Protracted statelessness and nationalitylessness among the Lahu, Akha and Tai-Yai in northern Thailand: Problem areas and the vital role of health insurance status

Abstract

Thailand has one of the largest stateless populations in the world. Stateless people are denied access to basic rights and services, driving inequality and discrimination and threatening peace and security. This article aims to explore the problems that stateless people are facing in their daily lives, with a focus on healthcare services, health insurance coverage, and mobility. Primary data were collected in 2020 from 108 stateless and nationalityless adults in Chiang Mai province, belonging to three ethnic minorities, and analyzed using a mixed methods approach. The respondents are exposed to daily environmental stressors, the most serious being exclusion from the Universal Coverage Scheme, mobility restrictions and the absence of land rights. While out-of-pocket health expenditures increase financial vulnerability, a lack of health insurance is also associated with perceived poor quality of care and unmet healthcare needs. However, observed differences among the three ethnic groups highlight that some problems are specific to individual ethnic groups and not necessarily a consequence of citizenship problems. Given the experience Thailand has gained in achieving universal health coverage for Thai citizens, there is an opportunity to address the healthcare plight of Thailand’s stateless and nationalityless population through prioritizing the expansion and improvement of the existing Health Insurance for People with Citizenship Problems policy.