Healthcare Inequities: The Visible Challenges We Keep Leaving Behind

Contributor: Kronthip Inmueang

As an undergraduate nursing student, I understood that obtaining healthcare services in Thailand, my home country, was straightforward and equitable for everyone, regardless of poverty or social status, as I learned from the course material. Nevertheless, after graduating, becoming a nurse, and working in a government hospital, I started seeing a different reality. Based on my previous work experience, one of my stroke patients, who had irregular migration and was poor, came to the hospital with weakness on one side of his body.T hankfully, he did not have a brain haemorrhage and was immediately given a CT scan. The doctor advised him to have an MRI Brain scan for a more thorough examination; however, due to his lack of health insurance and the financial burden of personal expenses, the patient denied the MRI because he could not afford the additional charges. Because of this fact, my previous belief in healthcare equity is merely an ideal, as my personal experience points out the gap in healthcare resulting from economic inequities.

In addition to economic disparities, other factors, such as differences in urban and rural residences and legal constraints, might contribute to healthcare inequity. These can lead to barriers to accessing medical care and result in unequal allocation of healthcare resources, which often impacts vulnerable populations. In this context, the vulnerable population involves undocumented migrant laborers, ethnic minorities living in remote areas, and low-income families, who often struggle with systemic and societal barriers to receiving healthcare services.

Several schemes, both international and domestic organizations, attempt to address the disparity issue. For instance, the World Health Organization (WHO) has released a Universal Health Coverage campaign, which has the important message that no one is left behind in accessing high-quality healthcare, regardless of their financial situation, whenever and wherever they need it (Espinosa et al., 2023). Like Thailand, our government has undertaken policies to reduce healthcare service gaps, such as the 30 Baht Universal Healthcare Scheme. This policy initially aimed to deliver healthcare services for Thai citizens, regardless of the nature or severity of their disease, for 30 baht per illness (NaRanong & NaRanong, 2006). This strategy is beneficial in encouraging equal access to medical care for Thai populations, notably those with low incomes; however, it fails to include migrant workers without documentation, who play a vital role in Thailand’s economy.

In the real world, it can be challenging to resolve in practice since Thailand has 65 million residents, with roughly 1.5 million undocumented migrants from neighboring Cambodia, Laos, and Myanmar (Suphanchaimat et al., 2017). Economic hardship is one of the major drivers of migration, forcing many to seek higher incomes. Unfortunately, this group frequently experiences inequities, including limited access to primary healthcare under Thailand’s 30 Baht Universal Health Scheme and restricted access to information and education. These limitations ultimately increase their vulnerability to illness.

Although the project of Thai government’s 30 Baht Universal Health Scheme has notably enhanced healthcare equity for low-income Thais, it also revealed and reinforced infrastructural disparities when analyzed through the Critical Caring Theory lens. This concept shows how the policy reinforces social biases by classifying people as deserving or undeserving of access to the 30 Baht healthcare service. Hence, I recognize that these disparities result from policies formed by power and oppression inside the healthcare sector’s infrastructure rather than individual failure.

Furthermore, healthcare disparity arises from the unfair distribution of healthcare resources, especially for rural hospitals that confront substantial resource shortages, such as a lack of healthcare workers and critical equipment. In many emergencies, patients living in remote areas must be transported to urban hospitals to access advanced technology and expert personnel. This issue, therefore, demonstrates existing gaps in the distribution of resources between cities and rural communities.

As a result of all the challenges I have raised above, it became evident that these might all limit access to healthcare. Consequently, it is time for all parties to address these issues, particularly nurses, who play a crucial role in the healthcare system. As a nurse, I am inspired by Emancipatory Nursing Praxis to contribute to addressing this issue. This notion reveals the crucial role of nurses in recognizing and solving social injustices that limit access to healthcare, especially for marginalized populations. It is a transformative process that consists of four keyelements: becoming aware, awakening, engaging, and transforming. It guides nurses beyond acknowledgement toward meaningful action and systemic change.

Based on my experience, language barriers between healthcare practitioners and immigrant patients exemplify such inequities. Nurses can move beyond identifying the problem by advocating for translation services to become a standard practice, ensuring equitable access rather than a privilege. Furthermore, engaging in community-based initiatives is essential to advancing health equity. Nurses can work with local authorities to develop culturally inclusive health campaigns, provide preventive health education, and conduct screenings in underserved areas, ultimately fostering healthcare system accessibility and social justice.

To sum up, as both a current PhD student and a nurse, I am committed to raising awareness about this issue and ensuring no one is left behind in accessing our healthcare system. I believe that delivering sufficient healthcare services to these patients is beneficial for health prevention and reduces the rate of sickness requiring hospitalization and mortality, as well as the expense of treatment in the country. Hence, although we may not have the authority to change the entire healthcare system, we can speak up and bring these oftenoverlooked issues to light, fighting for significant improvements because our commitment to equitable health services must overcome racial, linguistic, social hierarchy and cultural barriers, ensuring that all patients receive the care they deserve.

References:

Espinosa, M. F., Andriukaitis, V. P., Kickbusch, I., Nishtar, S., Saiz, E., Takemi, K., Barron, G. C., Koonin, J., & Watabe, A. (2023). Realising the right to health for all people—UHC is the umbrella to deliver health for all. The Lancet Global Health, 11(8), e1160-e1161.

NaRanong, V., & NaRanong, A. (2006). Universal health care coverage: impacts of the 30-Baht health-care scheme on the poor in Thailand. TDRI Quarterly Review, 21(3), 3-10.

Suphanchaimat, R., Putthasri, W., Prakongsai, P., & Tangcharoensathien, V. (2017). Evolution and complexity of government policies to protect the health of undocumented/illegal migrants in Thailand–the unsolved challenges. Risk management and healthcare policy, 49-62.

About Kronthip Inmueang

I am 100% Thai and the first generation of my family to pursue a higher education beyond a bachelor’s degree. I am interested in equity in the healthcare system since I worked as a nurse in Thailand and frequently had to care for undocumented immigrant patients. They led me to discover various issues with them. Importantly, although many countries strive to implement a rich policy, we must acknowledge that this strategy cannot equally address the difficulties across the country. I discovered that language challenges, geographical and social status differences, and economic issues impact patients and make them feel tough. As a result, I want to be a part of the empowerment to generate equity, particularly in the healthcare industry, and keep going forward indefinitely through my future studies.

References:

NaRanong, V., & NaRanong, A. (2006). Universal health care coverage: impacts of the 30-Baht health-care scheme on the poor in Thailand. TDRI Quarterly Review, 21(3), 3-10.