Mudslide and Community

help in the North of Thailand:

six months after
Public-Private Mix: a Public Health Fix?
Strategies for Health Sector Reform in South and Southeast Asia

22 June 2007

Jain Weraphong Ph.D.student

Prof. Dr.Supasit Pannarunothai
Faculty of Medicine Naresuan University
1

CONTENTS

Background
Research questions
Method
Result
Discussion

Map of Uttaradit
Bankhok
Fakta
Thapla
Disaster
affected district

Comparison
district

Mueang
Lublae
Tron

Nampard

Thongsankhan

Pichai
3

Research questions
Can the community protect people from
catastrophic health spending?

Method
1. Cross-sectional survey (Quantitative study)
- Household survey
2. Qualitative study
- Focus group discussion
- In-depth interview

Results

Quantitative results

Population characteristics
Characteristics
All household
Resident

Rural

Population
- Sex
- Mean age

220
100%
752

Female

56.8%
36.8 years
10

Educational levels of samples

3.6

16.9

67.3

Primary

Secondary

Vocational

University

11

Occupation of samples

3.5 0.9

24.6

27.4

31.5

None

Farmer

Employee

Commercial

Civil servant
12

Comparing populations structure by

socioeconomic

Poor

Not poor

13

Health insurance coverage of samples

Not poor
n=128
n
%

CSMBS

6.4

6.3

UC

75

81.5

107

83.5

SSS

4.4

13

10.2

No insurance

7.6

Health
insurance

Poor n=92

14

Comparing of household income and

spending
10,000
8,000
6,000
4,000
2,000
0
poor households
income

not poor households

spending
15

Average of household asset and

debt by socioeconomic groups
500,000
400,000
300,000
200,000
100,000
0
poor

not poor
Asset

Debt
16

Top of disease or condition of patients

in a month by socioeconomic status
Diseases /
conditions

Poor

Not poor

cases

cases

Illness

27

42

Hypertension

12

Diabetes

Heart

17

Health care seeking behavior of samples by

socioeconomic status

Poor

Health facilities
n
Illness

Not poor
%

n
42

27

Health centers

27.3

29.2

Private clinics

36.3

11

35.4

Public hospitals

27.3

11

35.4

Drug stores

9.1

18

Percentage of households faced with

catastrophic health spending

Poor

Not poor

All households

92

128

Catastrophic

Percent

5.4

1.5

Catastrophic

19

Catastrophic health spending in

any health insurance scheme
Scheme

Poor

Not poor

CSMB

20.0

UC

80.0

100

20

Qualitative study

21

Implementation
In-depth interview
patients and relatives 8 persons
Provincial hospital officer 3 persons
Provincial health officer 2 persons
Focus group discussion
15 participants per community in 4
communities
22

Health service problem

Provincial level
1. Inequity in chronic renal failure cases
(not addressed in core-package of UC)
- CSMB scheme does not pay out-of-pocket
spending
- SSS pay only half of out-of-pocket
spending
- UC scheme pay all of out-of-pocket
spending
23

Health service problem

2. By-pass primary care among the

UC card holder

Because low satisfaction of services.

Because they migrated from other
provinces.
24

Health service problem

3. Patients with motorcycle accident which
should be covered by the Traffic
accident Protection Act,

their vehicles did not have vehicle

insurance.
or
had expired vehicle insurance.

25

Health service problem

At community level

Issues

Lublae

- Facility

Health center

- Distance

1 Km

- Waiting time for service 20 minutes

- Satisfaction

Satisfaction

- Social welfare

-Elderly, 5 persons
-Handicap, all
-HIV,AIDS Patients
26

Health service problem

At community level

Issues

Lublae

-Health service utilization

More in public

-Participation in health

- DHF campaign
- Exercise club
- Avian Flu. Campaign
- Elderly club
- Local government support
subsidy for health service
- Plan to fund the deprived 27

Health service problem

An extra out-of-pocket payment for

special service from health personnel.

Labor cases
and
Operation cases
28

Conclusion

UC. Scheme could not protect the poor

because it have 5% still faced catastrophic
spending!
Community organization could protect the
poor by giving support to health service
provider and deprived persons

29

Thank you for your

kind attention

30