Equity In the Utilization of Primary Health Care Services Among The Thai Population

Abstract

Background: Equity in primary health care (PHC) utilization is a central principle of Thailand’s Universal Health Coverage (UHC) policy. Despite near-universal insurance coverage, disparities in health care utilization may still arise from demographic, socioeconomic, and health system factors.

Objectives: This study aimed to 1) describe the characteristics of the Thai population; 2) examine differences in health needs across demographic and regional factors; 3) identify determinants of illness as a proxy for primary health care utilization; and 4) assess equity in PHC access.

Methods: Secondary data from the Health and Welfare Survey 2023 were analyzed using descriptive statistics, Chi-square tests, and complex samples logistic regression. Illness during the past month was used as a proxy indicator for health care needs and potential utilization. Both crude odds ratios (COR) and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were estimated.

Results: A total of 69,078 individuals were included in the analysis, of whom 13.3% reported illness during the past month. Bivariate analysis showed significant associations between illness and sex, age, education, health insurance, and region (p < 0.001). In multivariable analysis, age (AOR=1.29, 95% CI: 1.23–1.36), sex (AOR=1.02, 95% CI: 1.02–1.02), education (AOR=0.92, 95% CI: 0.91–0.93), and health insurance (AOR=1.12, 95% CI: 1.06–1.19) remained significant predictors (all p < 0.001), while region was not statistically significant after adjustment (AOR=1.00, 95% CI: 0.98–1.02, p=0.819).

Conclusions:  Thailand’s Universal Health Coverage policy has contributed to improving equity in primary health care utilization. Although regional differences were not statistically significant after adjustment, demographic and socioeconomic characteristics continued to influence health care needs. These findings suggest that achieving sustainable health equity requires strengthening primary care capacity, workforce competency, service quality, and continuous monitoring of contextual disparities beyond insurance coverage alone.