Impact of the health insurance scheme for stateless people on inpatient utilization in Kraburi Hospital, Thailand.

OBJECTIVES: This study sought to investigate the impact of the Thai "Health Insurance for People with Citizenship Problems" (HI-PCP) on access to care for stateless patients, compared to Universal Coverage Scheme patients and the uninsured, using inpatient utilization as a proxy for impact. METHODS: Secondary data analysis of inpatient records of Kraburi Hospital, Ranong province, between 2009 (pre-policy) and 2012 (post-policy) was employed. Descriptive statistics and multivariate analysis by difference-in-difference model were performed. RESULTS: The volume of inpatient service utilization by stateless patients expanded after the introduction of the HI-PCP. However, this increase did not appear to stem from the HI-PCP per se. After controlling for key covariates, including patients' characteristics, disease condition, and domicile, there was only a weak positive association between the HI-PCP and utilization. Critical factors contributing significantly to increased utilization were older age, proximity to the hospital, and presence of catastrophic illness. CONCLUSION: A potential explanation for the insignificant impact of the HI-PCP on access to inpatient care of stateless patients is likely to be a lack of awareness of the existence of the scheme among the stateless population and local health staff. This problem is likely to have been accentuated by operational constraints in policy implementation, including the poor performance of local offices in registering stateless people. A key limitation of this study is a lack of data on patients who did not visit the health facility at the first opportunity. Further study of health-seeking behavior of stateless people at the household level is recommended

"Health Insurance Card Scheme" for cross-border migrants in Thailand: Responses in policy implementation & outcome evaluation.

The health of migrants has attracted increasing attention in the international policy dialogue in recent years. Thailand is one of many countries where migrant health is a major political issue. This is because the country is situated at the centre of the Indochinese Peninsula and its economy is fast-growing relative to its neighbouring countries, particularly Cambodia, Lao PDR, and Myanmar. As a result, Thailand has, for decades, attracted a large number of low-skilled cross-border migrants. The majority of these immigrants have passed the border without any valid travel document. However, most of the time, past governments did not impose strict deportation measures on these undocumented/illegal immigrants since they were considered a key contributor to the Thai economy. Measures often used by recent governments included granting them leniency for temporary residence, issuing work permits for certain jobs, and insuring them through public-oriented health insurance, namely, the 'Health Insurance Card Scheme' (HICS). The primary aim of this thesis is to evaluate (i) the enrolment of cross-border migrants in a public health insurance scheme, namely, the HICS, in Thailand through the viewpoints of various stakeholders, and (ii) the effects of insurance on use of services. Ranong province was selected as the study site since it had the largest proportion of migrants compared to other provinces. The main objectives are: (1) to explore how the HICS evolved over time in light of changes in surrounding policies, (2) to investigate the responses of local officers and relevant stakeholders towards the HICS and to examine how the policy affects migrants' health-seeking behaviour in practice, (3) to evaluate the outcomes of HICS in terms of utilisation numbers and financial implications for its insurees, and (4) to provide policy recommendations. A multimethods approach was employed. In-depth interviews, document review and facilitybased data analysis were undertaken. Policy makers, local healthcare providers, and migrants were interviewed. Thematic and analyses were applied. 4 The findings revealed conflicting ministerial objectives and gaps in both inter- and intraministerial policies. In addition, policy objectives were not clear from the outset. While the health sector aimed to insure ‘all’ migrants, this was constrained by the security and economic authorities where the focus was mainly only on migrant workers who registered with the government. Besides, in reality, the boundary between ‘legal’ and ‘illegal’ migrants was very fluid. Though the current government attempted to address policy gaps by overhauling the HICS and instigating a new measure, namely, 'One Stop Service', it is difficult to claim that the deep-rooted implementation problems were resolved. This situation was even more complicated at the local level as some frontline health officers adapted the policy in various ways, and occasionally made the policy diverge from its initial objectives. For users, the cost of registration was a significant barrier in obtaining the insurance card, and a reliance on private intermediaries (both legal and illegal) to help them obtain the insurance card was not uncommon. Besides, there were migrants who were neither insured, nor able to return to their home country. However, the HICS still had some merits in reducing out-of-pocket payment, and helping increase utilisation of services amongst insurees. It was noteworthy that the most important factor determining the number of visits was history of experiencing catastrophic illness, not insurance status, and this influence was even more apparent in Thai patients than in migrants. Evidence suggested that there might be insured migrants with catastrophic illness who still experienced difficulties in accessing services, let alone uninsured migrants. Unless policies to protect the health of this population are put in place, poor access to health services for the uninsured will continue being a serious public health problem, not only to migrant communities but also to Thai society as a whole. Both macro- and micro policy recommendations are provided, for example, integrating the different authorities’ information systems on migrants, amending some outdated laws and regulations, and strengthening the capacity of the insurance governing body

