Catastrophic health expenditure in an urban city: seven years after universal coverage policy in Thailand.

Abstract. This study explored the burden of household out-of-pocket health expenditure on urban inhabitants with different socio-economic status and health insurance schemes in Nakhon Sawan Municipality. This study employed a cross sectional survey by using a structured questionnaire. Health personnel from six primary care units interviewed a representative of the sampled households. Sampled households were selected by a two-stage random sampling technique. Descriptive statistics were used to describe general household characteristics, and Mantel-Haenszel odds ratio was used to explain the relationships between factors and catastrophic health expenditure. From 406 sampled households, there were 1,421 household members and 340 individuals who reported illness within the last month. The poor and non-poor groups reported hypertension, diabetes, and the common cold as the most common ailments. Most patients sought care at a regional hospital and then primary care units, drug stores, and private hospitals, respectively. Household out-of-pocket medical costs were most frequently paid to drug stores and to private clinics. The direct non-medical costs were mostly paid for transportation and food. Factors related to catastrohpic health expenditure were the Civil Servant Medical Benefit Scheme (CSMBS) cardholder, use of public hospital, private hospital, and clinic. Furthermore, catastrophic expenditures were related to non-medical costs and time loss for indirect cost. Catastrophic rates of the poor were 12.5 and 30.4% from direct and non-medical cost, respectively. The rates for the non-poor were lower.