Centre for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok, Thailand.
PLoS One. 2020 Jul 2;15(7):e0234642. doi: 10.1371/journal.pone.0234642. eCollection 2020.
The role of external actors in national health policy in aid-independent countries has received relatively little attention in the literature, despite the fact that influence continues to be exerted once financial support is curtailed as countries graduate from lower income status. Focusing on a specific health policy in an aid-independent country, this qualitative study explores the role of external actors in shaping Thailand's migrant health insurance. Primary data were collected through in-depth interviews with eighteen key informants from September 2018 to January 2019. The data were analysed using thematic analysis, focusing on three channels of influence, financial resources, technical expertise and inter-sectoral leverage, and their effect on the different stages of the policy process. Given Thailand's export orientation and the importance of reputational effects, inter-sectoral leverage, mainly through the US TIP Reports and the EU carding decision, emerged as a very powerful channel of influence on priority setting, as it indirectly affected the migrant health insurance through efforts aimed at dealing with problems of human trafficking in the context of labour migration, especially after the 2014 coup d'état. This study helps understand the changed role external actors can play in filling health system gaps in aid-independent countries.
外部行为体在援助独立国家的国家卫生政策中的作用在文献中相对较少受到关注，尽管一旦这些国家摆脱低收入地位，财政支持减少，它们的影响力仍在继续发挥。本研究以援助独立国家的一项特定卫生政策为重点，探讨了外部行为体在塑造泰国移民医疗保险中的作用。主要数据是通过对 2018 年 9 月至 2019 年 1 月期间的 18 名关键信息提供者进行深入访谈收集的。使用主题分析方法对数据进行分析，重点关注影响的三个渠道，即财政资源、技术专长和跨部门杠杆作用，以及它们对政策过程不同阶段的影响。鉴于泰国的出口导向和声誉效应的重要性，通过美国《人口贩运问题特别报告》和欧盟点名决定等手段发挥的跨部门杠杆作用，成为对优先事项设定具有非常强大影响力的渠道，因为它通过旨在解决劳动力移民背景下人口贩运问题的努力，间接地影响了移民医疗保险，特别是在 2014 年政变之后。本研究有助于理解外部行为体在填补援助独立国家卫生系统空白方面可以发挥的变化了的作用。
