Table 2.
Migrant-inclusive features of UHC in five GMS countries.
| Indicators | Cambodia | Lao PDR | Myanmar | Viet Nam | Thailand |
|---|---|---|---|---|---|
| Policy and national-level frameworks | Constitution 2008 (Article 72) ‘All Cambodians’; Ministry of Health goal of UHC | National Health Strategy on UHC 2015–2020 | National Health Plan UHC goal for citizens and designated ethnic groups | Health policies refer to citizens. Health Insurance Law 2008 aims for UHC | National Health Act 2002 set up UHC for those not covered by SHI schemes. National Health System Charter (Article 16) extends to everyone living in Thailand regardless of nationality. |
| Service models and coverage | HEFs cover 90% target of population (i.e. poor population) and 20% of national population | Limited SHI schemes. HEFs cover 41% of population | No specific programs | Govt. SHI covers 60% of population. Govt. subsidises premiums in poor areas | Mainly tax-financed: pay-roll tax SHI schemes, tax-based UHC for informal sector and poor. UHC covers 75% of Thai population who must register with district provider |
| UHC developments | HEFs scaling up across districts | HEFs being extended | UHC an accepted concept | Private health insurance allowed from 2011 | Less OOP payment and increased out-patient visits for UHC beneficiaries |
| Migrant-inclusive features | District HEFs unlikely to enrol migrants. Some programs for emigrant workers, and some infectious disease programs | HEFs unlikely to enrol migrants. Some donor-funded programs for migrant workers | Not a national priority | Emigrant worker programs; joint government and donor infectious disease programs in border areas | MHI Scheme: legal migrant workers registered; irregular migrants can opt in. Targeted policies address migrant health: e.g. the National Master Plan for HIV/AIDS Prevention; Care and Support for Migrants and Mobile Populations (2007–2011); 2003 Thai Migrant Health Program |
| Current challenges | Huge challenge to fund and rebuild health system. High OOP payment | High OOP payment and inadequate health services | Huge challenge to improve health services. High OOP payment | Govt. services under-resourced. User fees for public and private health services | Migrant workers pay annual fees for MHI. Many irregular migrants do not register for MHI. MHI benefits are not portable and are less comprehensive than for Thai nationals |