Development of a Model to Enhance Emergency Medical Literacy under the “Universal Coverage for Emergency Patients (UCEP)” Policy

Abstract

Appropriate access to emergency medical services depends on the health literacy of the population, particularly regarding the Universal Coverage for Emergency Patients (UCEP) policy, for which evidence in Thailand remains limited. This study aimed to (1) assess the situation and determinants of emergency medical literacy related to the UCEP policy, and (2) develop an appropriate literacy-promotion model. A two-phase mixed-methods design was employed. Phase 1 was a cross-sectional survey of 1,400 participants in six provinces representing six regions of Thailand using multistage sampling, analyzed by descriptive statistics and multiple logistic regression. Phase 2 used a knowledge-management process with in-depth interviews of 25 stakeholders—citizens, health personnel, local officers, and emergency-medicine administrators. Most participants had adequate (45.14%, 95% CI: 42.54-47.76) or excellent (32.57%, 95% CI: 30.16-35.07) emergency medical literacy. Significant determinants (p<0.05) included age <30 years (AOR = 3.46, 95% CI: 1.68-7.12), income >30,000 THB/month (AOR = 1.97, 95% CI: 1.04-3.73), awareness of the UCEP policy (AOR = 3.09, 95% CI: 2.11-4.51), presence of community volunteer groups (AOR = 1.68, 95% CI: 1.01-2.82), and community cohesion (AOR = 2.04, 95% CI: 1.42-2.92). Interviews revealed that UCEP facilitates timely lifesaving care; however, both the public and personnel still lack clear understanding of eligibility criteria, reimbursement procedures, and inter-hospital referral, particularly in private hospitals. Recommendations are to prioritize older adults and low-income groups, intensify communication of eligibility criteria to citizens and local officers, foster community engagement, clarify reimbursement and referral systems, and develop digital tools to sustainably enhance emergency medical literacy.