Household Solar Photovoltaic Adoption in the Maldives: A Socioeconomic Perspective

Energy has become an essential part of our lives, but the current energy sources we used are depleting and non-renewable. In the case of Maldives, fuel energy is expensive due to importation and high transportation cost.  Besides, Atoll islands' characteristics require each island to have a power plant using fossil fuel, and the fuel storage availability is limited, making the electricity in these islands unstable and costly. Therefore, the need for cleaner and reliable resources for energy is essential in order to ensure a better future.  This study aimed to determine the factors influencing solar energy acceptance by inviting people to participate in the electronic survey in the Maldives, with 119 samples collected. The result revealed that most respondents were willing to go for a solar energy source for electrification due to the current high electricity bills. A binary logistic regression analysis was performed to predict the factors for the acceptance of solar energy. The result showed that people's attitudes and current electricity bills were significantly influential in solar energy acceptance. The presumptions for policymakers are to increase the people's knowledge and awareness to elevate a positive attitude and involve the private sector to increase competition and utility in the fiel

Missing: Where Are the Migrants in Pandemic Influenza Preparedness Plans?

Influenza pandemics are perennial global health security threats, with novel and seasonal influenza affecting a large proportion of the world’s population, causing enormous economic and social destruction. Novel viruses such as influenza A(H7N9) continue to emerge, posing zoonotic and potential pandemic threats. Many countries have developed pandemic influenza preparedness plans (PIPPs) aimed at guiding actions and investments to respond to such outbreak events. Migrant and mobile population groups—such as migrant workers, cross-border frontier workers, refugees, asylum seekers, and other non-citizen categories residing within national boundaries—may be disproportionately affected in the event of health emergencies, with irregular/undocumented migrants experiencing even greater vulnerabilities. Because of a combination of political, sociocultural, economic, and legal barriers, many migrants have limited access to and awareness of health and welfare services, as well as their legal rights. The conditions in which migrants travel, live, and work often carry exceptional risks to their physical and mental well-being. Even if certain migrant groups have access to health services, they tend to avoid them due to fear of deportation, xenophobic and discriminatory attitudes within society, and other linguistic, cultural, and economic barriers. Evidence indicates that social stigmatization and anxieties generated by restrictive immigration policies hinder undocumented immigrants’ access to health rights and minimizes immigrants’ sense of entitlement to such rights

The Speech-to-Song Illusion Is Reduced in Speakers of Tonal (vs. Non-Tonal) Languages.

The speech-to-song illusion has attracted interest as a probe of the perceptual interface between language and music. One might anticipate differential speech-to-song effects in tonal vs. non-tonal languages, since these language classes differ importantly in the linguistic value they assign to tones. Here we addressed this issue for the first time in a cohort of 20 healthy younger adults whose native language was either tonal (Thai, Mandarin) or non-tonal (German, Italian) and all of whom were also fluent in English. All participants were assessed using a protocol designed to induce the speech-to-song illusion on speech excerpts presented in each of the five study languages. Over the combined participant group, there was evidence of a speech-to-song illusion effect for all language stimuli and the extent to which individual participants rated stimuli as "song-like" at baseline was significantly positively correlated with the strength of the speech-to-song effect. However, tonal and non-tonal language stimuli elicited comparable speech-to-song effects and no acoustic language parameter was found to predict the effect. Examining the effect of the listener's native language, tonal language native speakers experienced significantly weaker speech-to-song effects than non-tonal native speakers across languages. Both non-tonal native language and inability to understand the stimulus language significantly predicted the speech-to-song illusion. These findings together suggest that relative propensity to perceive prosodic structures as inherently linguistic vs. musical may modulate the speech-to-song illusion

