Launching a Private Non-Profit Health Micro Insurance for Migrants in Thailand
Focus group in Mae Sot
The first refugee camp along the Thai-Myanmar border was established in 1984 in Mae La to welcome Myanmar refugees escaping their war-torn country. Since then, a total of 9 camps were created along the Thai-Myanmar border, still hosting nowadays about 120,000 people. In these camps, refugees have been provided assistance, including healthcare, by international NGOs.
Outside of refugee camps, many economic migrants have also been seeking better job and life opportunities. Legal migrants can receive free health care in public hospitals if they are enrolled in the government Migrant Health Insurance (MHI) program, but illegal migrants are not eligible for the scheme. Today, out of an estimated 3.5 million migrants living in Thailand, over 1.5 million are illegal, and 65% of them come from Myanmar (previously known as Burma).
Facing Health Access and Funding Challenges
Near Mae Sot, along the Thai-Myanmar border, the Shoklo Malaria Research Unit (SMRU) and the Mae Tao Clinic (MTC) have provided health care services to Burmese refugees, unregistered migrants, and people living inside Myanmar for 30 years. These services are supported by different institutional donor mechanisms and the SMRU and MTC services for migrants have been, and continue to be fully donor-dependent. However, this support has decreased substantially over the past few years.
Furthermore, most of migrants working at the Thai-Myanmar border are illegals and have to face serious challenges like being abused by police (for instance, being robbed), living with half of the minimum legal wage, and having no access to healthcare. The Government of Thailand is not prepared to massively legalize migrants, who could then demand legal access to social protection and fair salaries. They represent a cheap workforce that is welcome in the local economy, but strong nationalistic positions prevail against their legalization. These illegal migrants however need to be in good health to participate in the country’s growth.
Designing the Health Micro Insurance Model
In this context, building a micro insurance emerged as a possible new mechanism to sustain health services for illegal migrants and other underserved communities along the border.
In 2014, the non-profit mission-driven social enterprise Dreamlopments conducted research to assess the interest among migrants for this concept of a private low-cost health insurance. Among 400 migrants recruited in Tak province along the Thai-Myanmar border, 74% were unregistered, 60.5% had jobs paid on a day-to-day basis, and 93.5% of them had monthly income below 6,000 Thai Bahts (~US$180). 90.5% of those migrants had no government health insurance (which besides eligibility criteria requires yearly premium payment and limits provision of free care in only one designated hospital), and yet 88% stressed that they would want one that they can pay monthly and that covers services in several facilities.
Building on these findings, Dreamlopments and the SMRU worked together to conduct a full feasibility assessment of setting up this insurance model for people living along the Thai-Myanmar border, as a mechanism for this vulnerable population to self-determine sustainable and unrestricted access to health care services through a network of partner health care providers on both sides of the border.
Among the main challenges foreseen as result of this study for the set-up and provision of this service were: obtaining the approval from the Thai authorities, dealing with the economic vulnerability of the target group, collecting the monthly premium fee in a rural context, addressing pre-existing conditions and chronic diseases, and financing initial set-up costs. Many of these challenges have been addressed, government support to operate the project and start-up funding have been secured. The project formally started in Mae Sot on August 1st, 2017.
Deployment, Data Analysis and Business Model Adjustment
The digital dimension is indeed an important part of the M-Fund initiative and building a strong data management system was seen as essential from the beginning, to have both quantitative data and qualitative information to refine the model, to test management costs, and ensure efficiency in the model.
The M-Fund platform tasks ranging from members’ registration, payment recording and follow-up, claim management, claim reimbursement, plans management, partners and staff management, to personal health record access, as well as data analysis. This platform is the link between different actors and run on a secured server, accessible via different terminals such as tablets, smartphones, laptops and desktops, and respect open standards and interoperability protocols. This secured system is adapted to insured members’ needs, local infrastructures and current legislation. It is easily scalable, adaptable and replicable, and able to manage information flows between the different partners and end-users.
The dataset analysis and feedbacks from insured members allow on the fly premiums redesign and pricing revaluation in order to response sharply to health migrants’ needs. Indeed, it captures all indicators required to scale-up the initiative, monitor performance, define members’ profiles, pricing assumptions, and determine healthcare providers’ practices and patterns to adjust processes and services based on performance observed. A personal health record is an extension that is being planned, and should allow M-Fund members and possibly other individuals to access health history using a web-based interface. Researchers could possibly access anonymized data to determine patterns, although this will need further careful consideration.
The Dreamlopments team plan is to continue working further on adapting the business model according to data analysis and to include new services such as a personal health record management tool, a claim management tool, offline access, internal communication tools and a full reporting interface for deeper data analysis.
Thus, this initiative could be taking into consideration for a national plan and being reproduced in countries having similar issues with illegal workforce in order to provide a fair healthcare access to all. Dreamlopments pursues indeed the goal of extending the project to other areas and migrant communities in need of health protection in the country, and possibly in other countries in the region in the future.
Originally published at ICT for Development.