How a health care plan quickly lowered infant mortality


April 30, 2014
Brain & Behavior, Health

Study: Improved hospital access lowered infant death rate among Thailand’s poor within a year.

Few problems in developing countries are as gut-wrenching as high infant mortality — and yet it is a problem that has solutions. A policy change in Thailand’s health care system has quickly led to significantly lower infant mortality rates among less-wealthy citizens, as a study co-authored by MIT economists shows.

“It’s a very dramatic shift,” says Robert Townsend, the Elizabeth and James Killian Professor of Economics at MIT, and a co-author of a new paper outlining the findings. The study was conducted along with Jon Gruber, an MIT professor of economics and health care expert, and Nathaniel Hendren, an economist at Harvard University.

The researchers found that Thailand’s “30 Baht” program, which increased access to hospitals, led to a 13 percent drop in infant mortality in about a year. That change seems largely attributable to fewer infant deaths in rural areas, where previously the poor might never have entered hospitals to seek care.

The paper, “The Great Equalizer: Health Care Access and Infant Mortality in Thailand,” recently published in the American Economic Journal: Applied Economics.

The big impact of small copays

Instituted in 2001, Thailand’s 30 Baht program altered health care arrangements in several ways. It provided for funds of about $35 per capita to be granted to provincial hospitals, based on the numbers of local residents, and lowered copays to 30 Thai baht, or about 75 cents, per visit. Previously, about 30 percent of Thailand’s population had been enrolled in a modestly funded health care program, the Medical Welfare Scheme (MWS), while another 50 percent of the population was too well-off for MWS, but not well-off enough to have other insurance.

The study was based on data from a health and welfare survey in Thailand covering years from 2001 to 2005, and consisted of a cross-section of the population in all 76 Thai provinces.

The people most affected by the policy change included those previously enrolled in MWS, which was replaced by the 30 Baht program; moreover, the study found, hospital utilization increased most for women ages 20 to 30 and for infants. In conjunction with this, the decrease in infant mortality was a striking medical outcome stemming from the greater access to hospitals.

“One of the most surprising things about the results is how quickly you see the shift in infant mortality,” Hendren says. “You see it within a year. It’s well known that a lot of the causes of infant mortality are caused by very preventable things, such as dehydration.” Infants with diarrhea, for instance, can become dehydrated; other treatable causes of infant death in the developing world, as studies show, include pneumonia and infection.

The 30 Baht program lowered infant deaths by about 2 per 1,000 births in Thailand over the course of the study; previously, the national rate may have been around 15 per 1,000 births, according to the World Bank’s World Development Indicators.

High-visibility program

To be sure, the 30 Baht program was not strictly designed to combat infant mortality alone; its goal has been to increase health care access for all. For that reason, the researchers note, the visibility of the program seems to have helped save lives, in part, by letting more people recognize they have a right to hospital access.

“It’s hard to find somebody who doesn’t know about the 30 Baht program, in the more rural areas,” Hendren says. For hospitals, he adds, “You get the sense there was this greater ability to expand their reach into the community.”

Other scholars say the study’s results are interesting and suggest additional issues for scholarly investigation.

“I think it’s a good-news paper,” says Glenn Melnick, a professor at the University of Southern California who focuses on health economics and finance, and who has previously studied the 30 Baht program. The visibility of the program, Melnick agrees, has likely helped direct people in rural areas to hospitals: “A lot of the time, people don’t know what to do” about locating health care providers, he observes. Still, Melnick suggests, there are lingering questions about whether the Thai program can support more expensive forms of care over the long term.

As Townsend notes, plenty of research questions remain about how the operations of hospitals have changed since the implementation of the 30 Baht program.

“If we could, we would try to know more about the delivery mechanism of health care within the hospitals, how they allocate care and treatment depending on the patients,” Townsend says.



How a health care plan quickly lowered infant mortality

12 Responses to How a health care plan quickly lowered infant mortality

  1. u14385369 May 5, 2014 at 5:46 am #

    The rate at which it was lowered is not a problem, though i’m surprised why they took such a long time not dealing with the issue. Its not too hard to build hospitals and clinics in the rural areas, but hey,it has passed then there’s no reason to fight over it. the rate is good and could have been better if the matter was dealt with earlier than it this. shame the consequence of this problem is bad and hopefully now everyone is happy. i just hope they completely get rid of the disease and not lower it.

  2. 14020085 May 4, 2014 at 1:16 am #

    It is a human right to have access to good medical treatment; however in undeveloped countries the death rate of infants and elderly people is much higher than in developed countries. The availability, quality, and time of treatment received are the main reason for high mortality rates. Dyhrea, infection and dehydration is the cause of most deaths and if treated in time, will have a huge impact on the death rate. The time taken up to where a patient receives medical treatment is normally an indication of its infrastructure and health treatment system.

    The 30 Bath Programme in Thailand had shown a decrease of 13% in infant death rate. Poor healthcare is unacceptable and if not made available and located so that every person has reasonable access to treatment when require it will affect the development and future of any country.

