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การตอบสนองของนโยบายและผลลัพธ์ของบัตรประกันสุขภาพคนต่างด้าวและผู้ติดตามในประเทศไทย

ระพีพงศ์ สุพรรณไชยมาตย์; วีระศักดิ์ พุทธาศรี; คนางค์ คันธมธุรพจน์;
Date: 2559-08-30
Abstract
At the present age, health of migrants is an issue on a spotlight in many countries. This is due to a rapid economic growth and a swift change in communication and transportation technology around the globe. Thailand also has a huge demand on migrant labour, and the recent governments always paid much attention on this matter. In 2004, the government introduced 'Health Insurance Card' for cross policy for cross-border migrants, who were not covered by the Social Health Insurance (SHI). The insurance was regulated by the Health Insurance Group (HIG) under the Ministry of Public Health (MOPH), and was tied with the nationality verification process (managed by the Ministry of Interior (MOI)) and the registration for legitimate work permit (managed by the Ministry of Labour (MOL)). So far, there has been very few studies exploring the management and performance of the insurance. The aforementioned reason thus becomes the objectives of this study. Study objectives The study ahas 4 main objectives: (1) to systematically review evidence of the management of health insurance and the attitudes of healthcare providers in healthcare practice for migrants from international literature, (2) to explore attitudes of local healthcare providers and migrant patients on the operation of health insurance policy for migrants in the real setting, (3) to assess the effect of the insurance on volume of use and out of pocket payment (OOP) of migrants, relative to the uninsured migrants and Thai beneficiaries, and (4) to synthesise policy recommendations for better management of the health insurance policy for migrants in the future. Methodology Ranong province was served as study site. The study employed both qualitative and quantitative methods. Data collection techniques were composed of: (1) a systematic review, (2) in-depth interviews with 24 local healthcare providers and 11 migrant patients, and (3) the investigation of routine faciliy-based data. Thematic analysis was used for qualitative data analysis and econometric models were used for quantitative data analysis. Results The management of health insurance policy for cross-border migrants in Thailand was quite complex. The policy was also open to all types of migrants. However, there has been a number of operational problems and challenges because: (1) In theory, the process of buying the insurance card is tightly linked with the acquisition of legitimate residence permit, managed by the MOI, and the registration of work permit, regulated by the MOL. In fact, the enforcement of such regulation is ineffective. A large number of migrants were not registered for the work permit. In addition, the registration policies (by the three ministries) were inconsistent and frequently changed over time, (2) The policy does not fir the local context of Ranong province since the province has a long border connecting to Myanmar, which renders the cross-border control difficult. Many migrants enter the country for various purposes rather than seeking for jobs. Thus, some migrants relied on "brokers" to make them accessible to the registration process (in order to acquire the work permit and then be eligible to buy the insurance card), (3) The MOPH does not have sufficient institutional capacity in regulating, and monitoring the performance of each facility in implementing the insurance scheme. This problem is intermingled with inadequate communication between the MOPH and the local authorities, (4) Many healthcare providers viewed that the insurance is always running deficit. This is because the healthy migrants are not willing to buy the card, and the pooling size is too small (the card revenue is collected at each individual facility). Accordingly, some health facilities adapt the policy by various means, such as allowing only healthy migrants to buy the card, andimposing a lag time between the starting valid day and the time of buying the card, (5) One of adaptive measures of health facility is hiring migrants to work as 'migrant health workers (MHW)', serving as bridging personnel between migrants in nearby communities and the local providers. However, the sustainability of this measure is questionable due to the limitation of law on the work of migrants, which still disallows official authorities to hire migrants as official employees. Many healthcare providers hence finds a way out by hiring migrants as their house maids, but in fact these migrant employees are still working as MHWs. The quantitative analysis shows that the utilisation rate of migrants was about 3-4 folds was low as the Thai beneficiaries, covered by the Universal Coverage (UC) scheme. The absolute effect of having the card (after adjusting all covariates) did not significantly increase the volume of use of the patients, who ever visited a facility. The key factor of increasing the use is clinical factor that is a patient's disease status per se. Moreover, the card was proved to reduce the OOP of migrants at point of care by 157-756 Baht per outpatient visit and 2,706 Baht per inpatient visit.
Copyright ผลงานวิชาการเหล่านี้เป็นลิขสิทธิ์ของสถาบันวิจัยระบบสาธารณสุข หากมีการนำไปใช้อ้างอิง โปรดอ้างถึงสถาบันวิจัยระบบสาธารณสุข ในฐานะเจ้าของลิขสิทธิ์ตามพระราชบัญญัติสงวนลิขสิทธิ์สำหรับการนำงานวิจัยไปใช้ประโยชน์ในเชิงพาณิชย์
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HSRI Knowledge BankDashboardCommunities & CollectionsBy Issue DateAuthorsTitlesSubjectsThis CollectionBy Issue DateAuthorsTitlesSubjectsSubjectsการบริการสุขภาพ (Health Service Delivery) [619]กำลังคนด้านสุขภาพ (Health Workforce) [99]ระบบสารสนเทศด้านสุขภาพ (Health Information Systems) [286]ผลิตภัณฑ์ วัคซีน และเทคโนโลยีทางการแพทย์ (Medical Products, Vaccines and Technologies) [125]ระบบการเงินการคลังด้านสุขภาพ (Health Systems Financing) [158]ภาวะผู้นำและการอภิบาล (Leadership and Governance) [1281]ปัจจัยสังคมกำหนดสุขภาพ (Social Determinants of Health: SDH) [228]วิจัยระบบสุขภาพ (Health System Research) [28]ระบบวิจัยสุขภาพ (Health Research System) [20]

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