This subsection describes the key themes from the interviews with service users. Six common themes were identified, namely, (1) Difficulties in managing the insurance for migrant employees, (2) Diverse reasons for seeking the insurance card, (3) Ambiguity of employment status, (4) Support from family and employers, (5) Satisfaction with the health service and the card policy in general, and (6) Uncertain future of the vulnerable.
The first theme was mainly raised by the employer respondents, while the other five themes were described by migrant interviewees. Note that, to protect confidentiality of the respondents, names of respondents below have been changed.
Difficulties in managing the insurance for migrant employees
All four employers (RN_E1, RN_E2, RN_E3, and RN_B1) articulated that the HICS created difficulties for employers. From their outlook, the HICS should not be a compulsory measure. The rationale behind this idea was that most migrant workers, especially those working in offshore fishing boats, were very mobile. Besides, most seafarers spent much of the time offshore. Thus the employers mentioned that it was not worth paying for the insurance for their employees as they had fewer chances to enjoy services.
This problem was coupled with the registration of migrant workers. Legalised migrants (those who passed the NV) were able to travel throughout the country. From the perspective of employers, this regulation created the risk of losing their employees. In contrast, (illegal) migrants, who had not completed the NV, were not allowed to move outside the registered province. As a result, it was more likely that illegal migrants would not leave their employers.
The situation of migrant sea workers in Thailand became more complex following EU sanctions in 2015. The EU attempted to crack down on illegal, unreported, and unregulated (IUU) fishing with the threat of import restrictions. In April 2015 Thailand acquired a warning, so-called, the 'yellow card', from the EU due to an allegation of IUU
193 fishing as well as slave labour and trafficking on fishing vessels. Such a situation caused the country's fishery industry to fall into disarray and prompted the government to issue a new Royal Decree on Fishery to respond to this pressure (The Nation, 2015). The new Decree imposed 'stricter' supervision and a 'more severe' punishment on those who breached the law. This created massive strikes from many domestic fishing entrepreneurs since they deemed that this new regulation was 'unfair' and 'impractical' (for example, downsizing the permitted fishing areas of local fisheries), and those likely to benefit most from the Decree, were large-scale enterprises (Isranews Agency, 2015).
Kwan-on (2015) suggested the stringent supervision created fear of being arrested in many migrant sea workers because some migrants worked offshore over months and at times exceeded the permitted length of stay/work in the country. Accordingly, some migrants might leave their employers before the boat embarked on a journey, or right after the boat landed.
"I always opposed the HICS. If that is for land migrants or those at the fish docks, I will be OK with it. But for seafarers, I totally disagree because they don't have a chance to use the insurance. They are always aboard. I lost over a million for the insurance. Some migrants stayed with me for just a couple of months, then they left their work. And who paid for their insurance? It is the employer! I didn't even have a chance to deduct their salary to recover my expense. The policy makers did not understand this setting. Do you think this policy is successfully implemented? I think it was just 30% successful."
[RN_E3]
Another problem raised by the interviewees was the red tape in the registration. Two employers (RN_B1 and RN_E2) pointed out that the registration process was burdensome. As a result, a reliance on private intermediaries or brokers was considered an effective means to overcome this difficulty despite causing additional expense. The Thai Chamber of Commerce (2014) also reported that there were a number of unregulated employment intermediaries or 'ghost' brokers in Thailand.
"Now there emerges a new job that helps complete the registration for migrants on behalf of the employers…It is more convenient but I had to pay more (laugh!). It
194 charged me 500 Baht per head of migrant. But the registration takes numerous steps, and is very tiresome, and there are so many people. That's why I don't want to get involved. So I am OK with hiring them (brokers)." [RN_E2]
Diverse reasons for seeking the insurance card
Of the ten migrant interviewees, seven were insured. For the insured respondents, there were diverse reasons in obtaining the card: from health benefit, security benefit, and even having no specific idea about the card (since the employer initiated it).
Almost all respondents (except MM3, who was a translator at the health facility) stated that they did not have clear knowledge about the card benefit. Two respondents (MK2 and MK4) stated that they did not have a specific intention when buying the card. They viewed the health card as part of the 'package' when they registered with the authorities (through the assistance of employers or brokers).
