The rapid implementation of universal health coverage in Thailand presents a unique opportunity to measure the impact of health insurance expansion and capitated payment on utilisation of medicines.
The PBF scheme is a supply-side results-based financing programme which involves a 'fee-for-service conditional-on-quality of care'fee-for-service conditional-on-qualityhealth facilities with monthly payments determined by service utilisation levels and performance on quality measures [ 43].
4 The recent implementation of universal health coverage in Thailand presents a unique opportunity to measure the impact of health insurance expansion and hospital payment changes (the majority of the population is now covered under a closed-ended payment scheme 5) on utilisation of medicines.
In addition, the NHIS offers a broad benefits package, with no co-payments and limited gate-keeping, and also faces cost escalation related to its new payment system and the growing utilisation of members.
These studies show that an expensive co-payment system can affect the utilisation and demand for drugs.
The Person Summary File includes person-level data on eligibility, demographics, managed care enrolment, a summary of utilisation and Medicaid payment by type of service.
It is well documented in the literature that co-payment charges can reduce the utilisation of both essential and non-essential medicines in vulnerable populations such as the poor, elderly and chronically ill [ 34, 35].
The resource utilisation parameters included total payments, Medicare spending and the proportion of beneficiary-paid amount.
Data were collected on self-reported illness, health care utilisation patterns, health care payments, knowledge of health insurance in general, the NHIF and preferred designs for a future NHIS.
Out-of-pocket payments constitute a strong barrier to the utilisation of health care services, as well as precluding adherence to long term treatment especially among the vulnerable and poor [5].
