How a health care plan quickly lowered infant mortality

April 30, 2014 by Peter Dizikes, Massachusetts Institute of Technology
Thailand’s “30 Baht” program, which increased access to hospitals, has 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. Credit: Thinkstock

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 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 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 , 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 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 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 to hospitals: "A lot of the time, people don't know what to do" about locating , 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.

Explore further: Access to health care among Thailand's poor reduces infant mortality

Related Stories

Access to health care among Thailand's poor reduces infant mortality

June 6, 2013
When health care reform in Thailand increased payments to public hospitals for indigent care, more poor people sought medical treatment and infant mortality was reduced, even though the cost of medical care remained free ...

Maternal health program in India failing to deliver, study shows

December 11, 2013
A prominent program that claims to reduce infant and maternal deaths in rural India by encouraging mothers to deliver in private hospitals has been unsuccessful, despite the investment of more than $25 million since 2005, ...

'It takes a village'—Community-based methods for improving maternal and newborn health

February 18, 2014
A series of studies are published in a special supplement that presents results of the Maternal and Newborn Health in Ethiopia Partnership—a three-year pilot program funded by the Bill & Melinda Gates Foundation with the ...

Major lung resection safer than ever, especially at the busiest hospitals

April 29, 2014
A major new study using data from the National Cancer Data Base details the impact of annual hospital volume on 30- and 90-day mortality rates. Investigators found that major lung surgery has become progressively safer over ...

Black infants in US twice as likely to die as whites, CDC reports

August 8, 2013
(HealthDay)—Survival odds for black American infants are considerably worse than for white babies, a new U.S. study finds.

New study explores contributors to excess infant mortality in the US South

February 4, 2014
Researchers consider infant mortality to be a key indicator of population health. Currently, the United States ranks 27th among industrialized nations in infant mortality, but rates within the U.S. vary significantly by race, ...

Recommended for you

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

Can muesli help against arthritis?

January 15, 2018
It is well known that healthy eating increases a general sense of wellbeing. Researchers at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) have now discovered that a fibre-rich diet can have a positive influence ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.