Suphanchaimat Rapeepong, Putthasri Weerasak, Prakongsai Phusit, Tangcharoensathien Viroj
International Health Policy Program (IHPP), The Ministry of Public Health, Nonthaburi.
Banphai Hospital, Khon Kaen.
Risk Manag Healthc Policy. 2017 Apr 15;10:49-62. doi: 10.2147/RMHP.S130442. eCollection 2017.
Of the 65 million residents in Thailand, >1.5 million are undocumented/illegal migrants from neighboring countries. Despite several policies being launched to improve access to care for these migrants, policy implementation has always faced numerous challenges. This study aimed to investigate the policy makers' views on the challenges of implementing policies to protect the health of undocumented/illegal migrants in light of the dynamics of all of the migrant policies in Thailand.
This study used a qualitative approach. Data were collected by document review, from related laws/regulations concerning migration policy over the past 40 years, and from in-depth interviews with seven key policy-level officials. Thematic analysis was applied.
Three critical themes emerged, namely, national security, economic necessity, and health protection. The national security discourse played a dominant role from the early 1900s up to the 1980s as Thailand attempted to defend itself from the threats of colonialism and communism. The economic boom of the 1990s created a pronounced labor shortage, which required a large migrant labor force to drive the growing economy. The first significant attempt to protect the health of migrants materialized in the early 2000s, after Thailand achieved universal health coverage. During that period, public insurance for undocumented/illegal migrants was introduced. The insurance used premium-based financing. However, the majority of migrants remained uninsured. Recently, the government attempted to overhaul the entire migrant registry system by introducing a new measure, namely the One Stop Service. In principle, the One Stop Service aimed to integrate the functions of all responsible authorities, but several challenges still remained; these included ambiguous policy messages and the slow progress of the nationality verification process.
The root causes of the challenges in migrant health policy are incoherent policy direction and objectives across government authorities and unclear policy messages. In addition, the health sector, especially the Ministry of Public Health, has been de facto powerless and, due to its outdated bureaucracy, has lacked the capacity to keep pace with the problems regarding human mobility.
在泰国的6500万居民中，有超过150万是来自邻国的无证件/非法移民。尽管泰国出台了多项政策以改善这些移民获得医疗服务的机会，但政策实施一直面临诸多挑战。本研究旨在根据泰国所有移民政策的动态情况，调查政策制定者对实施保护无证件/非法移民健康政策所面临挑战的看法。
本研究采用定性研究方法。通过文献回顾收集数据，这些文献涉及过去40年有关移民政策的相关法律法规，并对7名关键政策层面官员进行了深入访谈。采用了主题分析法。
出现了三个关键主题，即国家安全、经济需求和健康保护。从20世纪初到20世纪80年代，国家安全话语占据主导地位，当时泰国试图抵御殖民主义和共产主义的威胁。20世纪90年代的经济繁荣造成了明显的劳动力短缺，这需要大量移民劳动力来推动经济增长。在泰国实现全民健康覆盖后，21世纪初首次出现了保护移民健康的重大尝试。在此期间，为无证件/非法移民引入了公共保险。该保险采用基于保费的融资方式。然而，大多数移民仍然没有保险。最近，政府试图通过引入一项新措施，即一站式服务，来彻底改革整个移民登记系统。原则上，一站式服务旨在整合所有负责当局的职能，但仍然存在一些挑战；这些挑战包括政策信息不明确以及国籍核查过程进展缓慢。
移民健康政策面临挑战的根本原因是政府各部门政策方向和目标不一致以及政策信息不明确。此外，卫生部门，尤其是公共卫生部，实际上一直无能为力，并且由于其过时的官僚体制，缺乏跟上人口流动问题的能力。
