London School of Hygiene & Tropical Medicine

'Health insurance card scheme' for cross-border migrants in Thailand: Responses in policy implementation and outcome evaluation

Brief:
The primary aim of this thesis is to help improve access to care of cross-border migrants in Thailand through the evaluation of health care providers' and relevant stakeholders’ responses to the current ‘Health Insurance Card Scheme’ (HICS) policy. The study took place in Ranong province. The main objectives are: (1) to explore how the HICS evolved over time in light of the change in surrounding policies, (2) to investigate the responses of local officers and relevant stakeholders towards the HICS and to examine how the policy affects migrants' health-seeking behaviour in the real setting, (3) to evaluate the HICS’ outcome in terms of utilisation volume and financial implications for its insurees, and (4) to provide policy recommendations. Mixed-methods approach was employed. In-depth interviews, document review and facility-based data analysis were undertaken. Thematic analysis and econometric models were applied.

The findings revealed conflicting ministerial objectives and gaps with both inter- and intra-ministerial policies. In addition, the policy objectives were not clear from the outset. While the health sector aimed to insure ‘all’ migrants, this faced constraints from the security and economic authorities which focused only on migrant workers who registered with the government. Besides, in reality, the boundary between ‘legal’ and ‘illegal’ migrants was very fluid. Though the current government attempted to address policy gaps by overhauling the HICS and instigating the One Stop Service, it is difficult to claim that the deep-rooted implementation problems were resolved.

This situation was even more complicated at the local level as frontline health officers adapted the policy in various ways, and occasionally made the policy diverge from its initial objectives. For example, a local facility created its own rule to prohibit sick migrants from buying the insurance. In the users’ view, cost of registration was a significant barrier in obtaining the insurance card, and a reliance on private intermediaries (both legal and illegal) to help them obtain the insurance card was not uncommon. However, the HICS still had some merits in reducing out-of-pocket payment, and helping increase utilisation of its insurees. Both macro- and micro policy recommendations are provided, including integrating the information systems for migrants amongst government authorities.
 
About the speaker:
Rapeepong Suphanchaimat is a scholar from International Health Policy Programme (IHPP), Ministry of Public Health of Thailand. After graduating from medical school, he spent three years of clinical practice in the Thai-Myanmar border, then he joined the health systems research fellowship programme at IHPP. His interest is mainly related to the areas of health policy and systems research, econometrics, and mixed-methods.

In recent years, he has expanded his research’s population scope to non-Thai populations, including undocumented migrants and stateless people in Thailand. Now he is pursuing his degree at LSHTM. His thesis is about the responses in the existing insurance policy for cross-border migrants in Thailand and the evaluation of the insurance in terms of utilisation volume and out-of-pocket payment on its beneficiaries.