Because of bureaucratic impediments, foreign migrant workers are often unable to get social security cards and obtain access to the Thai public health care system.

People line up for Covid-19 test at Samut Sakhon (file photo)

A Mon family whose child was diagnosed with Hydrocephalus, a fluid build-up around the brain that can cause brain damage, is suffering from the tangled process of getting public health insurance. As their visas and work permits had expired, the parents were unable to obtain social security support. A donation campaign also failed to raise enough money for medical expenses. Members of the Mon community in Surat Thani donated around 10,000 baht  but the surgery costs almost 100,000 baht.

After Maung Mon Chan, the child’s father who works in Surat Thani, posted the story on Facebook, more than ten local organisations contacted them to inquire about the matter.

The post on Maung Mon Chan’s Facebook asking for donations from the Mon community

The parents, who previously had work permits,  became undocumented after they were let go by their employer. They were unable to find new jobs in time to register for the social security scheme, which provides employees and their dependents access health care for injury, sickness, maternity, and disabilities, as well as death benefits.

The law stipulates that migrant workers must have active passports and work permits to obtain social security cards.  The cards cost 2,100 Thai baht for adults and 365 Thai baht for children under seven. As only legal, full-time and full-year employees are qualified, large numbers of foreign workers are left without coverage.

“This is more common than we think, especially in the agriculture sector”, said Assoc Prof Sudarat Musikawong, Sociology professor from Institute for Population and Social Research, Mahidol University.

In the agriculture sector, workers are categorised as temporary seasonal or independent contractors. As hiring full-time workers from Myanmar requires costly visa and work permits documents, most employers avoid doing so, an economic rationale that affects migrant workers’ access to healthcare.

“If you don't have legal status in this country, it is 10 times worse. You do not exist,” Sudarat added.

Complicated public health system makes it more difficult

Even though migrant workers are allowed to apply for visas and work permits themselves, most choose to use the services of brokers, who know how to deal with the complex procedures involving multiple documents that must be submitted in a specific order.

“Many officials set extra conditions that can cause confusion and difficulties for applicants,” said Adisorn Kerdmongkol, a coordinator from a Migrant Working Group (MWG), NGO working on migrant workers issues.

Maung Mon Chan paid a broker to get his passport and work permit to qualify for a social security card. The broker charged him 10,000 Thai baht, a rate far higher than the official price of 6,800 baht for both documents.

“Now he has already paid 8,000 baht and he still has not received a public insurance card,” said Pago Man, 42, a worker from Myanmar and a close friend of the Mon family.

There is also a lot of confusion over which hospitals provide medical treatment. Migrant workers can only receive treatment from the hospital they bought public health insurance from. When workers change job locations, they also have to go through the complicated process of changing their address for social security registration as well.

Operations covered by social security cards are listed on the Ministry of Public Health’s webpage.  According to Adisorn, however, “many medical centres do not provide listed treatments such as maternal care and the treatment of some of chronic diseases.” Some hospitals also refuse to provide medical care within the price range supported by social security, resulting in migrant workers having to cover their own medical expenses.

Pago Man recalls that his child once had surgery and needed medicine that was not covered by the social security scheme so he had to pay for it out of pocket. “It is unlikely that I will ever get that money back,” he said.

Discrimination and language barriers

“There is not much information available for migrant workers about how to access public health services.  It has yet to be translated into their languages.  As a result, migrant workers often don’t have much information,” Adisorn notes.

The process of applying for a social security card is quite complex.  It is even worse when the procedures are only described in Thai.

“If hospital providers cannot communicate well in the languages of migrant workers, they cannot explain the steps involved in getting access to medical treatment … [causing] misunderstandings that are life-threatening,” said Sudarat.

In some cases, workers from Myanmar also feel that they are being discriminated against by hospital staff. Some report being told that social security does not cover the full medical expenses. On occasion, hospitals charge additional fees when a patient needs more medicine or needs to be hospitalised. With language barriers and little knowledge, workers have no choice but to pay the additional expenses themselves.

As noted by Sudarat, “Health care has structural discrimination against undocumented persons and there is the language barrier on-top. The Thai health care system … is unwilling to cover the expense of medical treatments for the undocumented.”

The Rak Thais Foundation, civil society organisations (CSOs), and non-governmental organisations (NGOs) can provide migrant workers with interpreters for hospital visits, but Sudarat said she is not sure how many hospitals are working with these organisations.

“The system needs reevaluation to address both language capacity of hospital staff and the economic burden posed by the border crisis and influx of undocumented workers.  Together with those who slip out of legal status, they number in the millions,” said Sudarat.

Official Collaboration

Despite a recent extension of the social security card registration period, employers are still required to turn documents in on behalf of their employees. Migrant workers are unable to complete the process on their own.

Organisations like Raks Thai and the Migrant Working Group have been advocating for change and reform of the social security and universal health care systems. They propose that Thailand adopt International Labour Organisation (ILO) standards.

They suggest implementing a year-round open health registration system so that every worker and dependent, documented or otherwise, would qualify. Creating One Stop Service Centres around Thailand would also help accommodate migrant workers.

Revising a few conditions could help reduce the difficulties and misunderstandings that migrant workers face when accessing public health care as well.  According to Adisorn, this should include dropping the stipulation that insured migrant workers pay monthly social security fees for at least three months to be eligible for the insurance benefits.

“My sense is that we need comprehensive reform for low wage workers from neighbouring ASEAN countries,” said Sudarat. She believes that assisting all workers to qualify and receive social security could help Thailand to better integrate migrant workers in all sectors.