Billing system and health care utilization: Evidence from Thailand

Area of Science:

• Health Economics
• Public Health Policy
• Behavioral Economics

Background:

• Healthcare billing systems significantly influence patient access to services.
• Thailand transitioned from fee-for-service reimbursement to direct disbursement for outpatient care in October 2006.
• Understanding the impact of such policy shifts is crucial for optimizing healthcare utilization.

Purpose of the Study:

• To evaluate the effect of a direct provider payment policy on outpatient healthcare utilization.
• To identify specific demographic groups most affected by the change in payment mechanisms.

Main Methods:

• Utilized nationally representative micro-data from Thailand.
• Employed a difference-in-difference methodology to analyze the policy's impact.
• Compared healthcare utilization patterns before and after the payment system shift.

Main Results:

• The direct disbursement policy led to a significant increase in outpatient healthcare utilization among sick individuals.
• This increase was particularly pronounced and long-lasting for individuals in rural areas, with lower education levels, and lower incomes.
• The findings indicate that the policy effectively reduced liquidity constraints for accessing care.

Conclusions:

• Direct provider disbursement is an effective behavioral intervention to improve healthcare access for vulnerable populations.
• Policy changes in healthcare billing can have substantial and lasting impacts on service utilization.
• Addressing financial barriers through payment system reform enhances health equity.