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The Devil Is in the Detail—Understanding Divergence between Intention and Implementation of Health Policy for Undocumented Migrants in Thailand

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  • Rapeepong Suphanchaimat

    (Bureau of Epidemiology, Department of Disease Control, the Ministry of Public Health, Nonthaburi 11000, Thailand
    International Health Policy Program (IHPP), the Ministry of Public Health, Nonthaburi 11000, Thailand)

  • Nareerut Pudpong

    (International Health Policy Program (IHPP), the Ministry of Public Health, Nonthaburi 11000, Thailand)

  • Phusit Prakongsai

    (International Health Policy Program (IHPP), the Ministry of Public Health, Nonthaburi 11000, Thailand)

  • Weerasak Putthasri

    (National Health Commission Office of Thailand, Nonthaburi 11000, Thailand)

  • Johanna Hanefeld

    (London School of Hygiene and Tropical Medicine (LSHTM) WC1E 7HT, London, UK)

  • Anne Mills

    (London School of Hygiene and Tropical Medicine (LSHTM) WC1E 7HT, London, UK)

Abstract

Migrants’ access to healthcare has attracted attention from policy makers in Thailand for many years. The most relevant policies have been (i) the Health Insurance Card Scheme (HICS) and (ii) the One Stop Service (OSS) registration measure, targeting undocumented migrants from neighbouring countries. This study sought to examine gaps and dissonance between de jure policy intention and de facto implementation through qualitative methods. In-depth interviews with policy makers and local implementers and document reviews of migrant-related laws and regulations were undertaken. Framework analysis with inductive and deductive coding was undertaken. Ranong province was chosen as the study area as it had the largest proportion of migrants. Though the government required undocumented migrants to buy the insurance card and undertake nationality verification (NV) through the OSS, in reality a large number of migrants were left uninsured and the NV made limited progress. Unclear policy messages, bureaucratic hurdles, and inadequate inter-ministerial coordination were key challenges. Some frontline implementers adapted the policies to cope with their routine problems resulting in divergence from the initial policy objectives. The study highlighted that though Thailand has been recognized for its success in expanding insurance coverage to undocumented migrants, there were still unsolved operational challenges. To tackle these, in the short term the government should resolve policy ambiguities and promote inter-ministerial coordination. In the long-term the government should explore the feasibility of facilitating lawful cross-border travel and streamlining health system functions between Thailand and its neighbours.

Suggested Citation

  • Rapeepong Suphanchaimat & Nareerut Pudpong & Phusit Prakongsai & Weerasak Putthasri & Johanna Hanefeld & Anne Mills, 2019. "The Devil Is in the Detail—Understanding Divergence between Intention and Implementation of Health Policy for Undocumented Migrants in Thailand," IJERPH, MDPI, vol. 16(6), pages 1-19, March.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:6:p:1016-:d:215703
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    References listed on IDEAS

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    1. World Bank, 2015. "World Development Indicators 2015," World Bank Publications - Books, The World Bank Group, number 21634, December.
    2. World Bank, 2014. "World Development Indicators 2014," World Bank Publications - Books, The World Bank Group, number 18237, December.
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    Cited by:

    1. Mathudara Phaiyarom & Nareerut Pudpong & Rapeepong Suphanchaimat & Watinee Kunpeuk & Sataporn Julchoo & Pigunkaew Sinam, 2020. "Outcomes of the Health Insurance Card Scheme on Migrants’ Use of Health Services in Ranong Province, Thailand," IJERPH, MDPI, vol. 17(12), pages 1-15, June.
    2. Sonvanee Uansri & Watinee Kunpeuk & Sataporn Julchoo & Pigunkaew Sinam & Mathudara Phaiyarom & Rapeepong Suphanchaimat, 2023. "Perceived Barriers of Accessing Healthcare among Migrant Workers in Thailand during the Coronavirus Disease 2019 (COVID-19) Pandemic: A Qualitative Study," IJERPH, MDPI, vol. 20(10), pages 1-11, May.
    3. Peeraya Piancharoen & Hathairat Kosiyaporn & Rapeepong Suphanchaimat, 2021. "Equity of Social Health Insurance Coverage for Migrants in Thailand: A Concentration Index Analysis," IJERPH, MDPI, vol. 19(1), pages 1-11, December.
    4. Watinee Kunpeuk & Pard Teekasap & Hathairat Kosiyaporn & Sataporn Julchoo & Mathudara Phaiyarom & Pigunkaew Sinam & Nareerut Pudpong & Rapeepong Suphanchaimat, 2020. "Understanding the Problem of Access to Public Health Insurance Schemes among Cross-Border Migrants in Thailand through Systems Thinking," IJERPH, MDPI, vol. 17(14), pages 1-19, July.
    5. Watinee Kunpeuk & Sataporn Julchoo & Mathudara Phaiyarom & Pigunkaew Sinam & Nareerut Pudpong & Tharani Loganathan & Huso Yi & Rapeepong Suphanchaimat, 2022. "Access to Healthcare and Social Protection among Migrant Workers in Thailand before and during COVID-19 Era: A Qualitative Study," IJERPH, MDPI, vol. 19(5), pages 1-16, March.
    6. Woranan Witthayapipopsakul & Hathairat Kosiyaporn & Sonvanee Uansri & Rapeepong Suphanchaimat, 2022. "Effect of the Promulgation of the New Migrant’s Employment Law on Migrant Insurance Coverage in Thailand: An Interrupted Time Series Analysis, 2016–2018," IJERPH, MDPI, vol. 19(7), pages 1-12, April.

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