Abstract
Access to health care and financial protection for migrants can be promoted through diverse health insurance schemes, designed to suit migrants’ needs within a specific context. The Migrant Fund (M-Fund) is a voluntary, non-profit health insurance scheme operating along the Thai–Myanmar border in Thailand since 2017 and aims to protect the health of migrants uncovered by existing government insurance schemes. A qualitative evaluation was conducted between December 2018 and March 2019 to determine M-Fund’s operational impacts, provide recommendations for improvement, and draw suggestions about its role in protecting migrant health. In-depth interviews with 20 individuals and 5 groups were conducted in three categories: (1) International, national, and local partners; (2) M-Fund clients; and (3) M-Fund staff. Interview information was triangulated with findings from other informants, a document review, and researchers’ observations. Despite covering a small number of 9131 migrants, the M-Fund has contributed to improving access to care for migrants, raised awareness about migrant health protection, and reduced the financial burden for public hospitals. The M-Fund acts as a safety-net initiative for those left behind due to unclear government policy to protect the health of undocumented/illegal migrants. Despite clear merits, the issue of adverse selection to the scheme is a critical challenge. Evidence from this evaluation is useful to inform the future design of government insurance schemes for migrants.
Highlights
Micro-insurance is accepted as a useful type of insurance for protecting vulnerable groups of people through payments that are tailored to health needs, incomes, and levels of risk [1]
Results are presented in two main sub-sections, firstly describing the situation of migrant health protection in Thailand and the characteristics of Migrant Fund (M-Fund) members and secondly presenting the results from the thematic analysis
All Thai nationals are insured for their health according to the Thai Constitution, while the situation of migrants’ health insurance has fluctuated over time depending on the politics in different time periods
Summary
Micro-insurance is accepted as a useful type of insurance for protecting vulnerable groups of people through payments that are tailored to health needs, incomes, and levels of risk [1]. A wide range of health insurance schemes can be designed to protect the health of migrants within a given country-specific context. Protecting undocumented/illegal migrants can be politically sensitive, yet some Thai government health authorities and local public hospitals have supported the implementation of the M-Fund to address existing challenges of providing healthcare for unregistered migrants in their local area. This was for two main reasons: (1) The project appeared to do no harm; and (2) while there was still no clear policy direction for this vulnerable group of people, it would be a good learning process for all involved parties. The M-Fund collaborates with local non-governmental organizations (NGOs) that provide health and other services for migrants along the
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