Background: In 2001, the Government of Thailand introduced a universal coverage scheme with
the aim of ensuring equitable health care access for even the poorest citizens. For a flat user fee of
30 Baht per consultation, or for free for those falling into exemption categories, every scheme
participant may access registered health services. The exemption categories include children under
12 years of age, senior citizens aged 60 years and over, the very poor, and volunteer health
workers. The functioning of these exemption mechanisms and the effect of the scheme on health
service utilisation among the poor is controversial.
Methods: This cross-sectional study investigated the prevalence of 30-Baht Scheme registration
and subsequent self-reported health service utilisation among an urban poor population in the
Teparuk community within the Mitrapap slum in Khon Kaen city, northeastern Thailand.
Furthermore, the effectiveness of the exemption mechanisms in reaching the very poor and the
elderly was examined. Factors for users' choice of health facilities were identified.
Results: Overall, the proportion of the Teparuk community enrolled with the 30-Baht Scheme
was high at 86%, with over one quarter of these exempted from paying the consultation fee. User
fee exemption was significantly more frequent among households with an above-poverty-line
income (64.7%) compared to those below the poverty line (35.3%), ?2 (df) = 5.251 (1); p-value =
0.018. In addition, one third of respondents over 60 years of age were found to be still paying user
fees. Self-reported use of registered medical facilities in case of illness was stated to be
predominantly due to the service being available through the scheme, with service quality not a
chief consideration. Overall consumer satisfaction was high, especially among those not required
to pay the 30 Baht user fee.
Conclusion: Whilst the 30-Baht Scheme seems to cover most of the poor population of Mitrapap
slum in Khon Kaen, the user fee exemption mechanism only works partially with regard to reaching
the poorest and exempting senior citizens. Service utilisation and satisfaction are highest amongst
those who are fee-exempt. Service quality was not an important factor influencing choice of health
facility. Ways should be sought to improve the effectiveness of the current exemption mechanisms.