Prevalence of, and Factors Associated with, Unmet Healthcare Need in Urban Refugees and Asylum Seekers in Bangkok, Thailand: a Mediation Analysis

Abstract

This study examines the prevalence of, and factors mediated to, unmet healthcare need of urban refugees and asylum seekers (URAS) in Thailand. In 2019, a cross-sectional survey of 181 URAS was merged with Thai data (total n=3,122). Self-reporting questionnaire was applied. Unmet healthcare need, defined as a status where a person needed health examination or treatment within the past 12 months, but he or she did not receive it, were analysed using multivariable logistic regression within a concept of mediation analysis. URAS were younger and had lower household economic status than Thais, and almost all URAS were uninsured. Most URAS suffered from a high prevalence of unmet healthcare need, 54.1% (range 31.4–100.0%) for outpatient (OP) care and 28.0% (range 0–83.3%) for inpatient (IP) care, while unmet healthcare need prevalence amongst Thais was 2.1% for both OP and IP care. For OP care, the direct effect of URAS status (predictor) on unmet healthcare need (outcome) showed a significant adjusted odds ratio (AOR) of 8.8 (95% CI 1.3–58.6), and a total effect (combining direct effect and indirect effect where insurance status served as a mediator) had AOR as large as 42.3 (95% CI 26.4–67.8). A significant total effect was also observed for IP care (AOR 13.1, 95% CI 7.8–22.0). Since most URAS substantially suffer from a lack of insurance coverage and this markedly influenced healthcare inaccessibility, policymakers should prioritise expanding insurance coverage towards URAS to promote health equity for all.