Economic impact of investment in maternal and newborn health care under the National Health Security Scheme of Thailand

Background: Evidence for the impact of health care spending in the area of maternal, newborn and child health (MCH) in developing countries is limited. Objectives: To examine the investment and medical care expenses for MCH under Universal Health Coverage (UHC) in Thailand. Methods: A prevention-appraisal-failure (PAF) cost element method was applied. Using a payer perspective, data related to PAF elements of MCH were collected from the Universal Coverage Scheme (UCS) inpatient claim database, UCS liability claims, the health-budget administration and health resource databases of the Ministry of Public Health, and the population census of The National Statistical Office in fiscal years 2007-2011. The main outcome measures included payments and budgets for MCH at a provincial level. Results: Investment and medical care costs of antenatal care to prevent and manage complications increased from US$7.77 per person per year (PPPY) in 2007 to US$ 11.69 PPPY in 2011. The payments to support qualityfocused activities ranged from US$0.60 to US$1.19 PPPY, whereas failure costs resulting from postpartum complications and UHC liability claims were US$1.92, 2.24, 2.35, 2.48, and 2.56 PPPY. Univariate regression analyses of year-on-year changes in prevention and appraisal costs for providing MCH and changes in the failure costs showed significant negative associations between 3 of 4 pairs of years Conclusions: Increased year-on-year costs of preventing MCH problems were associated with a reduction in year-on-year costs incurred for correcting problems. Despite increasing trends for all the costs, this finding indicated improvements in allocation of resources to address MCH challenges in Thailand.