  3. u14285909 May 2, 2014 at 3:08 am #

    Infant mortality is an urgent issue that needs to be addressed especially in third-world countries. The 30 Baht program of Thailand has shown the world which direction to take towards combating infant mortality as well as poor health in general.

    If it was possible for Thailand to dramatically lower infant mortality in just a year, what is stopping other countries from doing so as well? The world should learn from the 30 Baht program so as to reap the same fruits Thailand has in a space of one year. This is a great opportunity to save lives and should not be left to slip through our fingers.

  4. m Usi u14217733 May 1, 2014 at 6:49 am #

    Infant mortality is a very crucial issue because we are lossing the leaders of tomorrow.We have to protect those infants as we do not know what they are holding for us.In most rural area there is a long distance between where they stay and where they can get health service.Most of children were not supposed to die before they reach one year but due to low health services they are gone.As Thailand has set an example we have to follow their footsteps and create program like 30 Baht to improve our health services. Health and infant mortality concern anyone so we must not wait for the goverment to bring change,we have to work together to improve health services in our country

  5. Carmen Britz (14040752) May 1, 2014 at 5:23 am #

    Is Thailand’s “30 Baht program” our first step in finding a solution for our high mortality rates in Africa? Although we already have a primary health care program running in South Africa, it’s mainly the rural and poor people that do not benefit from this program. This is due to the vast and remote rural areas, to few hospitals, that is anyway understaffed, and lastly long distances to travel with no transport infrastructure that can bring the patients to the hospital.

    Different from the “30 Baht program”, due to our geographical vastness, medical care and knowledge in Africa must be taken to the people, using the same principles of preventative health care.

    Healthier citizens will result in more productive workers, more consistent wages, less poverty and eventually a country that can economically sustain itself.

  6. Neo May 1, 2014 at 4:23 am #

    Infant mortality is one of the crisis that needs our attention. We really need to consider it
    as an important aspect of life and be thankful for having a program like the Baht program.This is amazing as someone else’s live is being saved.A new born is a gift that most of mothers appreciate, this program is very effective as it also brings joy in some of the families. ‘A 13 percent drop in infant mortality within a year’, it is a huge change in comparison with the rate of infant mortality before this program. it is therefore appreciated, not all of us have access to health care, the 30 Baht program contribution is indeed a great and good impact in the field of health.

  7. 14141877 May 1, 2014 at 2:06 am #

    It is absolutely heart-warming to read about how other people are helping those less fortunate in such a magnificent way. The fact that these infants are now more able to receive the healthcare they deserve and have the right to is a miracle. it has never been fair that these children have had to suffer the consequences of poor healthcare. if this program could become more popular throughout the world, and have a larger support system behind it, it could be the next greatest thing to happen to more less developed countries then just Thailand.
    It would be great if the 30 baht program could extend over the next few years to places such as Africa and the Middle Eat where famine and poor health care are a large issue, affecting mostly infants who are unable to help themselves and suffer terribly due to poor healthcare, or not being able to receive healthcare at all. It is these people who are unknowingly taking care of our future generations who deserve to be noticed and supported by more communities across the world, rather than those who are selfish and constantly in media. If more people were to know about these programs, the world would be one step closer to being united.
    These are just the first few steps to creating generations better and more caring than the generation of today.

  8. Mortailty April 30, 2014 at 11:55 pm #

    :)

  9. James (u14316872) April 30, 2014 at 5:05 pm #

    This is a very interesting subject to follow,and having to see such improved results in a space of a year in Thailand shows that indeed infant mortality can be curbed.Looking at it’s high rate in Africa as well,especially in the Dry East,It would be highly recommendable that a similar program like the 30 Baht program should be implemented in these areas,in in decade’s time this can reduce the number of infants dying due to these curable causes in Africa.

  10. U14013356 April 30, 2014 at 12:08 pm #

    We easily take things for granted. Most of us have access to quality health care and medicine. It is a crucial part in the development of a country. The 30 Baht program is one step in the right direction. Infant morality is unacceptable, especially if it can be prevented. The success of this program can be proved by the decrease in infant mortality in only a years time. The fact that this program does not only focus of infants, but also adults and to make health care more accessible to them as well assures us that Thailand is leading by example to many other places in the same situation.

  11. Beth van der Merwe April 30, 2014 at 11:26 am #

    The issue of infant mortality is an urgent one because they are our future generation, they are our future leaders. It is tough for mothers and care givers to access clinics in developing countries, and this proves challenging in maintaining the health of infants. The 30 Baht program, implemented in Thailand, aims to preserve the future of our world by helping the children.

  12. u14008794 April 30, 2014 at 10:05 am #

    This is the beginning of something new, addressing the issue of infant mortality is an urgency because infants are just as important adults. Most mothers’ primary concern is the health care of their babies especially within the first few weeks the baby is born. It is a great struggle for care givers in developing countries to access hospitals and clinics and Thailand has implemented a strategic plan to help overcome this.The 30 Baht program is a key towards ensuring the future of the world, which is in fact its children, is preserved. A lower infant mortality rate in turn causes a higher life expectancy in developing countries.

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