Abstract
The aim is to provide policy decision-makers with relevant information for incorporating mental health services into the benefits package under Health Insurance Card Scheme (HICS) for migrants and the Health Insurance for People with Citizenship Problems in Thailand. This study utilizes both quantitative and qualitative research methodologies, encompassing (1) a review literature about the benefits of mental health services for migrants and stateless people in foreign countries; (2) a quantitative study is divided into two parts. Part 1 investigates the accessibility of mental health services for migrants and stateless psychiatric patients in Thailand. This involves analyzing data from the Ministry of Public Health's Health Data Center (HDC) for the period between 2018 and 2022, with a specific focus on nationals from Cambodia, Myanmar, Vietnam, and Lao PDR who utilized the Health Insurance Card Scheme (HICS) and the Health Insurance Scheme for stateless people. Part 2 examines the prevalence of mental health patients, access to health services, and the quality of life of migrants and stateless people within communities. The survey is conducted in four provinces: Samut Sakhon, Ranong, Tak, and Chiang Rai, using interviews translated into four languages and conducted with interpreters for face-to-face data collection. (3) The analysis of budgetary impacts of providing mental health services to migrants and stateless people, and (4) a qualitative study consisting of in-depth interviews and focus group discussions with policymakers, healthcare providers, and healthcare recipients. The aim is to inquire about the readiness of hospitals providing mental health services to migrants and stateless psychiatric patients (personnel, tools, and medications for mental health service), identify encountered challenges, and assess the practical feasibility of the proposed comprehensive benefits package. Additionally, policy recommendations are provided based on the findings. The study finding; 1) The mental health care benefits for migrants and stateless psychiatric patients in Southeast Asia countries are largely not comprehensive, with only Qatar providing full coverage (as it has a lower-skilled migrant workers). Moreover, there are efforts to provide assistance, support, raise awareness, and offer relevant counselling services for the mental health of migrant workers from various organizations, including governmental, social, and non-profit organizations. As in Singapore, Malaysia, and Australia, where covers both psychiatric consultations at the clinic and through telemedicine. Nevertheless, there is still a cost to use the service while high-income countries like Qatar covers free health and medical services to long-term expatriates with a residence permit, as well as workers with low skills that have a Haman Health Card. 2) During the period from 2018 to 2022, regarding the access to services for migrants and stateless psychiatric patients, it was found that a total of 4,929 psychiatric patients sought services at hospitals. When considering the number of services uses per instance, a total of 13,159 service uses were recorded. This included 207 inpatient services (IPD) and 12,952 outpatient services (OPD). The most frequent service utilization was in the category of diseases diagnosed with the F1 code (Abnormalities of psychological and behavioral functions due to substance use) with a total of 4,928 instances (37.45%). Regarding the treatment entitlement of those seeking services, the majority were self-payers with 10,236 instances (77.79%), followed by the Health Insurance Card Scheme for migrant workers issued by the Ministry of Public Health with 1,924 instances (14.62%), and Health Insurance for People with Citizenship Problems (HIS-PCP) with 999 instances (ท.99) (7.59%). Analyzing the service expenditure over the 5-year period, the total service cost (cost of service) was 1 0 ,5 7 2 ,8 9 1 .5 Baht, with an additional 5,313,141.1 Baht billed to patients, but the actual amount collected from patients was only 4,094,682.0 Baht. 3) Surveying the prevalence of mental health disorders and the quality of life of migrants and stateless people in four provinces, totaling 480 participants, it was found that the prevalence of mental health disorders was 24.2%, and the prevalence of anxiety disorders was 11.2%. Meanwhile, regarding the quality of life in various aspects (physical health, mental health, social relationships, and environment) of migrants and stateless people, the average quality of life score was at a moderate level (mean score 82.26 + 13.60 SD). 4) The budget prediction reveals that the allocated budget for compensating hospitals which selling health insurance cards under the Health Insurance Card Scheme for migrant workers, over a period of 5 years, is 1,822,059.90 Baht (specifically for Cambodian, Lao PDR, Myanmar, and Vietnam). Additionally, the Health Insurance for People with Citizenship Problems (ท99) set aside for compensating hospitals over the same 5-year period is 12,493,137.11 Baht. 5) The perspective of healthcare providers suggests that there is a possibility of enhancing mental health benefits in the Health Insurance Card Scheme for migrants and the Health Insurance Scheme stateless people in Thailand. This is because all hospitals provide services to migrants and stateless people, emphasizing equality in treatment rights as with the Universal Health coverage. Summary of the findings from this study indicate that there is a possibility of enhancing mental health benefits in The Health Insurance Card Scheme for migrants and the Health Insurance for People with Citizenship Problems in Thailand. This is supported by the following reasons: 1) In practical terms, most hospitals already provide mental health services to both groups of patients, even though it may not be covered by the existing benefits. 2) The cost of service during the period from 2018 to 2022 amounted to a total of 15,042,083.7 Baht. Additionally, there was an additional amount charged to patients after the main expenses, totaling 5,387,310.97 Baht. This indicates that there are certain items of expenditure for which hospitals can make claims even if the services are not covered by health insurance. 3) In terms of budget burden for the services provided over a 5-year period, it is only 1,822,059.90 Baht for the Health Insurance Card Scheme funding and 12,493,137.11 Baht for the Health Insurance for People with Citizenship Problems. 4) Increasing these benefits is likely to improve access to mental health services and enhance the quality of life for psychiatric patients in Thailand. Good mental health contributes to sustainable well-being, aligning with the Sustainable Development Goals (SDG).
