Unmet need for health services among refugees and asylum seekers in Thailand, relative to the Thai population: an analytic cross sectional study, 2019

BackgroundAlthough the Thai government has introduced policies to promote health of migrants, it is still the case that urban refugees and asylum seekers (URAS) seem to be neglected. This study aimed to explore the degree of healthcare access through the perspective of unmet need in URASs, relative to the Thai population.MethodsA cross-sectional survey, using a self-reporting questionnaire adapted from the Thai Health and Welfare Survey (HWS), was performed in late 2019, with 181 URASs attending the survey. The samples were randomly selected from the roster of the Bangkok Refugee Center. The data of the URAS survey were combined with data of the Thai population (n=2,941) from the HWS. Unmet need for health services was defined as the status of when a respondent needed healthcare in the past twelve months but failed to receive it. Bivariate analysis was conducted to explore the demographic and unmet need difference between URASs and Thais. Multivariable logistic regression and mixed-effects (ME) model were performed to determine factors associated with unmet need.ResultsOverall, URASs were of lower age, less educated and living in more economically deprived households, compared with Thais. About 98% of URASs were uninsured by any of the existing health insurance schemes. The prevalence of unmet need among URASs was significantly higher than Thais in both outpatient (OP) and inpatient (IP) services (54.1% versus 2.1% and 28.0% versus 2.1%, respectively). Being uninsured demonstrated the greatest degree of association with unmet need, especially for OP care. The association between insurance status and unmet need was more pronounced in ME model, relative to multivariable logistic regression. URASs migrating from Arab nations suffered from unmet need to a greater extent, compared with those originating from non-Arab nations.ConclusionThe prevalence of unmet need in URASs was drastically high, relative to the prevalence in Thais. Factors suggesting a positive relationship with unmet need included advanced age, lower education achievement, and, most evidently, being unsinured. Policy makers should consider a policy option to enrol URASs in the nationwide public insurance scheme to create health security for the entire Thai society.