Background: The utilization of health services in Thailand increased significantly after the implementation of universal health coverage (UHC) in 2002. However, evidence suggested that the structural mechanisms that generate social stratification affected the utilization of health services despite UHC. This study aims to examine the effects of the structural determinants on health inequities in Thailand using the Commission of Social Determinants of Health (CSDH) conceptual framework as a theoretical guide. Specifically, the study assesses the effects of socioeconomic status, education, gender, ethnicity, and occupation on the utilization of health services.
Methods: This systematic review was conducted in Medline, Global Health, Scopus, and Web of Science. The inclusion criteria consisted of quantitative studies that analyzed and quantified the difference in health service utilization between population subgroups stratified by the structural determinants.
Results: A total of 19 studies were included in this review. The results showed that the poor utilized health services more than the rich, but there is a rich-poor disparity in tertiary care services. People with high-income occupations and higher-level education utilized more health services than their lower counterparts. Women are more likely than males to utilize health services. Ethnic minority migrants and stateless populations have the lowest level of health service use compared to Thais, and the presence of health insurance does not necessarily increase the utilization of health services in this group. Maternal and Child Health services have the least inequity gap due to high service coverage, while dental service use showed substantial pro-rich inequity.
Conclusions: The structural determinants of health contribute to inequities even after the implementation of UHC. To further close the inequity gap, future policy should focus on ensuring adequate and timely referral from primary health centers to specialist care, removing barriers to access care for ethnic minority migrants and stateless populations, and reducing the scarcity of dental resources in rural areas.
