Economic changes and public health resources associated with satisfaction toward the state health service system among older adults under the Universal Coverage Scheme across 77 provinces in Thailand, 2017–2024

Thailand has rapidly transitioned into a complete aged society, placing increasing pressure on the public health system, particularly under the Universal Coverage Scheme (UCS), which serves as the primary source of healthcare for older adults. While the UCS has achieved near-universal population coverage, disparities in healthcare resources, service congestion, and socioeconomic conditions across provinces may influence older adults’ satisfaction with the state health service system. However, longitudinal and spatial evidence examining these associations over time remains limited. A provincial-level panel study with three time points utilized provincial-level secondary panel data from the National Statistical Office of Thailand, covering 77 provinces for the years 2017, 2021, and 2024. We used panel regression analysis with both Random Effects and Fixed Effects models to examine factors associated with provincial-level satisfaction. The analysis utilizing the Random Effects model, considered suitable for the dataset, identified factors significantly correlated with satisfaction. The Bed Occupancy Rate showed a negative correlation (Coefficient = -0.0593, P < 0.001), which means that having too many patients in the hospital lowers satisfaction levels. In contrast, the Physician to Population Ratio showed a positive correlation (Coefficient = 0.197, P = 0.037), indicating that sufficient physician availability improves elderly satisfaction. Furthermore, negative associations were observed for the Poverty Line (Coefficient = -0.003, P = 0.002) and Population Density (Coefficient = -0.002, P = 0.011), implying that areas with a higher cost of living and greater population density tend to exhibit lower satisfaction. However, no statistically significant associations were found regarding the Ministry of Public Health’s budget or average household expenditure. According to the results, the satisfaction of the elderly population under the UCS is significantly shaped by the availability of medical services, staffing levels, and socioeconomic environments. Improving the system’s responsiveness amidst an aging demographic necessitates a focus on managing bed capacity and ensuring an equitable distribution of doctors that reflects regional economic realities. By leveraging these empirical findings for health system planning, policymakers can better allocate resources to close regional gaps and secure the future sustainability of the scheme.