title: Thailand's universal coverage scheme and its impact on health-seeking behavior.
abstract: BACKGROUND
  Thailand's Universal Coverage Scheme (UCS) has improved healthcare access and utilization since its initial introduction in 2002. However, a substantial proportion of beneficiaries has utilized care outside the UCS boundaries. Because low utilization may be an indication of a policy gap between people's health needs and the services available to them, we investigated the patterns of health-seeking behavior and their social/contextual determinants among UCS beneficiaries in the year 2013.
  
  
  RESULTS
  The study findings from the outpatient analysis showed that the use of designated facilities for care was significantly higher in low-income, unemployed, and chronic status groups. The findings from the inpatient analysis showed that the use of designated facilities for care was significantly higher in the low-income, older, and female groups. Particularly, for the low-income group, we found that they (1) had greater health care needs, (2) received a larger number of services from designated facilities, and (3) paid the least for both inpatient and outpatient services.
  
  
  CONCLUSIONS
  This pro-poor impact indicated that the UCS could adequately respond to beneficiaries' needs in terms of vertical equity. However, we also found that a considerable proportion of beneficiaries utilized out-of-network services, which implied a lack of universal access to policy services from a horizontal equity point of view. Thus, the policy should continue expanding and diversifying its service benefits to strengthen horizontal equity. Particularly, private sector involvement for those who are employed as well as the increased unmet health needs of those in rural areas may be important policy priorities for that. Lastly, methodological issues such as severity adjustment and a detailed categorization of health-seeking behaviors need to be further considered for a better understanding of the policy impact.
authors.affiliation: Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand.
authors.forename: Seung Chun
authors.identifier: 0000-0002-9483-5572
authors.initials: SC
authors.lastname: Paek
authors.affiliation: Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand.
authors.forename: Natthani
authors.initials: N
authors.lastname: Meemon
authors.affiliation: Doctoral Program in Public Affairs, College of Health and Public Affairs, University of Central Florida, Orlando, FL 32816 USA.
authors.forename: Thomas T H
authors.initials: TT
authors.lastname: Wan
keywords: 30-Baht Scheme; Health-seeking behavior; Out-of-pocket payment; Thailand; Universal Coverage Scheme