Factors associated with the choice of public health service among nursing students in Thailand.

BACKGROUND: Despite the fact that public and private nursing schools have contributed significantly to the Thai health system, it is not clear whether and to what extent there was difference in job preferences between types of training institutions. This study aimed to examine attitudes towards rural practice, intention to work in public service after graduation, and factors affecting workplace selection among nursing students in both public and private institutions. METHODS: A descriptive comparative cross-sectional survey was conducted among 3349 students from 36 nursing schools (26 public and 10 private) during February-March 2012, using a questionnaire to assess the association between training institution characteristics and students' attitudes, job choices, and intention to work in the public sector upon graduation. Comparisons between school types were done using ANOVA, and Bonferroni-adjusted multiple comparisons tests. Principal component analysis (PCA) was used to construct a composite rural attitude index (14 questions). Cronbach's alpha was used to examine the internal consistency of the scales, and ANOVA was then used to determine the differences. These relationships were further investigated through multiple regression. RESULTS: A higher proportion of public nursing students (86.4% from the Ministry of Public Health and 74.1% from the Ministry of Education) preferred working in the public sector, compared to 32.4% of students from the private sector (p = <0.001). Rural upbringing and entering a nursing education program by local recruitment were positively associated with rural attitude. Students who were trained in public nursing schools were less motivated by financial incentive regarding workplace choices relative to students trained by private institutions. CONCLUSIONS: To increase nursing workforce in the public sector, the following policy options should be promoted: 1) recruiting more students with a rural upbringing, 2) nurturing good attitudes towards working in rural areas through appropriate training at schools, 3) providing government scholarships for private students in exchange for compulsory work in rural areas, and 4) providing a non-financial incentive package (e.g. increased social benefits) in addition to financial incentives for subsequent years of work

Lessons from the Thai Health Promotion Foundation.

To facilitate the policy response to noncommunicable diseases in Thailand, parliament adopted the Health Promotion Foundation Act in 2001. This Act led to the establishment of an autonomous government body, the Thai Health Promotion Foundation, called ThaiHealth. The foundation receives its revenue from a 2% surcharge of excise taxes on tobacco and alcohol. The fund supports evidence generation, campaigns and social mobilization to address noncommunicable disease risk factors, such as tobacco-use, harmful use of alcohol and sedentary behaviour. On average, its annual revenue is 120 million United States dollars (US$). Some notable ThaiHealth-supported public campaigns are for schools free of sweetened carbonated beverages; alcohol abstinence during three-month Buddhist lent; and nationwide physical activity. The percentage of people using tobacco decreased from 22.5% in 2001 to 18.2% in 2014. The annual per capita alcohol consumption decreased from 8.1 litres pure alcohol in 2005 to 6.9 litres in 2014. The percentage of the adult population doing at least 150 minutes of moderate-intensity or 75 minutes high-intensity aerobic exercise per week, increased from 66.3% in 2012 to 72.9% in 2017. A dedicated funding mechanism, a transparent and accountable organization, and the engagement of civil society organizations and other government agencies have enabled ThaiHealth to run these campaigns

Moving towards culturally competent health systems for migrants? Applying systems thinking in a qualitative study in Malaysia and Thailand.

