Utilisation of and factors associated with non-COVID-19 healthcare services in public facilities amongst cross-border migrants in Thailand, 2019-2022

Abstract

Background: It is believed that the COVID-19 pandemic might disrupt routine healthcare services. A vulnerable group such as cross-border migrants is of critical concern if the pandemic affects their service utilisation. In this study, we aim to explore the impact of COVID-19 and other related factors on non-COVID-19 service amongst cross-border migrants in Thailand.

Methods: We conducted an ecological time-series cross-sectional analysis using secondary data from 2019 to 2022, focusing on insured and non-insured migrants in a unit of a provincial monthly quarter. We obtained data on registered migrants from the Ministry of Labour and inpatient visits from the Ministry of Public Health (MOPH). Our analysis involved descriptive statistics and a random-effects negative binomial regression, considering variables such as COVID-19 cases, number of hospital beds, registered regions, and COVID-19 waves. We assessed inpatient utilisation number and rate as our primary outcomes.

Results: The admission numbers for insured and non-insured migrants in all regions increased 1.3-2.1 times after 2019 despite a decrease in the numbers of registered migrants. The utilisation of services for selected communicable and non-communicable diseases and obstetric conditions remained consistent throughout 2019-2022. The admission numbers and rates were not associated with an increase in COVID-19 incidence cases but significantly enlarged as time passed by compared to the pre-COVID-19 period (44.5-77.0% for insured migrants and 15.0-26.4% for non-insured migrants). Greater Bangkok saw the lowest admission rate amongst insured migrants, reflected by the incidence rate ratio of 5.7-27.5 relative to other regions.

Conclusion: The admission numbers and rates for non-COVID-19 healthcare services remained stable regardless of COVID-19 incidence. The later pandemic waves (Delta and Omicron variants) were related to an increase in admission numbers and rates, possibly due to disruptions in outpatient care, leading to more severe cases seeking hospitalisation. Lower admission rates in Greater Bangkok may be linked to the fragmentation of the primary care network in major cities and the disintegration of service utilisation data between private facilities and the MOPH. Future research should explore migrant healthcare-seeking behaviour at an individual level, using both quantitative and qualitative methods for deeper insights.

Keywords: COVID-19; Health service; Migrants; Negative binomial regression; Thailand.