# Health insurance coverages and demand for modern contraceptive choices among reproductive-age women in Thailand

## TL;DR

This study explores how different health insurance systems in Thailand influence the contraceptive choices of reproductive-age women.

## Contribution

The research reveals how structural features of health insurance schemes, not just financial coverage, affect contraceptive method preferences.

## Key findings

- Women under the Social Security Scheme prefer hormonal methods, possibly due to time-efficient dispensing incentives.
- Civil Servant Medical Benefit Scheme members prefer device-based methods, linked to provider flexibility and fee-for-service models.
- Religious beliefs and concerns about hormones influence adoption of natural methods among educated, affluent women.

## Abstract

Contraception is crucial for women's well-being and national development, which is particularly salient in Thailand's rapidly aging society where maximizing the health of the working-age population is essential. While health insurance is pivotal, this research moves beyond analyzing financial barriers to examine the distinct structural influence of Thailand's three major health insurance systems—the Universal Coverage Scheme (UCS), Social Security Scheme (SSS), and Civil Servant Medical Benefit Scheme (CSMBS)—on modern contraceptive method choices among reproductive-age women. Using data from the 2022 Multiple Indicator Cluster Survey (MICS) (n = 10,922 women currently using contraception), a Multinomial Logistic Regression model yielded significant findings. The results demonstrate that the specific scheme structure, rather than just the presence of coverage, significantly predicts method selection. Women under the Social Security Scheme (SSS) showed a statistically significant higher propensity for hormonal methods (pills, injections, implants). In contrast, members of the Civil Servant Medical Benefit Scheme (CSMBS) showed a significant preference for device-based methods (condoms, IUDs, diaphragms). These distinct preferences align with the structural incentives of the schemes: the SSS's capitation payment model may favor time-efficient hormonal dispensing, while the CSMBS's fee-for-service model and provider flexibility facilitate access to medical devices and non-hormonal options. Additionally, religious beliefs and concerns about hormonal side effects (observed among highly educated, affluent women) played a substantial role in the adoption of natural methods. This study underscores the need for public health policies that move beyond guaranteeing financial access and consider the structural diversity of health insurance systems to promote appropriate and sustainable contraceptive access and informed choice.