Understanding the Problem of Access to Public Health Insurance Schemes among Cross-Border Migrants in Thailand through Systems Thinking.

Watinee Kunpeuk,Nareerut Pudpong,Mathudara Phaiyarom,Rapeepong Suphanchaimat,Pard Teekasap,Hathairat Kosiyaporn,Sataporn Julchoo,Pigunkaew Sinam

doi:10.3390/ijerph17145113

Abstract

Thailand has become a popular destination for international migrant workers, particularly from Cambodia, Lao PDR, and Myanmar. However, only a fraction of these migrant workers were insured by public health insurance. The objective of this study was to apply systems thinking to explore contextual factors affecting access to public health insurance among cross-border migrants in Thailand. A group model building approach was applied. Participants (n = 20) were encouraged to share ideas about underlying drivers and barriers of migrants’ access to health insurance. The causal loop diagram and stock and flow diagram were synthesised to identify the dynamics of access to migrant health insurance. Results showed that nationality verification is an important mechanism to deal with the precarious citizenship status of undocumented migrants. However, some migrants are still left uninsured. The likely explanations are the semi-voluntary nature of the Health Insurance Card Scheme, administrative delay of the enrollment process, and resistance of some employers to hiring migrants. As a result, findings suggest that effective communication is required to raise acceptance towards insurance among migrants and their employers. A participatory public policy process is needed to create a good balance of migrant policies among diverse authorities.

Highlights

In 2018, there were about 258 million international migrants and approximately 60%were migrant workers who travelled abroad to address labour shortages in destination countries [1,2].The rise of cross-border migrants worldwide attracted political attention as reflected in the number of high-level dialogues and commitments
With the group model building (GMB) and the Causal Loop Diagramme (CLD), it is clear that the access to public health insurance among migrants in Thailand is a complex matter
The issue is deeply involved and interplays with the concept of economic necessity and national security. It is inextricably linked with many other measures that are not the mandate of the health sector, the nationality verification (NV) process and the issuance of a work permit

Summary

Introduction

In 2018, there were about 258 million international migrants and approximately 60%. Were migrant workers who travelled abroad to address labour shortages in destination countries [1,2]. The rise of cross-border migrants worldwide attracted political attention as reflected in the number of high-level dialogues and commitments. The health of migrants and refugees was raised in the 2017 World Health Assembly (WHA) Resolution. 70.15, ‘Promoting the Health of Refugees and Migrants’ [4]. According to this Resolution, Member States are urged to strengthen international cooperation regarding the health of refugees and migrants [5]. The provision of necessary health-related assistance through bilateral and international cooperation was recommended for countries with a high influx of refugees and migrants.

Objectives

Methods

Discussion

Conclusion