BY AKHIL UPNEJA
At a time when oppressive regimes are committing particularly heinous human rights violations, governments across the world are refusing to welcome refugees and migrants. Even in those nations that do accept migrants, accessing affordable health care is becoming an increasingly important issue. Thailand stands out as a leader in these respects. With a migrant population numbering over 4 million, Thailand allows migrants to buy the same universal health care plan that citizens are able to access. Thailand has been able to retain migrants in Bangkok and the surrounding areas, leading to thriving fishing and construction industries.1 In order for Thailand to continue extending healthcare access to its migrant population, two important problems will have to be addressed: first, increased costs due to a sicker population, and second, decreased access to external funding sources.
Currently, to pay for healthcare access in Thailand, migrants pay a yearly premium of 2,100 THB, the equivalent of about 60 dollars, regardless of their pre-existing health conditions.1 As a result of these generous healthcare policies, the population that migrates to Thailand is much sicker than the general population. With respect to HIV, a 2012 UN Report found that “HIV prevalence among migrants to Thailand from neighboring countries is up to four times the rate of prevalence found among the general population.”2 Sicker populations utilize healthcare services more frequently, driving up overall costs on the provider side. The Thai government felt this financial pressure and attempted to counteract it by switching from a per annum premium to a salary deduction.3 4 percent of a worker’s salary would be deducted, and the employer would contribute the other 4 percent.3 However, this program failed for three major reasons. First, the government underprovided social security cards to each business, so it was impossible for each employee to get access to insurance. Second, employers were not held accountable to contribute 4 percent. Finally, as stated by Ko Moe Thee of the Samutsakhon Reproductive Health Migrants Worker Centre at Mahachai, “the 4 percent levy was also unaffordable for most migrant workers.”3
Additionally, Thailand is facing a shortage in international funds to finance its migrant healthcare program. A representative example, The Global Fund is an organization that helps finance developing countries’ fight against HIV, malaria, and tuberculosis. The financial amount that each country gets from the Fund depends on its wealth status. Because Thailand is now considered as an “upper-middle-income country”, the Global Fund announced that it will cut off its funding completely by January 2017.1 While the Thai government theoretically pledged to continue providing the same services that it did with The Global Fund’s money, it has already slashed several programs funded through this organization. For example, the People Who Inject Drugs (PWIDs) HIV support program was 100 percent funded by the Global Fund. In 2015, with still half of the budget coming from the Global Fund,
Thailand stopped providing full support for PWIDs. With no transition to full governmental support in sight, there seems to be no guarantee that PWIDs will be covered into the future.4
The Thai government’s policy of allowing migrants to purchase healthcare is commendable and should be a model for all nations allowing migrant workers to contribute to their economies. Unfortunately, the Thai government now faces a financial roadblock as it becomes wealthier and loses its external funding sources. The Thai government must secure funds domestically to ensure that no one’s access to health services changes in the foreseeable future.
Akhil is a rising senior in Morse College majoring in Molecular, Cellular, and Developmental Biology. He is a staff writer for YGHR and is from Pennsylvania.
1. Yan, W. (2016, March 31). NPR Goats and Sodas: Only One Country Offers Universal Health Care To All Migrants. [Web log post]. Retrieved April 22, 2016.
2. Saonuam, P. (2012). Consultation on the Memorandum of Understanding to Reduce HIV Vulnerability Associated with Population Movement: Thailand (pp. 26-28, Rep.). Bangkok: Joint United Nations Initiative on Mobility and HIV/AIDS in South East Asia.
3. Oo, S. S. (2013, June 24). Migrant workers miss out on healthcare. Myanmar Times.
4. Ready, Willing, and Able? Challenges Faced by Countries Losing Global Fund Support (pp. 2-8, Working paper). (2015). New York, NY: Open Society Foundations.