The impact of Thailand’s universal coverage scheme on household catastrophic health expenditure

As Thailand faced rapid demographic changes with economic growth, single-person households (e.g., elderly people living alone) have become emerging types of family. Thus, this study, using single-person and non-single-person household factors, examined the impact of the Universal Coverage Scheme (UCS) on household catastrophic health expenditure with the national-level health survey data 2015. Specifically, defining household catastrophic health expenditure as out-of-pocket expenditure exceeding 40% of household disposable income, this study analyzed whether the selected factors were related to the catastrophic expenditure by performing binary logistic regression analysis. The study findings indicated that among all households which received the UCS inpatient services, around 2.78% experienced the catastrophic expenditure. Lower-income and single-person households were more likely to encounter catastrophic expenditure. Among the single-person households, those with lower socioeconomic conditions had a higher incidence of the catastrophic expenditure. Specifically, the elderly, female, low-educated, unemployed, or had any chronic diseases were more likely to encounter the catastrophic expenditure. To address the issue, in the short term, the current copayment rate, which is equally levied to beneficiaries, should be adjusted by socioeconomic conditions. Additionally, the UCS should consider a copayment ceiling as a supplementary policy intervention in the situations where the copayment rate adjustment is not sufficient to prevent catastrophic expenditure. In the long-term, the government’s effort to expand the benefits package should be continued by health care needs on the demand side as well as the cost-effectiveness of the policy on the supply side.