Horizontal Equity of Outpatient Care Utilization in Elderly under Universal Coverage Scheme: Evidence from 2 Area Health Managements in Thailand

Background: The Thai health system emphasized area health management in 2013 for better service provision. This study examined the equity of health care utilization among the elderly. The aims of this study were: 1) to quantify horizontal inequity in terms of number of hospital visits and health care expense among elderly patients with chronic non-communicable disease in Thailand in 2018; 2) to decompose factors explaining health inequity across area health management. Method: Econometric analysis was performed using the 43-file standard dataset from 2 health regions of the Ministry of Public Health, Thailand in 2018. The horizontal inequity (HI) index was used to assess the inequity in healthcare utilization by calculating the difference between observed and predicted utilization based on healthcare needs. The need factors included age, sex, and health status; while education, social class, and marital status were the non-need factors. Results: Concentration index (CI) and HI index were both positive, indicating that the health care utilization (expenditures and hospital visits) were pro-rich. The elderly with increased health needs had more access to health services. The distribution of health resources to health services utilization tended to increase among those with higher socioeconomic status. Conclusion: Horizontal inequity of health care utilization (expenses and hospital visits) favored higher age and higher morbidity with limited socioeconomic status adjustment. Future studies should explore how a more detailed and multidimensional approach to socioeconomic status could contribute to reducing inequities in health care utilization Key words: Elderly, Horizontal equity, Non-Communicable Diseases, Utilization, Thailand