The mortality risks of pneumonia patients with the same levels of health insurance coverage in Thailand before and after the implementation of the universal care project.

Objective: To compare the mortality risks of pneumonia patients with the same levels of health insurance coverage status before and after the implementation of the Universal Health Care Coverage Project (UC). Methods: A retrospective cohort study was conducted. The sample was pneumonia patients admitted to hospitals owned by the Ministry of Public Health (MOPH) of Thailand during 2001-2002. Logistic regression analysis was used to determine whether mortality risks of pneumonia patients with the same levels of health insurance coverage status before and after the implementation of the UC were different after controlling for important variables. Results: Of the 8,577,482 patients admitted to the Thai Ministry of Public Health Hospitals during 2001-2002, there were 112,205 and 115,386 patients diagnosed with a type of pneumonia in 2001 and 2002, respectively. After controlling for sex, age, marital status, hospital type and length of stay, patients admitted after the implementation of the UC who were insured or had UC with 30 baht co-payment coverage had no significant difference in mortality risks (OR = 1.08, P = 0.20; OR = 1.03, p = 0.62; respectively). In contrast, patients who were under the UC without co-payment had higher mortality risk after the implementation of the UC (OR = 1.12, P = 0.001). Conclusion: Before and after the implementation of the UC project, pneumonia patients who had the same levels of health insurance coverage had differences mortality risks regarding to their health insurance coverage status. Whether the results reflected the impact of the UC project, unmeasured differences in quality of care, restricted access to care, or differences in co-morbidities remains to be determined.