Development of a Financial Management Model and Access to Healthcare Services for Transnational Population in Thailand-Myanmar Border Areas, Tak Province.

Abstract

The Tak border area hosts a significant migrant population, posing challenges to the public health system due to geographical, linguistic, cultural, and financial barriers. Despite existing health insurance schemes, gaps remain, leading to substantial financial burdens on local hospitals. This study aimed to: 1) investigate healthcare access among migrants, 2) analyze the budgetary impact on health services, and 3) develop healthcare access and budget management models for border districts in Tak Province. A parallel mixed methods design was employed, encompassing three phases: planning, implementation, and evaluation. Data collection involved in-depth interviews, focus groups, and workshops.

Phase 1 (Planning) revealed approximately 400,000 migrants in the area, 60% of whom were uninsured. This lack of coverage resulted in an annual uncollectible debt of 150 million THB for five border hospitals. Utilization rates were 24.7% for out-patients and 34.7% for in-patients, indicating that existing facilities and personnel are insufficient for the growing population. Phase 2 (Implementation) introduced a dual-strategy model: 2.1) establishing Border Health Centers (BHC) to expand coverage and 2.2) promoting affordable health insurance. Phase 3 (Evaluation) showed that BHC utilization increased by 26.1% between June and November 2025. Furthermore, enrollment in Ministry of Public Health insurance and the M-Fund rose 4.0 and 4.4 times, respectively. This surge significantly mitigated financial losses, reducing uncollectible debt by 19.5% compared to the 2022–2024 period.

The findings suggest that decentralized service points and accessible insurance schemes are vital for enhancing healthcare equity and ensuring the financial sustainability of border health systems.