Universal coverage but unequal access? Factors affecting the use of health services in Northeast & South Thailand.

Abstract Thailand’s rapid economic growth has brought health challenges as well as benefits, namely a rise in life expectancy to 6.5 years above the global average, and an ‘epidemiological transition’ from infectious and deficiency diseases, to chronic non-communicable diseases such as diabetes. Previous research in Northeast and South Thailand by the Wellbeing in Developing Countries ESRC Research Group demonstrates the importance of health to people’s subjective quality of life and wellbeing, and suggests that ill health is a significant problem - nearly a fifth of households in WeD sites experienced severe health-related ‘shocks’ during the past five years, and a third of household heads defined themselves as chronically ill. In 2001 the Government of Thailand introduced the Universal Health Coverage scheme to offer near-universal health care coverage. However, while this has reduced ‘out of pocket’ expenditures for healthcare and impoverishment through ‘catastrophic expenditures’, the perceived quality of its services mean it is in danger of becoming little more than a safety net and failing to ameliorate existing inequalities. This proposition is explored using the results of large-scale qualitative health study carried out by WeD with 245 men and women from different age groups and socio-economic statuses in Northeast and South Thailand, supplemented by WeD household survey data. The paper is divided into three parts; the first briefly introduces Thailand and the WeD sites, and describes the sampling and methodology. It also reviews current discourses about health and health issues in Thailand, and outlines the context to health and health services. The second presents data from the qualitative health research covering health risks, and the incidence and impacts of chronic illness and disability. The final section looks at the health seeking behaviour of people in the WeD sites (illustrated with case studies), focusing particularly on use of the UHC and traditional medicine