BACKGROUND: Cultural competency describes interventions that aim to improve accessibility and effectiveness of health services for people from ethnic minority backgrounds. Interventions include interpreter services, migrant peer educators and health worker training to provide culturally competent care. Very few studies have focussed on cultural competency for migrant service use in Low- and Middle-Income Countries (LMIC). Migrants and refugees in Thailand and Malaysia report difficulties in accessing health systems and discrimination by service providers. In this paper we describe stakeholder perceptions of migrants' and health workers' language and cultural competency, and how this affects migrant workers' health, especially in Malaysia where an interpreter system has not yet been formalised. METHOD: We conducted in-depth interviews with stakeholders in Malaysia (N = 44) and Thailand (N = 50), alongside policy document review in both countries. Data were analysed thematically. Results informed development of Systems Thinking diagrams hypothesizing potential intervention points to improve cultural competency, namely via addressing language barriers. RESULTS: Language ability was a core tenet of cultural competency as described by participants in both countries. Malay was perceived to be an easy language that migrants could learn quickly, with perceived proficiency differing by source country and length of stay in Malaysia. Language barriers were a source of frustration for both migrants and health workers, which compounded communication of complex conditions including mental health as well as obtaining informed consent from migrant patients. Health workers in Malaysia used strategies including google translate and hand gestures to communicate, while migrant patients were encouraged to bring friends to act as informal interpreters during consultations. Current health services are not migrant friendly, which deters use. Concerns around overuse of services by non-citizens among the domestic population may partly explain the lack of policy support for cultural competency in Malaysia. Service provision for migrants in Thailand was more culturally sensitive as formal interpreters, known as Migrant Health Workers (MHW), could be hired in public facilities, as well as Migrant Health Volunteers (MHV) who provide basic health education in communities. CONCLUSION: Perceptions of overuse by migrants in a health system acts as a barrier against system or institutional level improvements for cultural competency, in an already stretched health system. At the micro-level, language interventions with migrant workers appear to be the most feasible leverage point but raises the question of who should bear responsibility for cost and provision-employers, the government, or migrants themselves

Effect of the Promulgation of the New Migrant's Employment Law on Migrant Insurance Coverage in Thailand: An Interrupted Time Series Analysis, 2016-2018.

This study explores the effect of the recently enacted Foreigners' Working Management Emergency Decree, 2017 on migrant insurance coverage between January 2016 and December 2018. We employed an interrupted time series (ITS) model to estimate the level and trend changes of the number of migrants enrolled in Social Health Insurance (SHI) for formal workers and the Health Insurance Card Scheme (HICS) for other migrants. Before the Decree's implementation, SHI covered roughly a third of the total migrants holding work permits, while HICS covered over half of migrants in the country. We found that the new employment law contributed to a rise in the volume of SHI members and a decline in the HICS members in the long run, which might be partly due to a switch from the HICS members in the formal sector to the SHI, as originally intended by the law. In addition to the law effect, some coincided political force from international trade partners and supranational organizations might also contribute to the progress in protecting the rights of migrant workers. The long-term monitoring of migrant insurance coverage and a mapping against the changes in migrant-related laws and contexts are recommended

Evidence on Child Nutrition Recommendations and Challenges in Crisis Settings: A Scoping Review

Adequate child nutrition is critical to child development, yet child malnutrition is prevalent in crisis settings. However, the intersection of malnutrition and disasters is sparse. This study reviews existing evidence on nutrition responses and outcomes for infants and young children during times of crisis. The scoping review was conducted via two approaches: a systematic search and a purposive search. For the systematic search, two key online databases, PubMed and Science Direct, were utilized. In total, data from 32 studies were extracted and included in the data extraction form. Additionally, seven guidelines and policy documents were included, based on relevance to this study. Overall, the existing evidence demonstrates the negative impacts of crises on nutritional status, diet intake, anthropometric failure, and long-term child development. On the other hand, crisis-related interventions positively affected nutrition-related knowledge and practices. Further studies should be carried out to explore the sustainability of the interventions and the success of existing guidelines. Since this study focuses only on nutrition among children under three, further studies should likewise consider an extended age range from three to five years