Abstract
BackgroundAlthough the Thai government has introduced policies to promote the health of migrants, it is still the case that urban refugees and asylum seekers (URAS) seem to be neglected. This study aimed to explore the degree of healthcare access through the perspective of unmet need in URAS, relative to the Thai population.MethodsA cross-sectional survey, using a self-reporting questionnaire adapted from the Thai Health and Welfare Survey (HWS), was performed in late 2019, with 181 URAS completing the survey. The respondents were were randomly selected from the roster of the Bangkok Refugee Center. The data of the URAS survey were combined with data of the Thai population (n = 2941) from the HWS. Unmet need for health services was defined as the status of needing healthcare in the past 12 months but failing to receive it. Bivariate analysis was conducted to explore the demographic and unmet need difference between URAS and Thais. Multivariable logistic regression and mixed-effects (ME) model were performed to determine factors associated with unmet need.ResultsOverall, URAS were young, less educated and living in more economically deprived households, compared with Thais. About 98% of URAS were uninsured by any of the existing health insurance schemes. The prevalence of unmet need among URAS was significantly higher than among Thais in both outpatient (OP) and inpatient (IP) services (54.1% versus 2.1 and 28.0% versus 2.1%, respectively). Being uninsured showed the strongest association with unmet need, especially for OP care. The association between insurance status and unmet need was more pronounced in the ME model, relative to multivariable logistic regression. URAS migrating from Arab nations suffered from unmet need to a greater extent, compared with those originating from non-Arab nations.ConclusionThe prevalence of unmet need in URAS was drastically high, relative to the prevalence in Thais. Factors correlated with unmet need included advanced age, lower educational achievement, and, most evidently, being uninsured. Policy makers should consider a policy option to enrol URAS in the nationwide public insurance scheme to create health security for Thai society.
Highlights
The Thai government has introduced policies to promote the health of migrants, it is still the case that urban refugees and asylum seekers (URAS) seem to be neglected
We found a piece of work by Busetta et al, which examined the prevalence of unmet need of refugees in Italy while applying the same unmet need questions as the Thai Health and Welfare Survey (HWS) [25]
URAS from Cambodia and Vietnam showed the smallest unmet need estimate (31.4–33.3% in OP care and 9.1–13.7% in IP care), in relation to other nationals, Fig. 5. To our knowledge, this piece of work is among the first few studies in Asia that quantitatively investigate the degree of healthcare access among URAS through the perspective of unmet need
Summary
The Thai government has introduced policies to promote the health of migrants, it is still the case that urban refugees and asylum seekers (URAS) seem to be neglected. In 2017, international cross-border populations amounted to 258 million (3.4% of global population) [1] Of these 258 million, 68 million were forcibly displaced people. The situation of refugees has gained increasing attention in the global health field in recent years, since the 2011 Syrian crisis which resulted in more than 6 million refugees fleeing from Syria to Europe [3]. Asia is another region that has encountered a refugee crisis. An obvious case is the exodus of more than 700,000 Rohingya refugees from Rakhine State in Myanmar to Bangladesh, during 2015–2017 [4]
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