Abstract
This study aims to study the feasibility of medical reimbursement for critical
emergency treatment under the “Universal Coverage for Emergency Patients (UCEP)” system
for the migrant health insurance system and the health insurance system for stateless
people by the Ministry of Public Health, Thailand. The results will provide information for
policy decision-making in developing a reimbursement system for critical emergency
treatment under the UCEP system, employing both quantitative and qualitative research
designs. Data collection consisted of four steps as follows: 1) Literature Review: An
examination of the laws, scope, and features of providing critical emergency services for
migrants and stateless people in foreign countries. 2) Synthesis of Secondary Data: Analysis
of secondary data on access to critical emergency services from the health database of the
Information and Communication Technology Center, Ministry of Public Health, covering the
period from 2018 to 2023 (3) Budget impact estimation; and (4) qualitative study with indepth interviews conducted in 4 provinces, Delphi survey among experts, and policymaker
discussions. The results of the study are as follows.
1) Laws and features of providing emergency critical services for migrant and
stateless people in Foreign Countries
The review of laws and emergency care models for foreign workers and individuals
with status and rights issues, both domestically and internationally, including Singapore,
Malaysia, Japan, the United Kingdom, and France, highlights variations in service models and
related regulations across these countries. The healthcare systems examined can be
categorized into two primary types; (i) Public health insurance systems: These systems vary
based on the membership type of each fund. The National Health Service (NHS) system
relies primarily on tax funding (United Kingdom), while social security systems are funded by
contributions from employers and employees (Malaysia, Japan), with the government
contributing as well (France). (ii) Private health insurance systems: There are two forms:
Mandatory insurance under legal requirements (Singapore, Malaysia), where employers pay
the insurance premiums (Singapore, Malaysia), and Voluntary insurance, where participation
is optional and not mandated by law (France, United Kingdom), with funding coming from
private premiums. In Thailand, the mandatory health insurance system only applies to
foreign workers in professions covered under social security. For other professions not
covered by social security, voluntary health insurance is available through the Ministry of
Public Health. In terms of service coverage, many countries provide basic healthcare,
inpatient and outpatient care, and critical emergency services. Health insurance systems in
these countries typically cover 70-100% of medical expenses, although some countries
impose limits on coverage or require co-payment. In Thailand, only the social security system
covers cases of critical emergency care..
2) Access to emergency critical services for migrants and Stateless people (2018-
2023)
Between 2018 and 2023, migrants and stateless individuals sought emergency critical
services at hospitals a total of 9,823 times. In terms of service utilization by nationality,
Burmese nationals accounted for most cases, with 5,776 visits (58.80%), followed by
Cambodians with 2,452 visits (24.96%), Laotians with 1,421 visits (14.47%), and Vietnamese
with 174 visits (1.77%). The total cost of these services across all treatment categories
amounted to 25,556,886.40 Thai Baht (THB), with the amount charged to patients after
deducting reimbursable expenses being 8,708,602.69 THB. Of this, the migrant health
insurance scheme accounted for a total service fee of 1,299,319.95 THB, with 101,472.40
THB charged to patients after deductions. The average service fee per visit in 2018 and 2023,
calculated from 43 files, was 4,259.64 THB per visit. In contrast, the average service fee from
the NHSO database was 35,089.08 THB per visit.
3) Budget Forecast for Hospital Compensation Over the Next Five Years
The budget forecast for compensating hospitals over the next five years is divided
into two scenarios: (i) Public Hospitals: If the government invests in providing services to
foreign patients insured with the Ministry of Public Health, the projected budget will range
from 366,329.04 to 553,753.20 THB (using the average service fee from the Health Data
Center, HDC, of 4,259.64 THB per visit) or approximately 3,017,660.88 to 4,561,580.4 THB
(using the NHSO average service fee of 35,089.08 THB per visit). If this investment is only for
stateless individuals, the projected budget will be 89,452.44 to 93,712.08 THB (HDC average)
or approximately 350,890.80 to 385,979.88 THB (NHSO average). (ii) Private Hospitals: If the
government invests in providing services to foreign patients insured with the Ministry of
Public Health for use in private hospitals, the projected budget would range from 850,376.84
to 1,285,453.36 THB. For individuals with status and rights issues, the required budget would
be 1,058,026.99 to 1,176,684.23 THB. (iii) Service providers' perspectives on
reimbursement feasibility for emergency and critical illnesses under the UCEP System
Service providers expressed that it is feasible to offer emergency medical services under the
Universal Coverage for Emergency Patients (UCEP) system for both the migrant health
insurance system and the health insurance for stateless individuals managed by the Ministry
of Public Health. This is possible due to existing regulations, such as the Hospital Act B.E.
2559, which mandates hospitals to provide emergency care to all patients in Thailand based
on human rights principles. Furthermore, a Cabinet resolution from March 28, 2017,
stipulates that hospitals should provide critical emergency care without imposing any
conditions related to medical fees. However, key informants raised concerns about the
adequacy of the budget if UCEP rights are extended to these patient groups. The migrant
health insurance fund is solely financed by the sale of health insurance cards, whereas the
health insurance fund for stateless individuals is funded by a lump-sum per capita allocation
from the government. Currently, the cost of providing services to patients exceeds the
average per capita budget allocation from the fund.
4) Delphi survey results on feasibility and future vision
The Delphi survey revealed that migrants with the Ministry of Public Health’s Migrant
Health Insurance Card and those with status and rights issues should be entitled to
emergency and critical illness services at government healthcare facilities. The National
Health Security Office (NHSO) should act as a "clearing house," ensuring payments to service
units and coordinating with related funds. Migrants without the right to treatment should be
responsible for their own expenses, or private development organizations should assume
this responsibility. The Health Economics and Health Insurance Division, Ministry of Public
Health, should serve as the primary agency responsible for policy formulation, health
insurance system development, and management of the Migrant Health Insurance Fund. To
ensure financial sustainability, there must be legislative support for the relevant authorities,
roles, and responsibilities, including drafting laws to provide health insurance for all nonThai nationals. Experts agreed that the purchase of the Ministry of Public Health’s Migrant
Health Insurance Card for migrant workers not covered by social security should be legally
mandated. The card’s cost should be based on an analysis of actual healthcare expenses
to ensure cost-effectiveness.
