Universal Coverage for Emergency Patients and outcomes after severe head injury in Thailand
A retrospective claims-based cohort study comparing treatment and survival before and after Thailand’s 2023 UCEP financing expansion for patients admitted with head injury.
patients in the draft cohort
Unreviewed pre/post analysis with major residual confounding from injury severity.The one-minute brief
Financial protection can improve access to emergency treatment, but coverage alone may not change survival if trauma pathways, transfers, and time-critical capacity remain constrained.
Was the October 2023 UCEP financing expansion associated with changes in surgical access or survival among patients admitted to public hospitals with head injury?
The analysis supports an association between the financing change and greater surgical access, but it cannot establish that the policy caused either treatment or survival differences. Higher mortality among UCEP users should not be interpreted as policy harm without adequate severity adjustment.
Unreviewed summary. No manuscript download is provided. Findings may change during analysis, co-author review, or peer review.
Methods
National claims · retrospective cohort
- 01
Analysed National Health Security Office e-claim records from public hospitals between October 2022 and September 2024.
- 02
Compared one year before and after expansion using descriptive statistics, chi-square and Mann–Whitney U tests, logistic regression, and Kaplan–Meier analysis.
- 03
Defined UCEP use from the claim’s recorded financing source and assessed mortality at 1, 3, 6, and 12 months.
Reported findings
The draft reports 4,939 patients: 2,213 before expansion and 2,726 after expansion.
Surgical intervention increased from 34.2% to 42.8% (p<0.001), while measured mortality did not differ significantly between periods.
Within the post-expansion cohort, UCEP use was associated with higher adjusted odds of death (aOR 1.58, 95% CI 1.22–2.03), likely reflecting greater baseline severity and residual confounding.
The analysis supports an association between the financing change and greater surgical access, but it cannot establish that the policy caused either treatment or survival differences. Higher mortality among UCEP users should not be interpreted as policy harm without adequate severity adjustment.
Figures from the source report
These are selected directly from the supplied source documents and captioned to aid interpretation. They are not decorative or newly generated.
Draft Kaplan–Meier plot comparing the two policy periods. The curves largely overlap after the early decline. This is an unadjusted descriptive plot and cannot establish a policy effect.
Draft unadjusted comparison by recorded UCEP use. The separation should not be read as harm from UCEP: users likely entered with greater injury severity, which the claims data could not adequately measure.
Limitations
The boundary of the claim is part of the result—not a footnote.
- 01
The administrative dataset lacks key severity measures such as Glasgow Coma Scale, pupil response, injury severity, and time-to-care.
- 02
The pre/post design is vulnerable to secular trends, coding changes, selection effects, and unmeasured confounding.
- 03
Private hospitals were excluded, and claims may not capture the complete clinical pathway.
- 04
The manuscript remains a draft and has not been peer reviewed.
Contributors & governance
Authors
- Peerasit SitthiratChakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University
- Thanakorn BuathongtanakarnSuankularb Wittayalai School
- Samrit Srithamrongsawat
- Paibul Suriyawongpaisal
Role
Thanakorn is listed as a co-author. The supplied draft leaves the author-contribution field incomplete, so no specific contribution is asserted.
Data
Only aggregate results are presented. NHSO claim records and patient-level information are not hosted or distributed by this website.
Ethics
An ethics approval or exemption statement is not present in the supplied draft. This must be completed in the manuscript before formal dissemination.
Competing interests
The conflict-of-interest field is incomplete in the supplied draft.
Read & cite
Sitthirat P, Buathongtanakarn T, Srithamrongsawat S, Suriyawongpaisal P. Universal Coverage for Emergency Patients: an analysis of financing model impact for multiple trauma patients in Thailand. Unreviewed manuscript draft.