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Article

The Devil Is in the Detail—Understanding Divergence between Intention and Implementation of Health Policy for Undocumented Migrants in Thailand

1
Bureau of Epidemiology, Department of Disease Control, the Ministry of Public Health, Nonthaburi 11000, Thailand
2
International Health Policy Program (IHPP), the Ministry of Public Health, Nonthaburi 11000, Thailand
3
National Health Commission Office of Thailand, Nonthaburi 11000, Thailand
4
London School of Hygiene and Tropical Medicine (LSHTM) WC1E 7HT, London, UK
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(6), 1016; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16061016
Received: 6 February 2019 / Revised: 13 March 2019 / Accepted: 15 March 2019 / Published: 20 March 2019
(This article belongs to the Special Issue The Health and Wellbeing of Migrant Populations)
Migrants’ access to healthcare has attracted attention from policy makers in Thailand for many years. The most relevant policies have been (i) the Health Insurance Card Scheme (HICS) and (ii) the One Stop Service (OSS) registration measure, targeting undocumented migrants from neighbouring countries. This study sought to examine gaps and dissonance between de jure policy intention and de facto implementation through qualitative methods. In-depth interviews with policy makers and local implementers and document reviews of migrant-related laws and regulations were undertaken. Framework analysis with inductive and deductive coding was undertaken. Ranong province was chosen as the study area as it had the largest proportion of migrants. Though the government required undocumented migrants to buy the insurance card and undertake nationality verification (NV) through the OSS, in reality a large number of migrants were left uninsured and the NV made limited progress. Unclear policy messages, bureaucratic hurdles, and inadequate inter-ministerial coordination were key challenges. Some frontline implementers adapted the policies to cope with their routine problems resulting in divergence from the initial policy objectives. The study highlighted that though Thailand has been recognized for its success in expanding insurance coverage to undocumented migrants, there were still unsolved operational challenges. To tackle these, in the short term the government should resolve policy ambiguities and promote inter-ministerial coordination. In the long-term the government should explore the feasibility of facilitating lawful cross-border travel and streamlining health system functions between Thailand and its neighbours. View Full-Text
Keywords: migrants; access to healthcare; health policy; health insurance; policy implementation; Thailand migrants; access to healthcare; health policy; health insurance; policy implementation; Thailand
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MDPI and ACS Style

Suphanchaimat, R.; Pudpong, N.; Prakongsai, P.; Putthasri, W.; Hanefeld, J.; Mills, A. The Devil Is in the Detail—Understanding Divergence between Intention and Implementation of Health Policy for Undocumented Migrants in Thailand. Int. J. Environ. Res. Public Health 2019, 16, 1016. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16061016

AMA Style

Suphanchaimat R, Pudpong N, Prakongsai P, Putthasri W, Hanefeld J, Mills A. The Devil Is in the Detail—Understanding Divergence between Intention and Implementation of Health Policy for Undocumented Migrants in Thailand. International Journal of Environmental Research and Public Health. 2019; 16(6):1016. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16061016

Chicago/Turabian Style

Suphanchaimat, Rapeepong, Nareerut Pudpong, Phusit Prakongsai, Weerasak Putthasri, Johanna Hanefeld, and Anne Mills. 2019. "The Devil Is in the Detail—Understanding Divergence between Intention and Implementation of Health Policy for Undocumented Migrants in Thailand" International Journal of Environmental Research and Public Health 16, no. 6: 1016. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16061016

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