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Welfare State is not enough
Health Care Disparities of Homeless People and Informal Workers in Thailand
Cholnapa ANUKUL
Ce...
4%
Private
6%
Civil Servant Medical Benefit Scheme
15%
Social Security Scheme
75%
Universal Coverage Scheme
Thailand at a ...
Vulnerable Population: Two Case Studies Research
Homeless
Bangkok Population 8.28 mio
Bangkok’s Homeless
Population 1,307*...
Objectives
To explore health and healthcare disparities
among Homeless and Informal Workers
.
To analyze the gap within we...
Health Disparities: Homeless Physical Health
Methodology
129 Homeless People
Questionnaires
Trained Interviewers
Results
S...
Health Disparities: Homeless Mental Health
Methodology
124 Homeless People
Thai PSQI (Pittsburg Sleep Quality
Index) Quest...
Healthcare Disparities: Informal Workers
Methodology
Secondary Data Analysis
Labor Force Survey (LFS)
Informal Employment ...
Discussion
Homeless
Exclusion from Public Health
Care Scheme
Invisibility
Failure of Welfare Policies
preventing Homelessn...
Conclusion
Health Inequity remains.
Welfare policies are not enough.
Wealth and Income Distribution are needed.
Living Wag...
Welfare State is not enough: Health Care Disparities of Homeless People and Informal Workers in Thailand
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Welfare State is not enough: Health Care Disparities of Homeless People and Informal Workers in Thailand

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Thailand has three public health insurance schemes covering almost all of its population. Everyone with Thai nationality has an access to health care services and is protected from catastrophic health spending. However, the health disparities among marginalized population still remain. This paper examines how homeless people are treated different from normal people and why informal workers have to pay for basic health service, which even non-worker could have access for free. In general, homeless people have poor health because of the lack of good nutrition and access to social service. Since homeless issue is quite new for Thai society, homeless people are understood as poor and lazy individual people rather than the evidence of policy failure against social poverty. Hence, the structural intervention using welfare strategy preventing homelessness is less spoken. The recent social safety net could not foresee how it could avoid sending people to homelessness. As well as the informal workers, who work harder than formal workers, but 2 millions of them are living in poverty and 6 millions are lower paid. Therefore, their incomes are not enough for living and have to co-pay in public health insurance scheme. Welfare system alone has less impact to health disparities among marginalized people. Thailand need more reform in income redistribution as well as wealth distribution.

Published in: Government & Nonprofit
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Welfare State is not enough: Health Care Disparities of Homeless People and Informal Workers in Thailand

  1. 1. Welfare State is not enough Health Care Disparities of Homeless People and Informal Workers in Thailand Cholnapa ANUKUL Center of Just Society Network CivicNet Foundation, Thailand RC15 Roundtable Session 1 : C Wednesday, 13 July 2016: 14:15-15:45 Hörsaal BIG 2 (Main Building) RC15 Sociology of Health
  2. 2. 4% Private 6% Civil Servant Medical Benefit Scheme 15% Social Security Scheme 75% Universal Coverage Scheme Thailand at a Glance Key Indicators Values Population (2014) 67.96 million Public Health Coverage 96% GDP (2015) $404.8 billion Gini Coefficient Index (2012) 39.26
  3. 3. Vulnerable Population: Two Case Studies Research Homeless Bangkok Population 8.28 mio Bangkok’s Homeless Population 1,307* 10% in Shelter 90% in public area Informal Workers** 31 mio workers Population 70% Informal Workers (22.6 mio) 2 mio Poor Informal Workers (monthly income < 73$) 6 mio Low Paid Informal Workers (monthly income 73$ – 173$) * Pithukthanin A. et al, Homeless Survey Project 2015 ** Ngamarunchot B. et al, Report of Vulnerability and Inequity by Informal Workers, 2015
  4. 4. Objectives To explore health and healthcare disparities among Homeless and Informal Workers . To analyze the gap within welfare policies.
  5. 5. Health Disparities: Homeless Physical Health Methodology 129 Homeless People Questionnaires Trained Interviewers Results Smoking 49% Alcohol Drinking 31% Disability 19% Skin Problems 47% Oral Health 51% High Blood Pressure 36% Risk of High Blood Pressure 39% Public Health Service Access: very low Findings Need of Sanitation Public Toilet/Bathroom Cloth washing and drying Need of Health Service Chronic disease
  6. 6. Health Disparities: Homeless Mental Health Methodology 124 Homeless People Thai PSQI (Pittsburg Sleep Quality Index) Questionnaires Trained Interviewers Informed Consents Approved by Ethic Committee of Faculty of Medicine, Rama Hospital Results Mental Disorder 70% Alcohol dependent 70% Major Depression & Dysthymia 30% Anxiety 10% Bipolar disorder 5% Findings Mental disorder rate 3 times alcohol dependent rate 16 times depression & dysthymia rate 25 times Anxiety rate 4.5 times Bipolar disorder rate 17 times higher than Bangkok Population*. Need of mental health service. *Thai National Mental Health Survey 2013
  7. 7. Healthcare Disparities: Informal Workers Methodology Secondary Data Analysis Labor Force Survey (LFS) Informal Employment Survey (IES) Socio-economic Survey (SES) Primary Data Analysis 439 informal workers 149 agricultural sector 126 industrial sector 164 service sector Results • Monthly income 229$ • 47% low wage workers • 85% more than 50 hours/week Finding Informal Worker has income rate 2.55 times lower than formal workers. Health Service Need unmet: Inconvenience, No Time, No Money
  8. 8. Discussion Homeless Exclusion from Public Health Care Scheme Invisibility Failure of Welfare Policies preventing Homelessness Homeless Risk Factors Poverty by Informal Economy Unemployment Low wage Mental Illness Informal Workers Exclusion from Social Security Scheme Only 2 mio (from 22.6 mio) informal workers could pay for SSS. Inequity within Social Security Scheme Pay more Less Health Service
  9. 9. Conclusion Health Inequity remains. Welfare policies are not enough. Wealth and Income Distribution are needed. Living Wage Negative Income Tax

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