Universal health coverage at the macro level: Synthetic control evidence from Thailand

Abstract

As more and more countries are moving towards Universal Health Coverage (UHC), it is important to understand the macro level or aggregate impacts of such a policy. We use synthetic control methods to study the impact of UHC, introduced in Thailand in 2001, on various macroeconomic and health outcomes. Thailand is compared to a weighted average of control countries in terms of aggregate health financing indicators, aggregate health outcomes and economic performance, over the period 1995 to 2012. Our results suggest that UHC helps alleviate the financial consequences of illnesses. The estimated treatment effect of UHC on out-of-pocket payments as a percentage of overall health expenditures is negative 13 percentage points and its effect on annual government per capita health spending is US$ 79. We detect a smaller effect of US$ 60.8 on total health spending per capita which appears with a lag. We document positive health effects as captured by reductions in infant and child mortality. We do not find any effect on GDP and the share of the government budget devoted to health. Overall, our results complement micro evidence based on within country variation. The counterfactual design implemented here may be used to inform other countries on the macro level repercussions of UHC.