Damrongplasit Kannika, Melnick Glenn
Faculty of Economics, Chulalongkorn University, Phayathai Road, Bangkok, 10330, Thailand,
Appl Health Econ Health Policy. 2015 Apr;13(2):157-66. doi: 10.1007/s40258-014-0148-z.
In 2001, Thailand implemented a universal coverage program by expanding government-funded health coverage to uninsured citizens and limited their out-of-pocket payments to 30 Baht per encounter and, in 2006, eliminated out-of-pocket payments entirely. Prior research covering the early years of the program showed that the program effectively expanded coverage while a more recent paper of the early effects of the program found that improved access from the program led to a reduction in infant mortality.
We expand and update previous analyses of the effects of the 30 Baht program on access and out-of-pocket payments.
We analyze national survey and governmental budgeting data through 2011 to examine trends in health care financing, coverage and access, including out-of-pocket payments.
By 2011, only 1.64 % of the population remained uninsured in Thailand (down from 2.61 % in 2009). While government funding increased 75 % between 2005 and 2010, budgetary requests by health care providers exceeded approved amounts in many years. The 30 Baht program beneficiaries paid zero out-of-pocket payments for both outpatient and inpatient care. Inpatient and outpatient contact rates across all insurance categories fell slightly over time.
Overall, the statistical results suggest that the program is continuing to achieve its goals after 10 years of operation. Insurance coverage is now virtually universal, access has been more or less maintained, government funding has continued to grow, though at rates below requested levels and 30 Baht patients are still guaranteed access to care with limited or no out-of-pocket costs. Important issues going forward are the ability of the government to sustain continued funding increases while minimizing cost sharing.
2001年，泰国实施了一项全民覆盖计划，将政府资助的医疗保险覆盖范围扩大到未参保公民，并将每次就诊的自付费用限制在30泰铢以内。2006年，泰国完全取消了自付费用。此前关于该计划早期情况的研究表明，该计划有效地扩大了医保覆盖范围，而最近一篇关于该计划早期效果的论文发现，该计划带来的就医机会改善导致婴儿死亡率下降。
我们对之前关于30泰铢计划在就医机会和自付费用方面影响的分析进行扩展和更新。
我们分析了截至2011年的全国调查数据和政府预算数据，以研究医疗保健筹资、覆盖范围和就医机会（包括自付费用）的趋势。
到2011年，泰国只有1.64%的人口未参保（低于2009年的2.61%）。虽然2005年至2010年间政府资金增加了75%，但多年来医疗服务提供者的预算申请超过了获批金额。30泰铢计划的受益者在门诊和住院治疗方面的自付费用均为零。随着时间的推移，所有保险类别的住院和门诊就诊率略有下降。
总体而言，统计结果表明该计划在实施10年后仍在继续实现其目标。现在保险覆盖范围几乎普及，就医机会或多或少得以维持，政府资金持续增长，尽管增速低于申请水平，并且30泰铢计划的患者仍能以有限或无自付费用获得医疗服务。未来的重要问题是政府在尽量减少成本分担的同时维持资金持续增长的能力。
