Association between Health Insurance and Incidence of Death in Stateless Children in Tak Province, Thailand

Abstract

This study assesses the association between health insurance and incidence of death in stateless children compared with uninsured children in Tak Province in Thailand. The study used electronic medical records of children aged between 0 and 15 who registered with selected health facilities between 01 January 2013 and 31 December 2017. The required data was obtained from ‘43-files database’ through the Provincial Public Health Office. The death case was used as a binary outcome variable while the exposure was three types of insurance: uninsured, stateless and the Universal Coverage Scheme (UCS). The age, sex and domicile of the children were used as covariates in the multivariate logistic regression. Of 164,435 registered children, 824 death cases were found during the study period. The study results suggest that insurance is associated with the reduced risk of deaths in stateless children. The odds of death is 86 per cent lower in the stateless insurees than in the uninsured children (adjusted odds ratio [AOR] = 0.242, 95% confidence interval [CI] = [0.136,0.403]; p < 0.001). The death is 69 per cent lower in the UCS beneficiaries than in the uninsured children (AOR = 0.385,95 per cent CI = [0.308,0.489]; p < 0.001). Age, sex and domicile of the children were independently associated with a varying risk of death.

Healthcare service utilization of hill tribe children in underserved communities in Thailand: barriers to access

“…Our study confirms the findings of the limited existing literature that long distances, socioeconomic status, education, healthcare provider-related barriers, and healthcare system structure were the common problems preventing the hill tribe community from receiving or accessing proper health information and services. Consistent with a few prior studies on this population in Thailand residency in underserved and poverty areas results in the need for a full day to visit the hospital [13,[18][19][20]. Along with other international studies, the study found tribal people faced health disadvantages that resulted from insufficient health services targeted for their specific needs [16,31,32].…”

“…As a result of the low EPI rate, in 2020, 6.71 hill tribe children per 100,000 population were reported to have measles infection with 24.8% of these children being under 5 years of age [17,18]. This is perhaps due to the many barriers hill tribe parents face in accessing in healthcare services for their children [18,19]. Not only is the risk for infectious disease high, but malnutrition is also a significant problem among hill tribe children.…”

“…There is a lack of research on the healthcare utilization of hill tribe populations in Thailand. Most previous studies have focused on the prevalence or incidence of infectious diseases, nutritional status, or factors related to vaccination in children and adolescent hill tribe members [13,[18][19][20][21][22][23][24][25]. This current study is the first qualitative research aimed at evaluating healthcare service utilization for these hill tribe children based on the experiences of parents, healthcare providers, and community leaders.…”