König Andrea, Sappayabanphot Jarntrah, Liang Li, Fleßa Steffen, Winkler Volker
Epidemiology of Transition, Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg 69120, Germany.
Faculty of Science, Asia Pacific International University, Saraburi, Thailand.
J Migr Health. 2024 May 13;9:100236. doi: 10.1016/j.jmh.2024.100236. eCollection 2024.
Even though Thailand has launched multiple migrant health policies, migrants still face various barriers in accessing health care. To some extent, these barriers may be reduced by health microinsurance. The M-FUND is a low-cost, not-for-profit health protection scheme for migrant workers in Thailand, created by Dreamlopments Social Enterprise and Foundation to support sustainable access to quality healthcare services for migrants. We aimed to investigate the impact of the M-FUND on utilization of health services.
Over a period of three months, we conducted quantitative face-to-face interviews with 408 M-FUND members, and 452 age, sex and location matched non-member controls in Tak Province, Thailand. We compared utilization of health services between members and non-members using logistic regression controlling for a number of socio-demographic variables and variables related to migration such as years in Thailand, legal status, etc.
M-FUND members were more likely to have utilized outpatient services (adjusted odds ratio: 1·74, 95 % confidence interval: 1·24-2·44), inpatient services (2·96, 1.11-7·92), and emergency care (1·89, 0·78-4·56), although the latter was not statistically significant. Members were more likely not to have purchased medicines over-the-counter (1·67, 1·22-2·27) than non-members. Members were also more likely to have utilized any additional specific service during a consultation (2·31, 1·49-3·58) including any type of imaging method (2·62, 1·29-5·29) and blood tests (1·64, 0·99-2·71). There were some differences between men and women, but most were not statistically significant.
The M-FUND health microinsurance was positively associated with the utilization of all major types of health services among migrant workers and their dependents in Thailand. For migrants, particularly vulnerable migrant workers and their dependents, the M-FUND appears to be a good approach to reducing barriers to health care. This study of the impact of health microinsurance for migrants provides important information for policy and program planners in the field of migrant health. However, more research is needed on health microinsurance schemes for migrants in different settings and for other underserved communities as well as the sex-specific impact on health service utilization.
尽管泰国已出台多项针对移民的健康政策，但移民在获得医疗保健方面仍面临各种障碍。在某种程度上，健康小额保险可能会减少这些障碍。M-FUND是泰国为移民工人设立的一项低成本、非营利性的健康保护计划，由Dreamlopments社会企业与基金会创立，旨在支持移民可持续地获得优质医疗服务。我们旨在调查M-FUND对医疗服务利用情况的影响。
在三个月的时间里，我们对泰国达府的408名M-FUND成员以及452名年龄、性别和地点匹配的非成员对照进行了定量面对面访谈。我们使用逻辑回归，在控制了一些社会人口变量以及与移民相关的变量（如在泰国的居住年限、法律地位等）的情况下，比较了成员与非成员之间的医疗服务利用情况。
M-FUND成员更有可能使用门诊服务（调整后的优势比：1.74，95%置信区间：1.24 - 2.44）、住院服务（2.96，1.11 - 7.92）和急诊护理（1.89，0.78 - 4.56），尽管后者在统计学上不显著。与非成员相比，成员更不太可能购买非处方药品（1.67，1.22 - 2.27）。成员在就诊期间也更有可能使用任何额外的特定服务（2.31，1.49 - 3.58），包括任何类型的影像检查方法（2.62，1.29 - 5.29）和血液检查（1.64，0.99 - 2.71）。男性和女性之间存在一些差异，但大多数在统计学上不显著。
M-FUND健康小额保险与泰国移民工人及其家属对所有主要类型医疗服务的利用呈正相关。对于移民，特别是弱势移民工人及其家属而言，M-FUND似乎是减少医疗保健障碍的一个好方法。这项关于移民健康小额保险影响的研究为移民健康领域的政策和项目规划者提供了重要信息。然而，对于不同背景下的移民以及其他服务不足社区的健康小额保险计划，以及对医疗服务利用的性别特定影响，还需要更多研究。
