Abstract
Health Management Service for Informal Sector : Hawkers and Garbage Collectors This research is aimed to 1) know their working conditions , major health risks, health problems and care, 2) know their awareness, understanding and access, of health service system for them, their selection of health service, rights and benefits, their satisfaction and problems of health service system use, their expectation of health service system and their ability to make additional payment into the health fund, and 3) propose guidelines on provision of health service system for informal sector : hawkers and garbage collectors. This is qualitative research and data were collected in 3 ways including 1) in-depth interview with 165 hawkers and garbage collectors in Bangkok and peripheral zones, 2) interview with 5 officials directing health service, and 3) 2 focus groups of the health service receivers and providers. The research can be concluded that most of 165 samples are women being 31-40 years of age and having primary education, single families and about 4 family members. Most samples migrated seasonally or permanently form the northeastern region, reside in rented houses with about ฿ 800/month. Most samples have worked for over 10 years with daily income of ฿300-400 being equal to their expenditure. Some have short-term debts with monthly interest rate of 7-20% being incurred to be their revolving fund for trade or to be their expenses for medical treatment. They work at kerbs or in public and crowded places for 8-10 hours a day without taking any holiday for relieving their stress or exhaustion from hard or repetitious work. They also encounter polluted air, dust, strong sunlight and noise of heavy traffic. So, this is rather risky work without certain income. As for their belief in health care, they believe that their families and themselves are strong at this middle age, so they are not aware of health protection or improvement. In case of illness, Most of them buy drugs instead of seeing a doctor for saving on time and money and for quicker recovery. Most of the samples and their families were not seriously ill during the past year but they suffered only from headaches, armaches, legaches, backaches, shoulderaches, colds, exhaustion and stress. Yearly expenses for health care are ฿ 200-300 per family. More than half of them have health insurance but the 48% remainder have not because they know nothing about health insurance schemes or think that such schemes are not worthwhile because they have never been ill or that better service results from cash payment, not from the use of health insurance cards. As for their problems of health service system use, those having no health insurance must bear medical expenses or borrow money if they are seriously ill. Public hospitals are open only during official hours and the health insurance schemes are usually publicized in announcements or leaflets which are hardly or cannot be read by them. Those having health insurance usually face problems with hospitals being provided for them according to administrative zones, so most of them suggest that suitable hospitals should be chosen in not only the social insurance schemes but also these health insurance schemes. Moreover they can willingly make additional payment into the health fund for about ฿ 500 –600 a year. The guidelines on provision of health service system for hawkers, garbage collector are as follows : 1. Public awareness of health improvement and protection must be more stimulated than medical treatment which finally requires high expenses. 2. Suitable health insurance should be basic health service system being provided for informal sector having no health insurance. It should be the same rights and benefits as those offered by the schemes of the poor and needy relief. The expenses of this basic health insurance must be borne by the government. If anybody wants more rights and benefits, e.g. selection of hospitals, treatment for chronic diseases, use of extra drugs, etc., should be offered and additionally paid for. The insurer taking good care of himself/herself without using health service of medical treatment should be given a discount for continuous insurance. Besides, the health insurance schemes must be fully publicized by local health volunteers or radio and television programmes for creating correct understanding of health insurance.
