Abstract:Background: The utilisation 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 utilisation of health services despite UHC. To explore the effects of the structural determinants on health inequities in Thailand, the Commission of Social Determinants of Health (CSDH) conceptual framework was used as a theoretical guide to assess the effects of socioeconomic status, education, gender, ethnicity, and occupation on the utilisation of health services. Methods: This literature review was conducted in Medline, Global Health, Scopus, and Web of Science. The inclusion criteria consisted of quantitative studies that analysed and quantified the difference in health service utilisation 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 utilised 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 utilised more health services than their lower counterparts. Women are more likely than males to utilise 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 utilisation 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. Conclusion: 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 centres 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.
Keywords: Health Systems and Universal Health Coverage (UHC), Universal Health Coverage, Health inequities, Structural determinants of health
