The social security health insurance model in Pattani, Thailand: Health status and patterns of utilization.

摘要

Objectives. The objectives of this study were to measure the association between insurance status and health service utilization among Thai workers and to examine the impact of health status and other factors on this relationship.Methods. The study setting was in the province of Pattani, Thailand. A double cohort study design was used. A representative sample of 455 insured workers were matched with 455 uninsured workers based on age and gender. Trained interviewers used a standardized questionnaire which included demographic and socio-economic variables health status (measured by the SF-36 Health Survey questionnaire) as well as the use of health care services. Multivariate analysis was used to predict utilization (as a binomial outcome variable) incorporating other predictor variables. Focus groups were organized to generate qualitative information on health status and patterns of utilization.Results. Sixty-one percent (61.3%) of insured workers made at least one visit to a health facility during the six-month period prior to the interview in comparison with 41.0% of uninsured workers. The difference was 20.2% (95% CI 13.8-26.6, P-value Conclusions. There is satisfactory empirical evidence that the SF-36 Health Survey Questionnaire is a feasible tool and is applicable for measuring the health status of workers in a developing country such as Thailand. The implementation of a compulsory health insurance program has had an impact on health service utilization among workers. This implies that expansion of the compulsory health insurance program to the general population in Thailand should lead to a reduction of the financial barriers to access to health services, especially among low income earners.