Socioeconomic inequalities in health outcomes among Thai older population in the era of Universal Health Coverage: trends and decomposition analysis.
Decomposition of concentration index
Older persons
Socioeconomic health inequality
Thailand
UHC
Journal
International journal for equity in health
ISSN: 1475-9276
Titre abrégé: Int J Equity Health
Pays: England
ID NLM: 101147692
Informations de publication
Date de publication:
02 08 2023
02 08 2023
Historique:
received:
23
12
2022
accepted:
06
07
2023
medline:
4
8
2023
pubmed:
3
8
2023
entrez:
2
8
2023
Statut:
epublish
Résumé
Thailand's Universal Health Coverage (UHC) has been achieved since 2002 when the entire population are covered by three main public health security schemes: (1) Civil Servant Medical Benefit Scheme (CSMBS); (2) Social Security Scheme (SSS); and (3) Universal Coverage Scheme (UCS). Citizens have access to healthcare services at all life stages and are protected from catastrophic expenditure and medical impoverishment. However, there are health inequalities in both health outcomes and access to healthcare among older Thais. This study aims to: (1) assess the degrees of socioeconomic inequalities in health outcomes among the older Thai population during the period of Thailand's UHC implementation (2003-2019), and (2) explain socioeconomic inequalities in health outcomes through decomposition of the contributions made by Thailand's UHC policy and other health determinants. Data sets come from a four-year series of the National Health and Welfare Survey (HWS) between 2003 and 2019. The health outcome of interest was obtained from the Thai EQ-5D index. The Erreygers' concentration index (CI) was used to calculate the socioeconomic inequality in health outcomes. Multivariate methods were employed to decompose inequalities. Findings indicated Thai older adults (aged 50 and older) are healthier during the UHC implementation. Better health outcomes remain concentrated among the wealthier groups (pro-rich inequality). However, the degree of socioeconomic inequalities in health outcomes significantly declined by almost a factor-of-three (from CI = 0.061 in 2003 to CI = 0.024 in 2019) after the roll-out of the UHC. Decomposed results reported that Thailand's UHC, urban residence, and household wealth were major contributors in explaining pro-rich inequalities in health outcomes among Thai older adults. Older persons in Thailand have better health while health inequalities between the rich and the poor have substantially decreased. However, there is inequalities in health outcomes within all three national health security schemes in Thailand. Minimizing differences between schemes continues to be a crucial cornerstone to tackling health inequalities among the older population. At the same time, making Thailand's UHC sustainable is necessary through preparing financial sustainability and developing health resources to better serve an ageing society.
Sections du résumé
BACKGROUND
Thailand's Universal Health Coverage (UHC) has been achieved since 2002 when the entire population are covered by three main public health security schemes: (1) Civil Servant Medical Benefit Scheme (CSMBS); (2) Social Security Scheme (SSS); and (3) Universal Coverage Scheme (UCS). Citizens have access to healthcare services at all life stages and are protected from catastrophic expenditure and medical impoverishment. However, there are health inequalities in both health outcomes and access to healthcare among older Thais. This study aims to: (1) assess the degrees of socioeconomic inequalities in health outcomes among the older Thai population during the period of Thailand's UHC implementation (2003-2019), and (2) explain socioeconomic inequalities in health outcomes through decomposition of the contributions made by Thailand's UHC policy and other health determinants.
METHODS
Data sets come from a four-year series of the National Health and Welfare Survey (HWS) between 2003 and 2019. The health outcome of interest was obtained from the Thai EQ-5D index. The Erreygers' concentration index (CI) was used to calculate the socioeconomic inequality in health outcomes. Multivariate methods were employed to decompose inequalities.
RESULTS
Findings indicated Thai older adults (aged 50 and older) are healthier during the UHC implementation. Better health outcomes remain concentrated among the wealthier groups (pro-rich inequality). However, the degree of socioeconomic inequalities in health outcomes significantly declined by almost a factor-of-three (from CI = 0.061 in 2003 to CI = 0.024 in 2019) after the roll-out of the UHC. Decomposed results reported that Thailand's UHC, urban residence, and household wealth were major contributors in explaining pro-rich inequalities in health outcomes among Thai older adults.
CONCLUSIONS
Older persons in Thailand have better health while health inequalities between the rich and the poor have substantially decreased. However, there is inequalities in health outcomes within all three national health security schemes in Thailand. Minimizing differences between schemes continues to be a crucial cornerstone to tackling health inequalities among the older population. At the same time, making Thailand's UHC sustainable is necessary through preparing financial sustainability and developing health resources to better serve an ageing society.
Identifiants
pubmed: 37533003
doi: 10.1186/s12939-023-01952-0
pii: 10.1186/s12939-023-01952-0
pmc: PMC10399069
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
144Informations de copyright
© 2023. The Author(s).
Références
Community Dent Health. 2011 Jun;28(2):136-42
pubmed: 21780352
Adv Health Econ Health Serv Res. 2009;21:57-81
pubmed: 19791699
Health Policy Plan. 2015 Nov;30(9):1152-61
pubmed: 25378527
Int J Equity Health. 2021 Nov 12;20(1):244
pubmed: 34772404
PLoS One. 2018 Oct 9;13(10):e0204666
pubmed: 30300369
Int J Equity Health. 2007 Dec 18;6:23
pubmed: 18088434
Qual Life Res. 2006 Oct;15(8):1403-14
pubmed: 16960751
Asia Pac J Public Health. 2011 Nov;23(6):980-95
pubmed: 20460292
Int J Health Care Qual Assur. 2014;27(6):456-67
pubmed: 25115049
Health Policy Plan. 2011 Mar;26(2):105-14
pubmed: 20736414
Bull World Health Organ. 2007 Aug;85(8):600-6
pubmed: 17768518
Health Place. 2010 Sep;16(5):1030-7
pubmed: 20634120
Aging Male. 2002 Mar;5(1):1-37
pubmed: 12040973
Int J Equity Health. 2016 Nov 22;15(1):190
pubmed: 27876056
Health Syst Reform. 2019;5(3):195-208
pubmed: 31407962
Health Aff (Millwood). 2009 May-Jun;28(3):w467-78
pubmed: 19336470
Lancet. 2018 Mar 24;391(10126):1205-1223
pubmed: 29397200
J Health Econ. 2011 Jul;30(4):685-94
pubmed: 21683462
Eur J Health Econ. 2015 Mar;16(2):141-51
pubmed: 24408476
BMC Public Health. 2012;12 Suppl 1:S6
pubmed: 22992431
Qual Life Res. 2000;9(8):901-10
pubmed: 11284209
Int J Equity Health. 2020 Sep 21;19(1):163
pubmed: 32958064
Ann Epidemiol. 2009 Nov;19(11):800-7
pubmed: 19560371
Lancet. 2016 Dec 10;388(10062):2837
pubmed: 27979390
Soc Sci Med. 1991;33(5):545-57
pubmed: 1962226
Health Policy Plan. 2006 Nov;21(6):459-68
pubmed: 17030551
J Health Econ. 2009 Mar;28(2):504-15
pubmed: 18367273
Stata J. 2016 1st Quarter;16(1):112-138
pubmed: 27053927