On migrant health care in Thailand

Two different (and opposing) perspectives on the cost of health care for migrants in Thailand:

Pradit floats idea for a regional health fund, The Nation, 15 June 2013

The large state spending for providing medical services to migrant workers and non-Thais along the Thailand-Myanmar border - in excess of Bt100 million a year - has prompted the Public Health Ministry to seek cooperation from the neighbouring country to set up a regional health fund. Public Health Minister Pradit Sinthawanarong said most of the hospitals in the five provinces along the border are having to shoulder the burden of providing healthcare services to migrant workers and non-Thais crossing the border.  Each year, the ministry has to spend more than Bt100 million to provide medical services to migrant workers and non-Thai citizens in five Tak districts along the border.  The government has allowed migrant workers to buy health insurance cards for Bt1,900 each to access medical services from hospitals they are registered with. But it found that only 32,154 workers had bought the insurance. Meanwhile, the ministry has spent more than Bt29 million to provide treatment for them and more than Bt112 million has been spent on non-Thais who have not registered yet.

Migrant workers miss out on healthcare, Myanmar Times, 24 June 2013

Migrant workers in Thailand say a new registration system has made it harder for them to access health care, with more than 1.2 million thought to be without any form of cover.
Under the National Verification program, which aims to register the millions of illegal migrant workers in Thailand, workers are supposed to have a percentage of their salary deducted and in return get a social security board card from the Ministry of Labour. However, few are able to access the social security program, sources say, and have to pay large sums for treatment in the private sector if they get sick or are injured.

Prior to the launch of the program in 2009, registered workers could join the Ministry of Public Health’s migrant worker healthcare program for 1900 baht (about US$60) a year, said Ko Yan Naing Soe, a driver at an ice factory in Mahachai in Samut Sakhon Province.

“If we have this card the cost of medical treatment at any hospital is just 30 baht [$1],” he said.

Under the new system, the social security board card costs 8 percent of a worker’s salary – half of which is paid is to be paid by their employer, said U Chit San, who operates machinery in an ice factory in the machine sector.
Employers are legally obligated to deduct 4pc from salaries and pay the other 4pc but there is little enforcement, sources say.

U Chit San said whether workers can get the card now depends on their employer and most are reluctant to pay for their employees’ health care.
“It is completely up to the boss. He has to do the social security card for all workers but in our factory he only did it for about one-fifth because he didn’t want to contribute 4pc for each person,” U Chit San said.

He said the Thai government also limits the number of social security board cards that it will issue to each employer based on the size of the business.
Ko Moe Thee, a member of the Samutsakhon Reproductive Health Migrants Worker Centre at Mahachai, said the 4pc levy was also unaffordable for most migrant workers.

“The employers also don’t care about it. Because they don’t have the social security card, the workers have to spend a lot if they are sick,” he said.
A spokesperson for the Migrant Worker Rights Network said access to affordable health care was “the major difficulty” for migrant workers in Thailand.

“Most workers have no social security card and have to pay a high price for treatment at the hospital,” he said. “The Thai government does not have a permanent policy for Myanmar workers. It is constantly changing.”

He said most of the 6000 reported cases of human rights violations perpetrated against migrant workers in Thailand related to accident-related health issues.
“For example, in Thailand all vehicles have to have insurance in case there is an accident. But when Myanmar workers are in an accident, there is no compensation for them from the insurance company.”

One source said recent data indicated that just 10pc of the approximately 1.4 million registered Myanmar workers had a social security board card, leaving more than 1.2 million with no health cover.

While in most cases it is because the employer does not want to pay to sign them up, some also miss out because they are working illegally for a different employer than the one with which they are registered or because their workplace is not legally registered.

Language problems also mean employers have difficulty explaining the deductions to their workers, the source said.

Even those who sign up for the program miss out on some of its main benefits. The pension included in the program requires 15 years of contributions and migrants are only eligible to work for four years. They also miss out on unemployment benefits because migrants have to return home if they do not have an employer for more than a week.