Understanding the problem of access to public health insurance schemes among cross-border migrants in Thailand through systems thinking

Abstract Background The migrant health agenda in Thailand has been shaped by domestic and international pressures relating to social and economic dimensions. 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. This study aimed to apply systems thinking to explore contextual factors affecting access to public health insurance arrangements among cross-border migrants in Thailand. Methods A group model building (GMB) was applied to explore contextual factors and their interplay influencing access to health insurance for migrants in Thailand. Participants (n = 20) were encouraged to share ideas about underlying drivers and barriers of access to health insurance among migrants. Triangulation was performed with the document review. The findings were analysed by a thematic approach. The causal loop diagramme (CLD) and stock and flow diagramme (SFD) were synthesised to identify the dynamics relating to access to migrant health insurance. Results Nationality verification was recognised as one of the most important mechanisms that the Thai government exercises to deal with the precarious citizenship status of undocumented migrants. Also, it is the key function that links economic necessity, national security, and public health concerns. In the formal sector, the government plays an important role in the enrollment of migrant workers in the Social Security Scheme (SSS) run by the Ministry of Labour (MOL). In the informal sector, the Health Insurance Card Scheme (HICS) managed by the Ministry of Public Health (MOPH) is the key option for migrant workers. However, some migrants are still left uninsured. The likely explanations are the semi-voluntary nature of the HICS, administrative delay of the enrollment process, and the resistance of some employers to hiring migrants. Conclusions Effective communication is required to raise awareness and acceptance towards the insurance among migrants and their employers. This needs cohesive effort from all stakeholders in society including the government, the business sector, civic groups, and even migrant communities. A public policy participatory process is needed to create a good balance of migrant policies among diverse authorities.

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17145113 ◽

2020 ◽

Vol 17 (14) ◽

pp. 5113

Author(s):

Watinee Kunpeuk ◽

Pard Teekasap ◽

Hathairat Kosiyaporn ◽

Sataporn Julchoo ◽

Mathudara Phaiyarom ◽

...

Keyword(s):

Public Health ◽

Health Insurance ◽

Systems Thinking ◽

Migrant Workers ◽

Model Building ◽

Public Health Insurance ◽

Flow Diagram ◽

Group Model ◽

Undocumented Migrants ◽

Cross Border

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.

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The Effect of Cross-Border Healthcare on Quality, Public Health Insurance, and Income Redistribution

SSRN Electronic Journal ◽

10.2139/ssrn.2766847 ◽

2016 ◽

Cited By ~ 2

Author(s):

Hiroshi Aiura

Keyword(s):

Public Health ◽

Health Insurance ◽

Income Redistribution ◽

Public Health Insurance ◽

Cross Border

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Policy Literacy, Barriers, and Gender Impact on Accessibility to Healthcare Services under Compulsory Migrant Health Insurance among Myanmar Migrant Workers in Thailand

Journal of Environmental and Public Health ◽

10.1155/2020/8165492 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Sa Hlyan Htet Naing ◽

Sang-Arun Isaramalai ◽

Phen Sukmag

Keyword(s):

Public Health ◽

Health Insurance ◽

Migrant Workers ◽

Health Care Services ◽

Personal Data ◽

Healthcare Services ◽

Migrant Health ◽

Cross Sectional Survey ◽

Cross Sectional ◽

And Gender

Accessibility to health service and experience of healthcare are important factors for public health policymaking. The current study aimed to describe the status of accessibility and barriers to getting care as well as policy literacy among Myanmar migrant workers and ultimately to identify the predictors of accessibility to healthcare services among this population through Thailand’s Compulsory Migrant Health Insurance (CMHI). A cross-sectional survey was used to collect data from 240 Myanmar migrant workers who were 18 years or older, resided in Songkhla Province, and had Compulsory Migrant Health Insurance. The instrument was a set of questionnaires consisting of a Personal Data Form, Policy Literacy Questionnaire, Barriers to Get Care Questionnaire, and Accessibility to Healthcare Services Questionnaire. Descriptive statistics, correlation analysis, and multiple regression analysis were used to analyze data. The majority of participants had a high level of policy literacy (36.3%), barriers to get care (34.2%), and accessibility to health care services (35.8%). Policy literacy (β = 0.35, p < 0.001 ), barriers to get care (β = −0.32, p < 0.001 ), and gender ( p < 0.001 ) were significant predictors of accessibility to healthcare services and could explain 43.2% of the total variance. To increase the accessibility to healthcare services among migrant workers with Compulsory Migrant Health Insurance, public health policymakers are recommended to cooperate more with healthcare staff and the workers’ employers to enhance the distribution of information about the health insurance to decrease barriers to get care.

