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#HEJC for 01/07/2013

This month’s meeting will take place Monday 1st July, at 5pm London time. That’ll be 6pm in Rotterdam and 7pm in Thessaloniki. Join the Facebook event here. We’ll also hold an antipodal meeting 12 hours later on Tuesday 2nd July, at 5am London time. That’ll be 11am in Bangkok and 4pm in Auckland. Join the Facebook event here. For more information about the Health Economics Twitter Journal Club and how to take part, click here.

The paper for discussion this month is a working paper published by the Tinbergen Institute. The authors are Supon Limwattananon and colleaguesThe title of the paper is:

“Universal coverage on a budget: impacts on health care utilization and out-of-pocket expenditures in Thailand”

Following the meeting, a transcript of the discussion can be downloaded here.

Links to the article




Summary of the paper

The authors estimate the impact on health care utilisation and out-of-pocket (OOP) expenditures of a
major reform in Thailand. The 2001 reform extended health insurance to one-quarter of the population – in effect achieving universal coverage – while keeping health spending below 4% of GDP. The authors use cross-sectional data from two nationally representative surveys. Implementing a difference-in-differences strategy, the authors compare changes in utilisation and OOP expenditure of groups to whom coverage was extended with those of public sector employees and their dependents whose coverage was not affected. The reform is estimated to have reduced the probability that a sick person goes without formal treatment by 3.2 percentage points (11%). It increased the probability of receiving public ambulatory care by 2.7 ppt (5%) and of admission to a public hospital by 1 ppt (18%). OOP expenditures were reduced by one-third on average, as was the probability of spending more than 10% of the household budget on health care, while spending at the very top of the OOP distribution was reduced by one-half representing substantial reductions in exposure to medical expenditure risk. The authors suggest that supply-side measures implemented with the coverage extension are likely to have helped produce these effects from an increased, but still very tight, budget.

Discussion points

  • Are the authors’ identification strategies satisfactory?
  • Is the number of data points sufficient?
  • Are the pre- and post-reform samples sufficiently comparable?
  • What are the implications of this work for the wider global movement towards universal coverage?

Missed the meeting? Add your thoughts on the paper in the comments below.

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