The Contribution of Universal Health Insurance Coverage Scheme to villagers’ wellbeing in Northeast Thaila

Abstract

The Universal Healthcare Insurance Coverage Scheme (UC) in Thailand, also known as the 30 baht scheme, was introduced in 2001 to improve access to healthcare among uninsured people before the UC scheme started. The ultimate goal of the UC scheme is to promote the wellbeing of Thai people. This thesis proposes a new approach to evaluation, ‘Wellbeing Focused Evaluation (WFE)’, to understand the impact of the UC scheme on the wellbeing of villagers in Northeast Thailand. This approach is adapted from the ‘Wellbeing in Developing Countries’ conceptual models, as proposed by Gough and McGregor (2007). The WFE is used to understand villagers’ experiences of having and using the UC card. Additionally, it investigates the villagers’ satisfaction with having and using the UC card and explores how this satisfaction contributes to their satisfaction with life. An ethnographic research was conducted for eight months in one non-remote and one remote village using a multi- methods approach, including questionnaire surveys, focus groups, in-depth interviews, participant observation and some of the WeD’s methods. The WFE shows that for villagers’ understanding of ‘wellbeing’, good mental and physical health are particularly what they need for ‘living well’. Most villagers consider wellbeing as a matter of having good mental and physical health more than as possessing wealth. In this respect the fact that before the UC scheme was introduced, the poor had very limited access to healthcare. By investigating the villagers’ experiences, it was found that the UC scheme has provided a sense of security and has lowered the cost of healthcare, thereby contributing to the wellbeing of the villagers. In particular it has benefited the poor in both of the studied locations, as indicated by the highest rate of UC card usage. However, the study also found that not everyone with a UC card used it and the main reasons given for this were: trivial illness, opportunity cost, having alternative facilities, the poor quality of service on offer and gender culture in the villages. In addition, the UC continues to experience problems with regards to its implementation and has come in for criticism. Such criticism has included: restricted number of choices, low quality of service and discriminatory treatment. Certain villagers feel they have been discriminated when using the UC because of their low economic level in particular when comparing to the other economic classes and to other two healthcare schemes provided by the government to the rest of Thai population. Although these problems have affected the UC card usage by villagers, they have not adversely affected their wellbeing and having a UC card is viewed by the villagers as a form of life insurance, which they can use whenever they need to. Therefore even those who have never used the UC card, the UC scheme still has promoted better feeling of security thereby minimising one threat to the wellbeing of villagers. The UC has not only enhanced people’s wellbeing individually but also collectively as one person’s wellbeing is not entirely independent from the other. Rather, they are indeed closely related. In this way, the UC scheme has created better conditions for better societies for most of Thai citizens in pursuit of their wellbeing. Recently, wellbeing becomes one of the desired outcomes of the Thai government policy and of the health policy. In order to apply this concept into the UC evaluations, it is argued that the ‘WFE’ can be applied as an analytical as well as explanatory approach in addition to some extents to the conventional UC evaluations UC evaluation. The WFE is particularly appropriate for a study of rural villages, in both non-remote and remote areas, in Thailand that are highly contextualised. The framework may also be applied to other forms of social policy, or in other developing countries particularly concerning the impact of its policy on people’s wellbeing.

Date of Award	1 Jun 2009
Original language	English
Awarding Institution	University of Bath
Supervisor	Joe Devine (Supervisor) & James McGregor (Supervisor)