Inequities in health status and access to health care among different socioeconomic
groups in the Thai population have been increasingly documented during the past decade, but
little is known about inequities in the quality of care. This paper examines inequities in the
quality of care in the context of Thai health care reform, particularly the 30 Baht Universal
Coverage Program that was introduced in 2001. To provide information about the impact of
health care reform on the quality of care, data were collected in Nakhonpathom province by
means of a questionnaire survey. Six hundred and fifty individuals aged 18 years or more
were interviewed concerning their perceived health status, their utilization of health care
services and the quality of care received. The consumer’s perspective was measured in terms
of satisfaction with health care services, choice of available health care services, ability to
understand the written instructions on medical prescriptions and the printed information
distributed by health care personnel, and, lastly, the quality of communication between
physicians and patients. The findings are that lower income groups rated their health status
more negatively than did the higher income groups, utilized more health care services than the
higher income groups, had fewer choices in terms of where to go for medical care, and rated
their understanding of the information distributed by health care personnel and the
instructions written by pharmacists on prescription medicines more negatively. Moreover,
their understanding of what the physician said was rated more negatively and they had fewer
opportunities to ask questions and to become involved in decision making with the physician.
Despite the coverage of preventive services of the Universal Coverage Program, the lower
income groups utilized these services significantly less than their counterparts in the higher
income groups. These results indicate that although improvements in the quality of health care
in the context of the Universal Coverage Program in general may be necessary, such
improvements are not sufficient to guarantee equity in the quality of care between different
socioeconomic subgroups.