Two respondents (MM4 and MM5) had a misconception that the card did not cover treatment of traffic accidents (in fact, the card covered traffic accident treatment in the same way as the UCS). One of the interviewees (MM6) shared her experience that the card benefit went beyond health issue by protecting her from the officials, who threatened her with deportation. She also expressed that, recently, just after the junta came into power, there was news that the military might arrest the uninsured migrants.
As a result, she decided to join the OSS.
While some health providers expressed that the insurance was spoiled by sick migrants, the interview with migrants found that only two of the seven card holders bought the card after they felt ill (MM2, and MM4), and one of the uninsured (MM1) sought the card when he was first diagnosed with HIV/AIDS (but at the time of writing, the card had already expired and had not been renewed). The story of MM2 (case study 1) shown in Appendix 11 was an example of this account.
195 Ambiguity of employment status
The seminal intention of the OSS was to 'sweep and clean' all illegal migrants in the country. A migrant granted a legitimate residence permit in Thailand must be a 'worker', with a clear job description and employer details. However, in the real world, especially in places like Ranong province, where most migrants were engaged in low-skilled jobs and transportation across the border could be done very easily, the employment status of migrants was not always clear. The above story of Monn (MM2) showed that there was a disparity between 'job written in the work permit' and the 'real job', in which a migrant was being engaged.
For this issue, there were three respondents whose life story could reflect the complexity of employment status. The first case was Tho (MM2), a 42-year-old illegal immigrant, who had been residing in Thailand for over 20 years. He joined the registration process during the OSS. Tho was running his karaoke shop in Muang district. Strictly speaking, registered migrants in Thailand were allowed to work in certain jobs only (see Chapter 5), but 'shop owner' is not in the list of permitted jobs. However, his work permit indicated that he was a labour employee. The real shop owner was his Thai employer, allowing Tho to run the shop freely as though it was Tho's asset. Tho needed to pay a monthly rent (about 5,000 Baht (US$ 152)) to his employer.
At the other end of the spectrum was the case of a 'migrant worker' without 'work permit'. Aye-Mo (MM5)'s story matches this scenario. She was a 50-year-old migrant who had been living in Thailand for more than 20 years. She had never been registered with the MOI. Thus she did not hold Tor Ror 38/1, and this explicitly meant that she could not apply for a work permit. Yet it was difficult to claim that she was an 'illegal resident' as she always held a 'border pass'.
The border pass was a document, authorised by the mutual agreement between the two nations, that allowed Thai and Burmese residents to commute between the border towns (in this case, crossing from Ranong province to Kawthaung district, and vice versa), with a maximum stay of not more than two weeks. The border crossing by the border
196 pass was valid for visiting the border town only. Onward travel to other places still needed visa and passport. In other words, the border pass was like a lenient border control that facilitated the travelling of inhabitants for short-stay tourism or business purposes, see Figure 24.
Figure 24 Appearance of the border pass
Source: Real picture taken from the interviewee
Aye-Mo always had her border pass stamped at the border biweekly as if she travelled from Myanmar. She always bought goods from the border and earned a living by selling them to her neighbours. Her overall health was still good; therefore buying the health card was not of interest at this moment. She mentioned that the card was too costly. If she wished to buy the insurance card, she would need to seek assistance from a broker to help her acquire a passport and a work permit first.
The last example was more complex. It was the story of Za's family (MM6), an illegal immigrant family from Myanmar, see her life story in Appendix 11 (case 2) for more detail. Za had been dwelling in Muang district for over ten years. Za peeled shrimps for
197 a living and had already acquired a work permit. However, the employer specified in the work permit was not the employer that hired her to peel shrimps. All of her documents (work permit, health card, and Tor Ror 38/1) were managed by a broker, and Za stated that she had no idea about her 'de facto' employer.
Support from family and employers
In general, migrants in Kraburi district appeared to have better living conditions than those in Muang district. Of the four migrant interviewees from Kraburi district, three were already insured and had completed the NV (MK2, MK3, and MK4). The interviewees from Kraburi district had higher income, lived in more spacious houses, and received better support from peers and family members.
A potential explanation of this phenomenon, as expressed by one of the employer interviewees, (RN_E2), was that most rubber field owners tended to treat their migrants nicely. The 'nice' treatment included provision of better shelters, fringe benefits, higher wages, and helping migrants to undertake the registration process. The interviewer opined that the likely explanations for this phenomenon were: (1) most migrants in Kraburi district were indeed 'not-poor' (some even owned their business on the other bank of Kraburi river) and (2) the rubber market price in Thailand had declined over recent years; therefore without proper treatment, migrant rubber field workers might leave for other provinces to seek more promising jobs.
