Differential trends in equity of health service utilization in primary, secondary & tertiary health care levels among Thai elderly across income groups By Bhumisuk Khananurak Writing workshop, 2009 Target Journal : IPSR Journal

Introduction World’s population aging are challenges and opportunities for many societies By 2025, 58 % or 1.2 billion people of the world’s population will become elderly Higher burden of elderly’s diseases become challenges for many societies Health equity in health care utilization among Thai elderly is a essential issue

Puzzle (Problem) Definition Universal health coverage improve equity in health care utilization Rapid increase of Thai elderly effect health care utilization of the elderly Thailand is a good place to study aging Rapid increase of aging society Nevertheless, Thailand is aging quickly. It like a health care utilization paradox for Thai elderly might be possible

Research Question How does trends in health equity in health service utilization across income groups among Thai elderly? To analyze trends in health equity of health care utilization in primary, secondary & tertiary health care levels across income groups among Thai elderly. Objective

Equity in health care utilization Egalitarian (Perfect equality) Rich elderly and poor elderly equally use health care services Pro-poor The poor elderly use health care services more than rich elderly Pro-rich The rich elderly use health care services more than poor elderly 

“Equity” Measurement Concentration Curve (CC) and Concentration Index (CI) Using CI. Cumulative % of person Ranked by economic status Cumulative %of ill health

Out-patient In-patient Primary : health center, PCUs Secondary : community hospital, private clinic Tertiary : provincial/regional hospital, other public hospital, private hospital, university hospital Concentration Index

Figure 1 : Concentration indexes of out-patient health services utilization at primary, secondary and tertiary levels from 2003 to ) Out-patient service use Pro-rich Pro-poor

Figure : Concentration indexes of in-patient health services utilization at secondary and tertiary level from 2003 to ) In-patient service use Pro-rich Pro-poor

Conclusion The trend of health care use: Out-patient At tertiary care level ; as the pro-rich. At primary and secondary care level : the pro-poor. In-patient At tertiary care level : as the pro-rich. At secondary care level : as the pro-poor Therefore, they are more equitable at secondary