Including undocumented migrants in universal health coverage: a maternal health case study from the Thailand-Myanmar border

BMC Health Services Research

Kulyapa Yoonut¹  Wichuda Jiraporncharoen¹  Chaisiri Angkurawaranon¹  Rojanasak Thongkhamcharoen²  Trygve Ottersen³  Naomi Tschirhart⁴ 

[1] Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand;Department of Social Medicine, Maesot General Hospital, Sripanich Road, Maesot, Tak, Thailand;Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway;Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway;Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway;Interdisciplinary School of Health Sciences, Department of Health Sciences, University of Ottawa, Ottawa, Canada;Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand;

关键词: Universal health coverage;    Health insurance;    Migrant;    Undocumented;    Maternal health;    Emergency obstetrical care;    Labor;   

DOI  :  10.1186/s12913-021-07325-z

来源: Springer

【 摘 要 】

BackgroundMany countries aspiring to achieve universal health coverage struggle with how to ensure health coverage for undocumented migrants. Using a case study of maternal health care in a Thailand-Myanmar border region this article explores coverage for migrants, service provision challenges and the contribution of a voluntary health insurance program.MethodsIn 2018 we interviewed 18 key informants who provided, oversaw or contributed to maternal healthcare services for migrant women in the border region of Tak province, Thailand.ResultsIn this region, we found that public and non-profit providers helped increase healthcare coverage beyond undocumented migrants’ official entitlements. Interview participants explained that Free and low-cost antenatal care (ANC) is provided to undocumented migrants through migrant specific clinics, outreach programs and health posts. Hospitals offer emergency birth care, although uninsured migrant patients are subsequently billed for the services. Care providers identified sustainability, institutional debt from unpaid obstetric hospital bills, cross border logistical difficulties and the late arrival of patients requiring emergency lifesaving interventions as challenges when providing care to undocumented migrants. An insurance fund was developed to provide coverage for costly emergency interventions at Thai government hospitals. The insurance fund, along with existing free and low-cost services, helped increase population coverage, range of services and financial protection for undocumented migrants.ConclusionsThis case study offers considerations for extending health coverage to undocumented populations. Non-profit insurance funds can help to improve healthcare entitlements, provide financial protection and reduce service providers’ debt. However, there are limits to programs that offer voluntary coverage for undocumented migrants. High costs associated with emergency interventions along with gaps in insurance coverage challenge the sustainability for NGO, non-profit and government health providers and may be financially disastrous for patients. Finally, in international border regions with high mobility, it may be valuable to implement and strengthen cross border referrals and health insurance for migrants.

【 授权许可】

CC BY