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Delivering Public Health Insurance Through Private Plan Choice in the United States

The Journal of Economic Perspectives ◽

10.1257/jep.31.4.3 ◽

2017 ◽

Vol 31 (4) ◽

pp. 3-22 ◽

Cited By ~ 5

Author(s):

Jonathan Gruber

Keyword(s):

Public Health ◽

United States ◽

Health Insurance ◽

Low Income ◽

Private Insurance ◽

The United States ◽

Public Health Insurance ◽

Market Failures ◽

Wide Range ◽

The Government

The United States has seen a sea change in the way that publicly financed health insurance coverage is provided to low-income, elderly, and disabled enrollees. When programs such as Medicare and Medicaid were introduced in the 1960s, the government directly reimbursed medical providers for the care that they provided, through a classic “single payer system.” Since the mid-1980s, however, there has been an evolution towards a model where the government subsidizes enrollees who choose among privately provided insurance options. In the United States, privatized delivery of public health insurance appears to be here to stay, with debates now focused on how much to expand its reach. Yet such privatized delivery raises a variety of thorny issues. Will choice among private insurance options lead to adverse selection and market failures in privatized insurance markets? Can individuals choose appropriately over a wide range of expensive and confusing plan options? Will a privatized approach deliver the promised increases in delivery efficiency claimed by advocates? What policy mechanisms have been used, or might be used, to address these issues? A growing literature in health economics has begun to make headway on these questions. In this essay, I discuss that literature and the lessons for both economics more generally and health care policymakers more specifically.

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Changing Origins of Inequalities in Access to Health Care Services in Turkey: From Occupational Status to Income

New Perspectives on Turkey ◽

10.1017/s0896634600001886 ◽

2013 ◽

Vol 48 ◽

pp. 55-77 ◽

Cited By ~ 22

Author(s):

Volkan Yilmaz

Keyword(s):

Public Health ◽

Health Care ◽

Health Insurance ◽

Health Care System ◽

Access To Health Care ◽

Health Care Services ◽

Occupational Status ◽

Public Health Insurance ◽

Care Services ◽

Access To Health

AbstractHealth care reforms have always been critical political arenas within which the parameters of citizens' access to health care services and thus the new terms of social bargain that backs social policies are negotiated. Despite the relative success of Turkey in establishing public health insurance schemes and developing a public capacity for health care service delivery since the late 1940s, Turkey's health care system has largely failed to institute equality of access to health care services. With the promise of abolishing the inequalities, the ruling Justice and Development Party (AKP) launched Turkey's Health Transformation Program in 2003. Since then, Turkey's health care system has been undergoing a significant transformation. On the one hand, with the unification of all public health insurance schemes under a compulsory universal health insurance scheme and the equalization of benefit packages for all publicly insured, the program has succeeded in abolishing the occupational status-based inequalities in access to health care services. On the other, this article suggests that the program has changed the main origin of inequalities in service access from occupational status to income. As the country suffers from an uneven distribution of income, it is argued that these incomebased inequalities in access pose a significant threat to the realization of the social citizenship ideal in Turkey.

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HAS REFORM OF THE SYSTEM OF PUBLIC HEALTH INSURANCE FOR THE POOR IN INDONESIA INCREASED HEALTH INEQUALITY? CONSIDERING DIFFERENT ACCESSIBILITY OF PUSKESMAS

INFO ARTHA ◽

10.31092/jia.v3i2.584 ◽

2019 ◽

Vol 3 (2) ◽

pp. 101-118

Author(s):

Rinasih Rinasih

Keyword(s):

Public Health ◽

Health Insurance ◽

Health Inequality ◽

Public Health Insurance ◽

Public Health Care ◽

The Poor ◽

The Government ◽

Using Data ◽

Public Health Insurance System ◽

The Village

Though the Indonesian government reformed its public health insurance system for the poor in 2008, the country still faces challenges with the disparity of accessibility to primary healthcare centres (puskesmas). This study examines whether the 2008 healthcare system reforms increased health inequality of the poor. Using data from the RAND Indonesian Family Life Survey (IFLS) and The Village Potential Statistics (PODES), this study found an indication that, in the aftermath of the reforms, the gap widened in the tendency for the poor to make insurance claims depending on their level of access to healthcare centres. Therefore, to protect the poor from catastrophic out-of-pocket expenditure, besides the provision of public health insurance, the government needs to be concerned about the accessibility of public health care, which includes not only the provision of direct healthcare infrastructure, but also improving road access conditions.

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