More than three million migrants live in Thailand, having crossed the border in search of higher wages and better job opportunities. But most aren’t able to pay for health care, despite being at high risk for dengue fever, tuberculosis, and several other infectious and respiratory diseases.
“We knew that the Thai government health insurance program set up for migrants 20 years ago wasn’t working,” says Nicolas Durier, a physician who has worked in public health in Thailand and around Asia since 2001. Two-thirds of Thailand’s migrant workers are ineligible for the state-run insurance program because they are undocumented and thus cannot register for coverage, Durier says. And registration among the rest has been low because the program requires them to pay insurance premiums for an entire year at once—an expense out of reach for workers who generally earn about $5 a day in the mining, fishing, construction, or domestic service industries.
So Durier took matters into his own hands. In September, his social enterprise Dreamlopments launched the Migrant Fund (M-FUND) to offer migrants a more accessible form of health insurance. He and a friend first began surveying Burmese migrants in 2015 to determine whether they were interested in such a service. After receiving a favorable response, Durier’s team spent the next year conducting feasibility assessments and running financial models to determine how to make the program financially sustainable.
The pilot program—funded by Unicef and approved by the Thai Ministry of Public Health—targets the approximately 200,000 Burmese migrants that Durier estimates live along the border in western Thailand’s Tak province. Mae Sot, the largest city in the area, is the gateway for most Burmese entering the country. To be insured by the M-FUND, workers must pay a premium of 100 Thai baht ($3) once a month. In return, they gain access to comprehensive care (including treatment for chronic conditions, but excluding dental and vision care) at hospitals and clinics.
While health statistics on Thailand’s Burmese migrant population are scarce, one Burmese migrant, May Yamon Kyaw, describes an environment of harsh working conditions and limited protections that contributes to workers’ health problems.
“Although Thailand [guaranteed] basic human rights to everyone regardless of citizenship in its 2007 constitution, the rights of Burmese migrant workers in Thailand are often abused and violated by employers, officers, and police,” says Kyaw, who was 12 when she fled political persecution in Myanmar (Burma) with her family in 2005. She adds that many employers force migrants to work more than 10 hours a day, seven days a week, and fail to compensate them for workrelated injuries, even though Thai labor laws in theory require them to do so.
“What Nicolas is trying to do is very good,” says Rose McGready, a professor of public health at Oxford University who heads up the maternal and child health department at the Shoklo Malaria Research Unit, a health clinic in Mae Sot dedicated to treating migrants. “The migrant workers we see are coming from a very neglected health-care system that has been broken down for five decades.”
Securing consistent health coverage for migrants is especially difficult because many of them regularly move back and forth across the border. But Dreamlopments is well-placed to help fill in these gaps, Durier says, because as a private, independent organization, it can engage in depoliticized dialogue with both the Thai and Myanmar governments about the health needs of this highly mobile population.
The M-FUND ultimately needs a minimum of 50,000 subscribers to be financially sustainable, but Durier’s immediate goal is to register 3,000 migrants in the first six months. Since most migrants don’t have cell phones, Durier has hired a team of community health workers to sign them up. After the first three weeks of enrollment, they had registered 260 people.
Because Thai health-care facilities tend to provide care before discussing who will pay for the costs, Oxford’s McGready cautions that Durier must successfully negotiate with the facilities for a cap on how much the M-FUND will pay for treatment. If not, she warns, the insurance program may not be able to sustain itself. If the M-FUND is successful, however, McGready says that it will help to ensure that struggling hospitals and clinics like her own receive reimbursement for the care they give.
Donations to McGready’s clinic have been drying up even as the number of migrants arriving in Thailand—and patients in need of care—has increased. “The health-care system is losing money,” she says. “But if migrant workers support the concept that they need to keep paying in to have insurance, it will help us sustain care for those who need it most.”