Ensuring access to healthcare for all

Ensuring access to healthcare for all

Migrant workers stand in front of a closed shrimp market during the coronavirus disease in Samut Sakhon province back in December 2020.  REUTERS
Migrant workers stand in front of a closed shrimp market during the coronavirus disease in Samut Sakhon province back in December 2020.  REUTERS

The spread of Covid-19 in Thailand showed how no one is safe until everyone is safe. Indeed, it was reported that the outbreak which began in the country back in December 2020, originated in migrant worker communities in Samut Sakhon, which faced challenges in accessing healthcare services.

Public health authorities broadly recognised the situation and have since reinforced initiatives to improve access to healthcare for all migrants in Thailand, including, for examplem, by passing Resolution 14.2 at the National Health Assembly in December 2021, on the Protection of Equitable Access to Health Services for Specific Populations in Crises.

Over the past few decades, Thailand has made incredible progress in extending access to free healthcare for Thai citizens. Currently, all Thais have access to free healthcare under different health protection schemes according to the National Health Security Act of 2002. However, ensuring access to care for all migrant workers and their dependents has proved to be more challenging.

It is estimated that up to 4 million migrants work or live in Thailand. In 2022, 87% of the 2.5 million legally registered migrant workers were effectively covered by health insurance. While in principle all registered migrants should be enrolled under the Social Security Scheme of the Ministry of Labour, or the Migrant Health Insurance of the Ministry of Public Health, some migrant workforces were never enrolled or weren't able to maintain coverage. In addition, it is estimated that 1 million migrant workers and their dependents in the country are unregistered, and they remain ineligible for inclusion under government insurance.

If they fall sick, migrants who are uninsured can still seek healthcare in government hospitals or private clinics, but they need to pay all costs incurred. In some instances, government hospitals absorb the cost of care for uninsured migrants who can no longer pay, but as a result, many hospitals in areas that host large numbers of migrant workers face budget deficits. Furthermore, uninsured migrants are also often worried that they can be reported to immigration and deported when they seek healthcare in government facilities, and prefer to self-treat until they become severely ill. While they wait, their illnesses can spread.

It is estimated that migrant workers contribute between 4.3 and 6.6% to Thailand's Gross Domestic Product, and the country ranks 17th in the world for the number of employed foreign workers. Several sectors of the economy depend heavily on employment of migrants, including the marine fishing industry, construction, agriculture and domestic work. Migrants typically occupy jobs that are difficult, dirty and dangerous. Yet employment of migrants is often subject of sensitive debates in society, owing in part to the particular challenge of ensuring that all migrants on Thai soil are legally registered. Migrants are often thought to be solely responsible for failing to register. However, the process involves their employers, can be time-consuming, expensive, and requires access to information on procedures that can be complex to grasp.

Many migrants are also employed on a day-to-day basis, in different locations, which is hardly compatible for registration by a unique employer and adding to their administrative burden when changing employers. Notwithstanding these complexities, unregistered migrants are often stigmatised, and when it comes to health benefits, a portion of the public opinion holds strong feelings that taxpayers' money should not be used to provide free healthcare to migrant workers.

Over the past decades, policy forums on the topic of healthcare for migrants have abounded. Sensitive challenges are unchanged. Here, we report on a novel initiative -- the M-FUND -- that has been set up by the Dreamlopments Foundation. The M-FUND is a low-cost not-for-profit health protection scheme for migrants who lack government health insurance. Launched as a pilot project in Mae Sot in September 2017, M-FUND now operates in several districts in Tak, as well as in Sa Kaeo, Kanchanaburi, Chiang Rai, Ubon Ratchathani and Trat provinces.

Migrants interested in the scheme can enrol with M-FUND community workers, and for monthly contributions of 100 baht per person per month for the base membership plan, they will have access to quality healthcare for most diseases, up to 5,000 baht per year for outpatient services, and 45,000 baht per year, for inpatient admissions.

As of November, 200 government district and sub-district hospitals have partnered up with the project to provide healthcare services to M-FUND members. Since September 2017, as many as 69,000 migrants have joined, and more than 82,000 consultations and 12,000 admission fees covered. While this number still represents only a small proportion of the migrants who lack government health insurance, M-FUND has gathered increasing interest and satisfaction from migrants themselves, as well as some employers, and government hospitals.

"We have been partnering with M-FUND for many years now. I think it's an excellent project. Many of these immigrants come to work in Thailand. We value the M-FUND project and thus, are giving full cooperation and support," said Anuchar Klongyut, Deputy Director of Khok Sung Hospital, one of the partner government hospitals in Sa Kaeo.

M-FUND provides many case studies that show problems that migrant workers face in terms of finding medical coverage.

Dao, a 65-year-old Burmese woman living in Mae Sot, is ineligible for government insurance. In February, she was able to register under M-FUND. After only 3 months, she sustained a leg injury. Under M-FUND coverage, she received healthcare services in Mae Sot Hospital, but the doctors suspected an unusual leg fracture and upon further investigations, Dao was diagnosed with a cancer that had extended to her bones. Although she was able to receive further care under M-FUND, the cancer was too advanced, and in July 2023, Dao returned to her hometown in Myanmar and later passed away at home. Dao was able to receive the health protection that she needed, under M-FUND, but it was too late.

Nop, an agricultural business owner in Mae Sot district, employs 20 Burmese workers. While waiting to register his workers, he learned about the M-FUND project, and decided to enroll them in the scheme, and to pay for their monthly contribution. He also included their family members.

He said: "The matter of hiring migrant workers is a sensitive issue in Thailand. I try to register all my employees. However, in some cases, there are limitations, and it can take time. I decided to enrol my migrant workers along with their family members. Because when they and their children have health insurance, they have peace of mind. Then they will be able to work to their full potential without worries."

Dreamlopments Foundation humbly acknowledges the tiny contribution that M-FUND has made so far by covering only 69,000 members out of more than 1 million migrants who still lack government health insurance. In policy forums, the foundation has been among those who advocate for consideration by policy-makers of the individual value and public health benefits that would come from giving access to free healthcare for all migrants living in Thailand, regardless of registration status, on the basis of the contribution made by all migrant workers to developing the economy, recognition that value-added taxes are paid by all migrants on some goods and services, and finally the health risks that inevitably increase for everyone, when 1 million people still lack prompt access to healthcare.

Dr Nicolas Durier is Founder & General Director, Dreamlopments Foundation. The article marks International Migrants Day which falls on Dec 18.

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