| Alisa Tang |
BANGKOK (Thomson Reuters Foundation) – Zaw, an illegal Burmese migrant dying of AIDS-related illnesses, spent a weekend hunched over in waiting rooms at three Thai hospitals near Bangkok – each denying him care as he gasped for breath, his lungs full of fluid.
At a fourth hospital that admitted him, a doctor drove a large-gauge needle between his ribs, draining litres of fluid, but by then the 34-year-old was gravely ill.
Zaw died 40 days later – a death the Bangkok-based HIV Foundation that was helping him says could have been prevented with timely care.
Hospitals across the country are denying insurance and care to migrant labourers like Zaw despite an insurance scheme launched over a year ago, officials and rights advocates say.
“That’s the story we have once every six to eight weeks: people in this situation, and we can’t get them the care they need in time,” Scott Berry, an Australian adviser for the HIV Foundation, told the Thomson Reuters Foundation.
“If we have a Thai, who has an identification card, we can pay for them to get them into a hospital, but if they’re from another country, then we find that really difficult to do.”
Thailand hosts an estimated three million migrant labourers, mostly from neighbouring Myanmar, Cambodia and Laos, and 1.6 million of them are legally registered with the government.
The country has had a health package for migrants for more than 10 years, officials say, but an August 2013 policy expanded the migrant health insurance benefits – at a cost of 2,100 baht ($64) per person – to include HIV prevention, care and antiretroviral (ARV) drugs.
“If you are non-Thai … documented or undocumented, you are eligible for that health insurance,” said Sumet Ongwandee, director of the health ministry’s bureau of AIDS and sexually transmitted diseases.
However, he and his colleagues acknowledge that many hospitals still turn away migrants because they do not understand how the insurance scheme works and worry they will have to cover the costly HIV care out of their own budgets.
For each migrant who buys health insurance, 600 baht ($18) is put into a fund for treatment of people with HIV/AIDS, and 50 baht ($1.50) into a fund for “high cost” care, including AIDS-related opportunistic infections such as tuberculosis, pneumonia and encephalitis.
Hospitals caring for HIV/AIDS patients need only to file claims and will be fully reimbursed, said Buncha Kakhong, head of the health insurance group in the permanent secretary’s office at the health ministry.
The ministry called in staff from the 800 hospitals around the country twice in the second half of last year to tell them how HIV/AIDS claims are made and how the central HIV/AIDS fund works, but some still may not understand, he said.
Hospitals are obliged to let patients buy an insurance card, Buncha told the Thomson Reuters Foundation.
The ministry is trying hard to improve awareness, but there are no punishments for those who fail to provide service, he said. Thailand has made huge strides in fighting HIV, slashing the estimated number of people infected to 8,100 in 2013, from 143,000 in 1991, and last year extending free ARV drugs to all Thais with HIV. HIV prevalence is about one per cent among Thais aged 15 to 49, and about one to two per cent among migrants, with low-paying migrants facing the most exploitation.
Migrants, who do low-paying, backbreaking jobs across the country, face widespread exploitation and discrimination.
In the past, when migrants with AIDS sought care at hospitals, the staff would hand them over to NGOs, who would help transport them to the border, where they would die, too poor or ill to cross the border to return home, said Promboon Panitchpakdi, head of the Raks Thai Foundation.