Obstetric Service Utilization in Public Health Facilities during COVID-19 Pandemic among Cross-border Migrants in Thailand, 2019–2022

Abstract

The COVID-19 pandemic caused changes in obstetric care for the general population in Thailand. This study aimed to determine changes in obstetric admissions among migrants and assess potential factors influencing obstetric inpatient visits during the COVID-19 pandemic. An ecological time-series cross-sectional study was conducted using nationwide data between 2019 and 2022. Descriptive statistics were used to investigate outcome variables, including incidence number for obstetric inpatient care among insured migrants and uninsured migrants, and admission rate for obstetric inpatients among insured migrants. Independent variables included the cumulative incidence number of COVID-19 cases in a particular quarter, the number of hospital beds, geographical regions and time periods. This study then used random-effects negative binomial regression to explore the relationships between the outcome and independent variables. The incidence of all outcome variables during the COVID-19 pandemic (2020–2022) was higher than in 2019. The incidence of COVID-19 cases did not show a strong effect towards the change in obstetric admissions. For every 1,000-bed increase in hospital capacity, the admission rate decreased by approximately 8% (IRR 0.92, 95% CI 0.89–0.95) when adjusted for yearly periods, and by 9% (IRR 0.91, 95% CI 0.89–0.94) when adjusted for 6-monthly interval periods. Compared to Greater Bangkok, other regions exhibited lower numbers of hospital admissions for both insured and uninsured migrants. Conversely, the admission rate among insured migrants was higher in these regions. Continuous monitoring of the utilization of obstetric services by migrants offers benefits for proper policy design to ensure universal healthcare access for all.