"The current migrants are those who expect that the rubber price may go up. But there are fewer new workers now. Some of our migrants even have their own rubber field on the other bank (of the river). It is like they use us as their learning field (laugh!)."
[RN_E2]
Three of four migrant interviewees (MK2, MK3, and MK4) in Kraburi district still had connections with their relatives in Myanmar. In contrast, almost all migrant interviewees in Muang district were distanced from their relatives in Myanmar. The only case in Muang district that still maintained her links with peers or relatives in Myanmar was Ae
198 (MM3), who had quite a good education background and was now serving as an interpreter at the health centre.
Kraburi district is separated from Myanmar by the Kraburi river. Travelling from one bank to the other is very cheap and convenient (about US$ 2 per head per trip by a speedboat). Therefore, migrant interviewees in Kraburi district stated that they travelled back to Myanmar quite often for various reasons (such as visiting relatives, joining cultural/religious festivals, or looking after their rubber fields in Myanmar). Jin (MK2) was an example. She lived with her husband and her one-month-old baby in a small house provided by the rubber field landlord. She did not pay for accommodation, except the utility bills. Everybody in the household was insured and had already acquired temporary passports through the assistance of the landlord. Her cousin from Myanmar also crossed the river to help her take care of her child every other day. Jin planned to take her son back to Myanmar to enter a school there. Another similar instance was Wei (MK3). The detailed story of Wei's life is presented in Appendix 11 (case 3).
Satisfaction with the health service and the card policy in general
All respondents who were insured by the HICS, opined that they were generally satisfied with the services they received. Wei (MK3) articulated that the hospital usually provided good quality care. Ayee (MM3) and Tho (MM2) confirmed that most doctors at the hospital were very kind, however frontline administrative staff and nurses tended to be less nice. They preferred visiting a hospital over a health centre as doctors were always available there (in the Thai context, services at a health centre are normally operated by nurses). They were happy with the card since it saved considerable treatment expense (compared to not having the card).
Nevertheless, a private clinic still had an important role in health-seeking behaviour, particularly in non-severe illnesses and for the uninsured migrants (see the case story of Su [MK1] in the subsequent subsection). Over half of the interviewees (~7/12) reported that they visited a private clinic when they got ill. Cho (MK4) emphasised that the critical advantage of visiting a private clinic was the shorter waiting time, though there
199 was always a cost incurred (ranging from 200 Baht [US$ 6] to 500 Baht [US$ 15] per visit).
It was worth mentioning here that Cho's family had some distinct features. She had been living with her Thai husband for over ten years without a marriage document. Legally speaking, with a long stay in Thailand and strong link to the country (through a marriage with a Thai national), she was eligible to apply for Thai nationality (but, in practice, she might need to complete the marriage document first). Cho's husband expressed that he had ever explored if Cho was able to obtain Thai nationality, but he finally forwent this idea after experiencing the red tape. As Cho was diagnosed with hypertension that demanded continuing treatment, her husband helped her acquire insurance by informing the official that he had hired Cho as a housemaid. Thus, in the work permit, Cho was acknowledged as a housemaid employee with her husband as a Thai employer, and this enabled her to be insured with the HICS.
Though Cho was satisfied with the status quo since at least she was insured, she said that it would be better if the insurance coverage could expand to her family members.
The important aspect of Cho's family was that it consisted of members of more than three nationalities. In the household, there were Cho (Burmese), her husband (Thai), her husband's son born by his ex-wife (Thai), and her husband's daughter in law, Kan (displaced Thai). Kan did not have a birth certificate or any identification document since her parents died when she was very young. She spoke Thai fluently and was familiar with Thai culture. People in the community always recognised her as displaced Thai.
Strictly speaking, Kan would have been insured with the HI-PCP if the national survey for stateless people by the MOI (according to the 2005 National Strategy, see Chapter 5) had been done completely. Although, in fact, the HICS allowed Kan to buy the 2,200-Baht card even though she was undocumented (see details of the H-series in ‘Unclear policy message—Devil is in the detail’), the health centre staff, who occasionally visited Kan's family, were still ignorant about this system, let alone Kan and her family.
However, Kan was still healthy. Obtaining the card was not her primary concern at this