Universal Health Coverage for Undocumented Migrant Workers in Thailand: Challenges in Policy Implementation

Abstract Background: The number of international migrants has been increasing from 2.8% of the world population in 2010 to 3.6% in 2020 according to a recent estimation of the United Nations (UN). One of the many challenges in migrants’ health is to obtain universal health coverage (UHC) in the host countries. The Sustainable Development Goals (SDG) urge policymakers to achieve UHC for all regardless of their nationality that each country is responsible for planning and implementing adequate policies towards migrant’s health. According to the Thai migration report in 2019, almost 5 million non-Thai are residing in Thailand. A majority are low-skilled migrant workers (LSMW) from neighbouring countries including Cambodia, Laos, and Myanmar (CLM). Only half of the LSMW, including the undocumented migrant workers (UMW), were covered by public health insurance in 2018. A significant number of UMW has no entitlement to any health insurance due to various barriers. The study was to review the gaps and challenges in health policies related to migrant workers. Recommendation will be introduced as the conclusion. Methods: Literature review from Pubmed, Biomed Central, and Google Scholar and discussion using WHO Universal Health Coverage cube as a framework Results: From the literature review showed the evolution of Thailand’s migration policies and migrant health insurance schemes. Intersectoral collaboration among the Ministry of Interior (MOI), the Ministry of Labour (MOL), and the Ministry of Public Health (MOPH) has been established yet fragmented with bureaucratic nature. Gaps in migrant health policy implementation persist due to the restrictive nature of migrant policies. The processes of providing social protection in health (SPH) to UMW are more of legalizing than protecting of human rights. The discourse that migrants are a burden to the health system still prevails. Discrimination towards LSMW has substantial negative impact on migrant health policies. The accessibility to basic health services remained limited. Additionally, little was achieved regarding the promotion of equal rights and working opportunities. Conclusion: To increase SPH for the vulnerable population is more than providing financial coverage. Improving access to social health assistance will have positive impact on the health outcomes of migrant workers. This paper proposes practical implementation at local health system.