Waiting, Worrying, and Paying: Migrant Healthcare Inequities in Northern Thailand

Background: Migrant workers face a double burden of disease: communicable and non-communicable diseases worldwide. Despite international and national agencies coordinated efforts for equitable health access for migrant workers through various health strategies and labor policies, profound inequalities in health-seeking behavior are observed. The Thai government has adopted a universal health coverage strategy to diminish marginalization and social exclusion for vulnerable groups. Myanmar migrant workers in Northern Thailand encounter complex systemic healthcare disparities occurring from structural factors, including precarious legal status, unstable employer-linked insurance, language barriers, fear of deportation, and discrimination. This study aimed to explore how and why migrant workers are marginalized and excluded from enriched health security. Methods: A qualitative descriptive study was conducted using in-depth, semi-structured interviews with 10 purposively selected Myanmar migrant workers (insured = 5, uninsured/undocumented = 5) in Chiang Rai Province. Interviews (25–40 minutes) were conducted in the Myanmar language. Detailed contemporaneous notes were translated into English summaries in collaboration with experts and analyzed thematically within the Andersen Healthcare Utilization Model framework for categorizing findings into predisposing and enabling factors. Stringent ethical protocols followed anonymity, confidentiality, and participant safety. Results: Key barriers included long waiting times at public facilities, insurance discontinuities, fear of legal repercussions among undocumented migrants, language difficulties, workers' mobility, and perceived discrimination, including financial toxicity. Participants often preferred private clinics or self-care due to convenience and accessibility. Health insurance facilitated service use but was frequently unstable due to employer practices and migrant mobility. Conclusions: Myanmar migrant workers encounter systemic and multifaceted obstacles that limit effective healthcare utilization despite nominal availability. These barriers lead to high out-of-pocket expenditure, even though migrants face social and financial challenges. Policy action is needed to ensure portable and non-discriminatory insurance and service points, interpreter services, and migrant-friendly units within the public health system, guaranteeing equitable access regardless of immigration status.