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首页> 外文期刊>Risk Management and Healthcare Policy >Evolution and complexity of government policies to protect the health of undocumented/illegal migrants in Thailand – the unsolved challenges
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Evolution and complexity of government policies to protect the health of undocumented/illegal migrants in Thailand – the unsolved challenges

机译：保护泰国无证/非法移民健康的政府政策的演变和复杂性-未解决的挑战

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Background: Of the 65 million residents in Thailand, >1.5 million are undocumented/illegal migrants from neighboring countries. Despite several policies being launched to improve access to care for these migrants, policy implementation has always faced numerous challenges. This study aimed to investigate the policy makers’ views on the challenges of implementing policies to protect the health of undocumented/illegal migrants in light of the dynamics of all of the migrant policies in Thailand. Methods: This study used a qualitative approach. Data were collected by document review, from related laws/regulations concerning migration policy over the past 40 years, and from in-depth interviews with seven key policy-level officials. Thematic analysis was applied. Results: Three critical themes emerged, namely, national security, economic necessity, and health protection. The national security discourse played a dominant role from the early 1900s up to the 1980s as Thailand attempted to defend itself from the threats of colonialism and communism. The economic boom of the 1990s created a pronounced labor shortage, which required a large migrant labor force to drive the growing economy. The first significant attempt to protect the health of migrants materialized in the early 2000s, after Thailand achieved universal health coverage. During that period, public insurance for undocumented/illegal migrants was introduced. The insurance used premium-based financing. However, the majority of migrants remained uninsured. Recently, the government attempted to overhaul the entire migrant registry system by introducing a new measure, namely the One Stop Service. In principle, the One Stop Service aimed to integrate the functions of all responsible authorities, but several challenges still remained; these included ambiguous policy messages and the slow progress of the nationality verification process. Conclusion: The root causes of the challenges in migrant health policy are incoherent policy direction and objectives across government authorities and unclear policy messages. In addition, the health sector, especially the Ministry of Public Health, has been de facto powerless and, due to its outdated bureaucracy, has lacked the capacity to keep pace with the problems regarding human mobility.
机译：背景：在泰国的6,500万居民中，有超过150万是来自邻国的无证/非法移民。尽管已出台了多项旨在改善这些移民获得照料的政策，但政策的实施始终面临众多挑战。这项研究旨在根据泰国所有移民政策的动态，调查决策者对实施保护无证件/非法移民健康政策的挑战的观点。方法：本研究采用定性方法。数据是通过文件审查，过去40年来有关移民政策的相关法律/法规以及与七名主要政策级官员的深入访谈收集的。应用了主题分析。结果：出现了三个关键主题，即国家安全，经济必要性和健康保护。从1900年代初到1980年代，随着泰国试图保卫自己免受殖民主义和共产主义的威胁，国家安全话语发挥了主导作用。 1990年代的经济繁荣造成了明显的劳动力短缺，这就需要大量的移民劳动力来推动经济增长。在泰国实现全民健康覆盖之后，保护移民的健康的第一次重大尝试是在2000年代初实现的。在此期间，引入了无证/非法移民的公共保险。保险使用了基于保费的融资。但是，大多数移民仍未投保。最近，政府通过引入一项新措施，即“一站式服务”，试图对整个移民登记系统进行全面改革。原则上，一站式服务旨在整合所有负责机构的职能，但仍然存在一些挑战;其中包括模糊的政策信息和国籍验证过程进展缓慢。结论：移民卫生政策面临挑战的根本原因是政府当局的政策方向和目标不一致，政策信息不清晰。此外，卫生部门，特别是公共卫生部，事实上已经无能为力，而且由于官僚机构过时，因此缺乏与人口流动问题保持同步的能力。

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