Predictors of Accessibility to Health Care under Social Security Scheme among Myanmar Migrant Workers in Hat Yai District, Songkhla Province, Thailand

Abstract

This cross-sectional study was designed to explore accessibility, policy literacy and barriers to health care services. Moreover, it was intended to test predictability of personal factors, i.e., gender, marital status, monthly income, educational level, living period, time taken to access the nearest health care service, policy literacy and barriers on accessibility to health care services under the Social Security Scheme among Myanmar migrant workers. Data was collected from 240 migrant workers in Hat Yai district, Songkhla province. Those living and working in Thailand for at least one year were purposively recruited from four types of factories: seafood, rubber, wood and mechanics. A structured questionnaire was used to collect the data and consisted of four parts: (1) Personal data form, (2) Policy literacy questionnaire, (3) Barriers on accessibility to health care service questionnaire, and (4) Health care service accessibility questionnaire. Open-ended questions were added to capture qualitative data on policy literacy, barriers and health care accessibility. Content validity of the tool was examined by three experts employed in areas of public health, health systems and community health. The reliability of the questionnaire was tested in 30 Myanmar migrants from one factory. Cronbach's alpha coefficients for policy literacy, barriers and accessibility to health care service questionnaire were 0.87, 0.84 and 0.72, respectively. Descriptive statistics were used to describe personal data, policy literacy, barriers and accessibility to health care services. A stepwise linear regression model was used to test predictability of individual factors, policy literacy and barriers on accessibility to health care services. Open-ended questions were analysed using simple content analysis. Results revealed moderate scores in total, including all domains of policy literacy and in the overall score barriers in accessibility to health care services at both the individual and system level. In addition, the total score of accessibility to health care services and subtotal scores of availability and financial accessibility were moderate. In contrast, geographic accessibility and acceptability were low. From the qualitative analysis we found that migrants would like to have more information sharing about the scheme and experienced barriers such as language issues, lack of knowledge on health care services, and long waiting times at hospital. Concerning with health care accessibility, Myanmar migrants reported that transportation, hospitality and attitudes of health care providers, and cross-culture understanding were important issues. Regression analysis showed only two factors significantly associated with accessibility of health care services: policy literacy (B = 0.53, p < 0.01) and barriers (B = -0.28, p < 0.01) and these factors could explain 47.2% of the total variance on accessibility to health care services. Therefore, recommendations such as distributing pamphlets and training health volunteers for informing about the scheme are essential to improve health care access for Myanmar migrants.