The Impact of a Billing System on Healthcare Utilization: Evidence from the Thai Civil Servant Medical Benefit Scheme

Abstract

This study examines how a new billing process of the Thai Civil Servant Medical Benefit Scheme affects outpatient care utilization. Unlike policy changes considered in most existing studies, there is no change in cost‐sharing for the scheme considered here. Previously, the beneficiaries had to pay out of pocket and receive their reimbursement later. The new billing system allows hospitals to charge the government directly. Using patient‐level data from a large hospital, we find that the change affects outpatient utilization through both visiting rates and treatment intensity. These positive impacts are moderate, but persistent. The estimates are not sensitive to our choice of a time window, but their magnitudes can be sensitive to model specifications. Our analysis also suggests that patients with lower utilization rates (conditional on illnesses) prior to the change in the billing process increase their healthcare utilization more proportionally.