Prevalence of, and Factors Associated with, Unmet Healthcare Need in Urban Refugees and Asylum Seekers in Bangkok, Thailand: a Mediation Analysis
DOI:
https://doi.org/10.59096/osir.v17i2.269288Keywords:
urban refugee, asylum seeker, unmet healthcare need, healthcare, Thailand, mediation analysisAbstract
This study examines the prevalence of, and factors mediated to, unmet healthcare need of urban refugees and asylum seekers (URAS) in Thailand. In 2019, a cross-sectional survey of 181 URAS was merged with Thai data (total n=3,122). Self-reporting questionnaire was applied. Unmet healthcare need, defined as a status where a person needed health examination or treatment within the past 12 months, but he or she did not receive it, were analysed using multivariable logistic regression within a concept of mediation analysis. URAS were younger and had lower household economic status than Thais, and almost all URAS were uninsured. Most URAS suffered from a high prevalence of unmet healthcare need, 54.1% (range 31.4–100.0%) for outpatient (OP) care and 28.0% (range 0–83.3%) for inpatient (IP) care, while unmet healthcare need prevalence amongst Thais was 2.1% for both OP and IP care. For OP care, the direct effect of URAS status (predictor) on unmet healthcare need (outcome) showed a significant adjusted odds ratio (AOR) of 8.8 (95% CI 1.3–58.6), and a total effect (combining direct effect and indirect effect where insurance status served as a mediator) had AOR as large as 42.3 (95% CI 26.4–67.8). A significant total effect was also observed for IP care (AOR 13.1, 95% CI 7.8–22.0). Since most URAS substantially suffer from a lack of insurance coverage and this markedly influenced healthcare inaccessibility, policymakers should prioritise expanding insurance coverage towards URAS to promote health equity for all.
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