Increased payments to hospitals reduced infant mortality in Thailand
21 June 2013
When healthcare reform in Thailand
increased payments to public hospitals for indigent care, more poor
people sought medical treatment and infant mortality was reduced a new
study by the Consortium on Financial Systems and Poverty shows.
The study, The Great Equalizer: Health Care Access and Infant
Mortality in Thailand, funded in part by the National
Institutes of Health, found that reducing out-of-pocket costs of
medical care had less of an impact than providing more money to
hospitals. The study, forthcoming in the Journal Applied
Economics, also suggests that health reforms should make
reimbursements to healthcare providers a primary concern for any
effective health reforms.
"When the Thai government provided hospitals with more resources
to care for the poor, more of the poor sought and received
treatment," said Nathaniel Hendren, a Post-Doctoral Fellow at the
National Bureau of Economic Research, who was one of the
researchers, along with Jonathan Gruber and Robert M. Townsend, both
professors of economics at the Massachusetts Institute of Technology
(MIT). "This increase in patient care and public confidence had a
direct impact on infant mortality, which suggests reimbursement
incentives to health care providers is an important factor in
improving health outcomes and access to medical care in developing
Thailand's health care reform occurred in 2001. Called the "30
Baht Program", it was one of the largest and most ambitious health
reforms ever undertaken in a developing country. The aim of the
program was to reduce long-standing geographical disparities in
public healthcare. The program both increased by fourfold the amount
hospitals were paid to care for the poor — from 250 Baht (about $6)
per enrollee per year to 1,200 Baht (about $35) — and reduced the
copays for non-welfare residents to 30 baht — essentially 75 cents.
In effect, the reforms made access to healthcare in public
facilities independent of a person's financial situation and
equalized health care access for rich and poor.
The new healthcare reform led to a moderate increase in the use
of health care among those who previously were uninsured. But the
greatest impact was among those who were previously covered by
Thailand's Medical Welfare program, particularly mothers and
Before the 30 Baht Program, poor provinces had higher infant
mortality rates, but after the program was implemented, infant
mortality rates in rich and poor provinces were nearly identical.
The study provides evidence that the new health reform reduced
infant mortality by as much as 30 percent in poor provinces.
"Indeed, the sharp equalization in infant mortality observed
between 2000 and 2002 is consistent with the fact that the most
common causes of infant mortality in the world are from treatable
diseases, such as dehydration associated with diarrhoea, pneumonia
and infection," the study's authors write.
The researchers used data from Thailand's Health and Welfare
Survey, a national cross section of all 76 Thai provinces, as well
as data from the provincial-level vital statistics registry. The
Thai National Statistics Office was instrumental in providing the
authors access to the data sources.