Abstract
BackgroundMany countries aspiring to achieve universal health coverage struggle with how to ensure health coverage for undocumented migrants. Using a case study of maternal health care in a Thailand-Myanmar border region this article explores coverage for migrants, service provision challenges and the contribution of a voluntary health insurance program.MethodsIn 2018 we interviewed 18 key informants who provided, oversaw or contributed to maternal healthcare services for migrant women in the border region of Tak province, Thailand.ResultsIn this region, we found that public and non-profit providers helped increase healthcare coverage beyond undocumented migrants’ official entitlements. Interview participants explained that Free and low-cost antenatal care (ANC) is provided to undocumented migrants through migrant specific clinics, outreach programs and health posts. Hospitals offer emergency birth care, although uninsured migrant patients are subsequently billed for the services. Care providers identified sustainability, institutional debt from unpaid obstetric hospital bills, cross border logistical difficulties and the late arrival of patients requiring emergency lifesaving interventions as challenges when providing care to undocumented migrants. An insurance fund was developed to provide coverage for costly emergency interventions at Thai government hospitals. The insurance fund, along with existing free and low-cost services, helped increase population coverage, range of services and financial protection for undocumented migrants.ConclusionsThis case study offers considerations for extending health coverage to undocumented populations. Non-profit insurance funds can help to improve healthcare entitlements, provide financial protection and reduce service providers’ debt. However, there are limits to programs that offer voluntary coverage for undocumented migrants. High costs associated with emergency interventions along with gaps in insurance coverage challenge the sustainability for NGO, non-profit and government health providers and may be financially disastrous for patients. Finally, in international border regions with high mobility, it may be valuable to implement and strengthen cross border referrals and health insurance for migrants.
Highlights
Many countries aspiring to achieve universal health coverage struggle with how to ensure health coverage for undocumented migrants
Free and low-cost antenatal care is available through a number of sources including village healthcare centres run by the Thai healthcare system, community health posts where care is provided by foreign health volunteers with support from Thai healthcare providers and NGO/non-profit clinics that provide care for documented and undocumented migrants
Birth services are free or low cost at migrant clinics but undocumented migrants without health insurance can be billed for emergency care if they need to present at a Thai hospital
Summary
Many countries aspiring to achieve universal health coverage struggle with how to ensure health coverage for undocumented migrants. Using a case study of maternal health care in a Thailand-Myanmar border region this article explores coverage for migrants, service provision challenges and the contribution of a voluntary health insurance program. Almost every country aspiring or claiming to achieve UHC struggles with how to include undocumented migrants. For countries that attempt to include migrants in universal health coverage there are different financing mechanisms such as general tax based financing or a self-financed pool with voluntary contributions [3]. Extending UHC to include undocumented persons furthers the right to health, that everyone should be able to access the services they need regardless of their migration status [5]
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