2015年-世界发展银行全球_Qualitative_Assessment_of_Health_Equity_among_the_Elderly_People_in_Thailand___Utilization_and_Financial_Protection_19页_979kb

Summary: Qualitative Assessment of Health Equity among the Elderly People in Thailand

Core Content

This report presents a qualitative assessment of health equity among the elderly population in Thailand, focusing on utilization of health services and financial protection under the Universal Health Coverage (UC) scheme. It highlights the challenges faced by the elderly, particularly those in lower socioeconomic groups, in accessing health care and the role of community support in mitigating these issues.

Main Objectives

• To identify gaps in the elderly population's access to health care services under the UC scheme.
• To examine the factors influencing utilization and financial protection of health services among the elderly.

Key Findings on Health Service Utilization

1. Utilization Trends by Age

• Utilization of health services increases with age, particularly after 55-60, but declines significantly after 75-80.
• Out-patient care utilization drops sharply for UC members after 75, while in-patient care utilization declines after 82 for UC members but continues to rise for CSMBS members.
• The decline in utilization is attributed to reduced mobility, dependence on caregivers, and increased travel distance to health facilities for the elderly in rural areas.

2. Barriers to Access

• Urban areas: Long waiting times are the main barrier.
• Rural areas: Long distance to health facilities is the primary issue.
• For frail and bed-ridden elderly, lack of caregivers and transportation is a significant barrier.
• Transportation becomes more of a challenge for elderly in rural areas, especially those who need to visit higher-level health facilities.

3. Role of Cataracts and NCDs

• Cataracts are a major cause of mobility issues and dependence on relatives.
• Non-communicable diseases (NCDs) are a common issue among the elderly, especially in their 50s and 60s, leading to frequent health facility visits. However, over time, these visits decrease as the elderly adapt to their conditions.

4. Co-residence with Adult Children

• Elderly individuals who live with adult children have higher utilization rates and lower catastrophic health expenditures.
• The absence of adult children leads to greater vulnerability and reduced access to health services, especially for the poor.

5. Village Health Volunteers (VHVs)

• VHVs play a crucial role in supporting elderly health, particularly in rural areas.
• They organize health education, home visits, and physical therapy for different groups of elderly (e.g., Tid Sangkom, Tid Ban, Tid Tieng).
• In Kalasin province, the Provincial Health Office has established Suksala, small health centers managed by VHVs, which offer free basic medical supplies and extended hours for elderly access.
• Training for VHVs in geriatric care enhances their ability to support the elderly effectively.

Key Findings on Financial Protection

1. UC Scheme Coverage

• The UC scheme provides high financial protection against catastrophic health expenditures, covering most public health services.
• Over 75% of the population is covered by UC, which includes all Thai citizens not covered by other schemes.
• Out-of-pocket expenses occur mainly at higher-level health facilities, such as university and regional hospitals.

2. Catastrophic Health Expenditures

• The incidence of catastrophic health expenditures is low for the poorest quintiles, but still exists.
• Among the poorest elderly, the incidence is 1% and 2% for the two bottom quintiles, respectively.
• Rural elderly without co-residence with adult children are more vulnerable to catastrophic health expenditures.

3. Foregone Care

• Some elderly individuals, particularly the poor, may forfeit care due to financial or logistical constraints, contributing to the low incidence of catastrophic health expenditures.

4. Uncovered Costs

• The UC scheme does not cover certain cost items, such as:
  • Drugs not on the essential drug list
  • Selected medical equipment for knee/hip replacement
  • Hemodialysis for chronic renal disease patients (except those using peritoneal dialysis)
  • Home-based non-medical accessories for peritoneal dialysis
  • Cancer therapies outside the UC treatment protocol (e.g., targeted therapy and selected chemotherapy drugs)

Methodology

• The study used qualitative methods, including focus group discussions (FGDs) and in-depth interviews (IDIs).
• It focused on elderly members of the UC scheme in urban and rural areas across four regions of Thailand: Central, North, Northeast, and South.
• Total participants: 797 elderly individuals, including 272 in FGDs and 94 in IDIs, with additional interviews with health facility staff and local government representatives.
• The data was supplemented by SES 2011 (Socio-Economic Survey) for a broader understanding of health utilization and financial burden.

Conclusion

• Despite the success of the UC scheme in expanding health coverage, health equity among the elderly remains a challenge, particularly for the poor and rural elderly.
• Financial protection is generally effective, but uncovered costs and transportation barriers still pose significant challenges.
• Co-residence with adult children is a key factor in reducing health service utilization gaps and financial burdens.
• Village Health Volunteers are vital in improving access and support for the elderly, especially in rural areas.

Recommendations

• Expand transportation services for the elderly, particularly in rural areas.
• Improve coverage of essential medical items and NCD treatments under the UC scheme.
• Strengthen community-based health support systems through better training and resources for VHVs.
• Address the decline in co-residence with adult children by promoting family support and caregiver availability.