inpatient services. Policy options for the short and long term to improve the equity of payment systems for health care are discussed.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 44 (1997)
    Issue (Month): 12 (June)
    Pages: 1781-1790

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    Handle: RePEc:eee:socmed:v:44:y:1997:i:12:p:1781-1790

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    Related research

    Keywords: equity health finance health expenditure private health care Thailand;

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    Cited by:
    1. Ravi P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Eddy van Doorslaer & Owen O’ Donnell, 2011. "Who Pays for Health Care in Asia?," Working Papers id:3608, eSocialSciences.
      • O'Donnell, Owen & van Doorslaer, Eddy & Rannan-Eliya, Ravi P. & Somanathan, Aparnaa & Adhikari, Shiva Raj & Akkazieva, Baktygul & Harbianto, Deni & Garg, Charu C. & Hanvoravongchai, Piya & Herrin, Ale, 2008. "Who pays for health care in Asia?," Journal of Health Economics, Elsevier, vol. 27(2), pages 460-475, March.
    2. Likwang Chen & Winnie Yip & Ming-Cheng Chang & Hui-Sheng Lin & Shyh-Dye Lee & Ya-Ling Chiu & Yu-Hsuan Lin, 2007. "The effects of Taiwan's National Health Insurance on access and health status of the elderly," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 223-242.
    3. Pitaknetinan, Kitti & Tangcharoensathien, Viroj & Supachutikul, Anuwat & Bennett, Sara & Mills, Anne, 1999. "Profit, payment and pharmaceutical practices: perspectives from hospitals in Bangkok," Health Policy, Elsevier, vol. 46(3), pages 179-194, March.
    4. Eddy van Doorslaer, 2007. "Paying Out-of-Pocket for Health Care in Asia: Catastrophic and Poverty Impact," Working Papers id:823, eSocialSciences.
    5. Adam Wagstaff, 2002. "Reflections on and alternatives to WHO's fairness of financial contribution index," Health Economics, John Wiley & Sons, Ltd., vol. 11(2), pages 103-115.
    6. Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184.
    7. Suraratdecha, Chutima & Saithanu, Somying & Tangcharoensathien, Viroj, 2005. "Is universal coverage a solution for disparities in health care?: Findings from three low-income provinces of Thailand," Health Policy, Elsevier, vol. 73(3), pages 272-284, September.
    8. Garcia-Diaz, Rocio & Sosa-Rub, Sandra G., 2011. "Analysis of the distributional impact of out-of-pocket health payments: Evidence from a public health insurance program for the poor in Mexico," Journal of Health Economics, Elsevier, vol. 30(4), pages 707-718, July.

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