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

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

doi:10.3390/ijerph17145113

Cited by 18 publications

(35 citation statements)

References 26 publications

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“…Pregnant women with low wealth status probably do not have a fixed source of income. A pregnant woman or her husband has a type of job that is not permanent, making it difficult to set aside income to pay health insurance premiums [18,20,37,38].…”

Section: Discussionmentioning

confidence: 99%

The determinant of health insurance ownership among pregnant women in Indonesia

2021

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Background Health insurance ownership is one indicator of the readiness of pregnant women for the delivery process. The study aimed to analyze the determinants of health insurance ownership among pregnant women in Indonesia. Methods The study population was pregnant women in Indonesia. The study involved 2542 pregnant women in Indonesia. The variables analyzed included type of place of residence, age group, education level, employment status, marital status, parity, wealth status, and know the danger signs of pregnancy. In the final step, the study employed binary logistic regression to explain the relationship between health insurance ownership and predictor variables. Results The results show that pregnant women with higher education were 3.349 times more likely than no education pregnant women to have health insurance. Pregnant women with wealth status in the middle category were 0.679 times the poorest pregnant women to have health insurance. Meanwhile, the richest pregnant women had 1.358 times more chances than the poorest pregnant women to have health insurance. Grande multiparous pregnant women were 1.544 times more likely than primiparous pregnant women to have health insurance. Pregnant women who know the danger signs of pregnancy were 1.416 times more likely than pregnant women who don’t see the danger signs of pregnancy to have health insurance. Conclusions The study concluded that four variables, including education level, wealth status, parity, and knowledge of the danger signs of pregnancy, were significant determinants of health insurance ownership in Indonesia.

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Section: Discussionmentioning

confidence: 99%

The determinant of health insurance ownership among pregnant women in Indonesia

2021

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“…The Social Security Act 2015 [ 17 ] indicates that employers must have their wage deducted in the same proportion of migrants as part of payroll contribution. However, a qualitative study by Kunpeuk et al, pointed out that some employers elude the law by not contributing to payroll tax, and this meant that their migrant workers were uninsured [ 18 ]. Aside from this breach of law by employers, paying for health insurance premiums was avoided by some migrant employees, especially those in good health who found that insurance provided little benefit compared with their health needs [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, a qualitative study by Kunpeuk et al, pointed out that some employers elude the law by not contributing to payroll tax, and this meant that their migrant workers were uninsured [ 18 ]. Aside from this breach of law by employers, paying for health insurance premiums was avoided by some migrant employees, especially those in good health who found that insurance provided little benefit compared with their health needs [ 18 ]. This situation was also found in China where uninsured migrants expressed that they did not want to join a health insurance plan because paying for health services by out-of-pocket was a better approach economically than making regular payments [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Spatial Panel Data Analysis on the Relationship between Provincial Economic Status and Enrolment in the Social Security Scheme amongst Migrant Workers in Thailand, 2015–2018

Viriyathorn

Phaiyarom

Rueangsom

et al. 2021

IJERPH

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Background: Thailand has a large flow of migrants from neighbouring countries; however, the relationship between economic status at the provincial level and the insured status of migrants is still vague. This study aimed to examine the association between provincial economy and the coverage of the Social Security Scheme (SSS) for migrants. Methods: Time-series data were analysed. The units of analysis were 77 provinces during 2015–2018. Data were obtained from the Social Security Office (SSO). Spatiotemporal regression (Spatial Durbin model (SDM)) was applied. Results: Migrant workers were mostly concentrated in Greater Bangkok, the capital city and areas surrounding it, but SSS coverage was less than 50%. However, the ratio of insured migrants to all migrants seemed to have positive relationship with the provincial economy in SDM. The ratio of insured migrants to all migrants was enlarged in all regions outside Greater Bangkok with statistical significance. Conclusions: Low enforcement on employment law in some areas, particularly Greater Bangkok, can result in lesser SSS coverage. The provincial economic prosperity did not guarantee large SSS coverage. Interventions to ensure strict insurance enrolment are required.

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“…Both MOU and OSS migrants need to pass a health screening for serious communicable diseases, such as tuberculosis, filariasis, and elephantitis, before being issued a work permit [ 19 ]. The majority of MOU migrants undertake the health check in Thailand in private hospitals (with certified standards as approved by the Hospital Accreditation System, or the Joint Commission International or International Standardization Organisation) [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…Due to the fact that Thailand shares a very long border with its neighbouring countries, the influx of undocumented migrants still continues [ 3 ]. Although the government attempts to address this problem by various means (including the OSS and the MOU), it seems that the nationality verification (NV) process still faces many challenges, and the volume of undocumented migrants is believed to be underestimated [ 20 ]. Since 2020, COVID-19 and its impact have put pressure on the global economy.…”

Section: Introductionmentioning

confidence: 99%

Access to Healthcare and Social Protection among Migrant Workers in Thailand before and during COVID-19 Era: A Qualitative Study

Kunpeuk

Julchoo

Phaiyarom

et al. 2022

IJERPH

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Thailand is a popular host nation for international migrant workers, particularly those from Cambodia, Lao PDR, and Myanmar. Thailand has introduced approaches to protect their rights for health and social welfare, using various mechanisms over many years. However, the implementation of these policies is dynamic and has been influenced by national security, economic necessity, and public health concerns. The aim of this study was to explore how Thailand designs and implements health and social welfare policies for migrants in Thailand, both before and during COVID-19. A qualitative analysis was used alongside interviews with 18 key informants in various sectors in this field. Thematic coding was applied. Results show that there were seven key themes emerging from the analysis, including: (i) sustainability of the HICS; (ii) people dropping out from the Social Security Scheme (SSS); (iii) quality of health screening in the Memorandum of Understanding (MOU) migrants; (iv) health screening problems and state quarantine management in response to COVID-19; (v) managing the migration quota and dependency on migrant workers; (vi) influx of migrants in the backdrop of COVID-19; and (vii) poor living conditions of migrants and the impact of COVID-19. The majority of interviewees agreed that undocumented migrants is a critical concern that impedes access to migrants’ health and social welfare. This situation was especially pronounced during the second wave of COVID-19 in Thailand, which took hold in migrant communities. In the short term, the poor living conditions of migrants urgently need to be addressed in order to contain and mitigate this crisis. In the long term, there needs to be an improved health system design that includes migrants, regardless of their immigration status. This requires intersectoral policy coherence, including the hastening of nationality verification to sustainably mitigate undocumented migrants.

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

Cited by 18 publications

References 26 publications

The determinant of health insurance ownership among pregnant women in Indonesia

The determinant of health insurance ownership among pregnant women in Indonesia

Spatial Panel Data Analysis on the Relationship between Provincial Economic Status and Enrolment in the Social Security Scheme amongst Migrant Workers in Thailand, 2015–2018

Access to Healthcare and Social Protection among Migrant Workers in Thailand before and during COVID-19 Era: A Qualitative Study

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