This study aimed to investigate illness situation, healthcare seeking behavior and use of different types of health services, in relation to contextual and individual characteristics of Myanmar people residing and/or working in Mae Sai – Tachileik border market area and to explore possible challenges to Thailand‟s health service system. Specifically, two data collection and analytic approaches were performed: (1) for the demand side, a survey questionnaire was used to obtain quantitative data from 520 potential users of health services in Thailand including Myanmar people residing/working in either Mae Sai or Tachileik and (2) for the supply side, semi-structured interviews were conducted to obtain qualitative data from 11 representatives of Thai health services providers in Mae Sai.
The survey results revealed that the proportion of the respondents in Tachileik who reported having illness in the past six months was higher than that in Mae Sai. The socio- economic characteristics among Myanmar people in Mae Sai was found to be more diverse and thus significantly contributed to their illness experience. In general, healthcare seeking for both groups followed a similar pattern, which was, Myanmar residents/workers were likely to seek for care at the place of work/residence. When seeking for care in the country of residence/employment, the respondents in Mae Sai and Tachileik mostly used self-medication, followed by private facility, and public facility. Those in Mae Sai appeared to have better access to public facility as compared to those in Tachiliek. A different pattern of healthcare seeking behavior was found between the respondents who sought for care across-border. Those who lived/worked in Mae Sai but sought for care in Myanmar mostly crossed the border for self- medication while those who worked/lived in Tachileik but sought for care in Thailand mostly crossed the border for getting care from health facilities. Myanmar people who worked/lived and sought for care in Mae Sai were people having better economic status, having less language barriers, having health insurance, and less mobile. Myanmar people who worked/lived in Tachileik but sought for care in Mae Sai were people with higher education, better economic status and more severe symptoms compared to those who sought for care within Myanmar border. Perceived quality, availability in specialized services, and familiarity were main motivations for using health services in Thailand.
The challenges to Thailand‟s health service providers, as indicated by Thai health practitioners included cultural barriers (i.e., language and false beliefs); lack of medical records and adherence to treatment of infectious diseases; insufficient resources in public hospitals; and dissatisfaction among Thai clients. Interestingly, no providers reported financial burden from direct services. To the system-level, the challenges were indirect costs for border health program implementation on Thailand‟s side due to underestimation of unregistered immigrant workers in the border regions. The utilization of healthcare services by Myanmar people was seen as an economic opportunity for both private and public health facilities. It was not certain that the number of potential healthcare users from Myanmar would increase in the midst of the establishment of AEC and border trade regulations.