Discrete Choice Experiment to Derive Willingness to Pay for Voluntary Health Insurance after Retirement in Thailand

Thailand has now reached a new demographic turning point with the advent of an ageing society [10]. The older population or population aged 60 and above increased from 1.5 million in 1960 to approximately 7.4 million in 2008, and it is expected to be 17.7 million in 2030 [14]. Since the number of elderly people is growing, the number of chronically-ill patients, including those with diabetes, hypertension and cardiovascular disease, will increase accordingly. It was found that 74.3 percent of the Thai elderly had at least one chronic illness and that most of them suffered from many chronic illnesses [15]. As the numbers of the older population that need healthcare and long-term care services increase, the public health insurance should be adjusted and reformed in order to meet the demands of people after retirement. In Thailand, there are three public health insurance schemes: the Social Health Insurance (SHI), the Civil Servant Medical Benefit Scheme (CSMBS), and the Universal Coverage Scheme (UC). The UC is mandatory for all Thai citizens that are not insured by another public insurance scheme. The CSMBS covers civil servants and their immediate family members, including spouses, parents, and up to three children under the age of 20 years. It also covers retirees and their dependents. The SHI provides mandatory coverage for workers in the formal sector, and since 2001 it has been mandatory for firms with more than one worker and for the self-employed. Presently, the government has provided free healthcare for older persons since the introduction of universal health coverage in 2001. Under this program, all government hospitals and health centers provide free medical services to persons aged 60 and upwards. However, only the elderly that are poor and are under the universal coverage scheme can use the free care. People under the Civil Servant Medical Benefit Scheme (CSMBS) still receive healthcare services after retirement; meanwhile, Social Health Insurance (SHI) does not cover workers after retirement. Therefore, there is a healthcare risk for workers under this health insurance scheme. As the number of the elderly increases, the number of retired workers under the SHI scheme will increase significantly. Because the workers under the SHI scheme are not covered for healthcare or long-term care services after retirement, they have a high risk of falling into the poverty trap. However, the government budget is tight in supporting universal healthcare and long-term care services for all of the elderly. As a result, the government should support older people—especially workers that have the ability to pay should pay for the quality of healthcare services through the voluntary mechanism. The question however is how much they are Abstract: This paper reports the results of a study that used the discrete choice experiment (DCE) method to estimate the willingness to pay for health insurance after retirement for workers under Social Health Insurance (SHI) in Thailand. In the DCE questionnaire, respondents were asked to choose their preferred scenario between status quo (using free healthcare services for the elderly, which has free but limited coverage of outpatient healthcare expenses and inpatient healthcare can be used in public hospitals covering only a non-private room and accommodations) and an alternative scenario (with hypothetical health insurance after retirement, including inpatient, outpatient, long-term care expenses and work compensation) that vary along several attributes, one of which is the price of the alternative. The sample of 300 workers under the Social Health Insurance (SHI) scheme, whose age were greater than 40 years, were interviewed by using a structured questionnaire. The study found that the workers under the SHI scheme that were more willing to pay for voluntary health insurance after retirement were willing to pay for inpatient (IPD) and outpatient (OPD) health service expenses more than other healthcare benefits.