SOC319: Sociology of Health and Healthcare: Inequalities in Healthcare

Question 1

Thailand is a diverse country as it is home to several ethnic, language and religious groups. Another less known distinction is the divide between the upland and lowland peoples. The majority of the lowland people constitute the Thai population who are mainly Buddhist; there are indigenous populations residing in the Northern reaches, like the Akha, Hmong and Lisu, to name a few. These ethnic minority groups adhere to a way of life distinct from those living in the lowlands (Vaddhanaphuti 2005) and they engage in swidden cultivation (Bruun et al. 2017). However, the thriving ethnic tourism project with businesses in the northern city of Chiangmai have repackaged the cultures of these ethnic highland minority groups and successfully sold them to tourists (Leepreecha 2005), bringing them into the forefront. In line with this, the Thai government has invested heavily in the infrastructure in the northern reaches where many of these ethnic groups live in an effort to promote ethnic tourism since it helps to grow the country’s economy.

Paradoxically the Thai government has attempted to assimilate these minority groups within the constructs of a “mono-cultural framing of Thailand” (Morton 2016: 3) in spite of exploiting their uniqueness for profit. In response, there has been a movement among these minority ethnic groups to redefine their identity and status in opposition to claims of the Thai state that these ethnic minorities are: “migrants…who by nature and historical background are not indigenous to the country” and therefore cannot be called indigenous peoples (Anaya 2008, as cited in Morton 2016: 4) and are instead “alien, uncivilized and [even] dangerous” (Morton 2016: 4). This marginalization they face and that many of these ethnic minorities live in very remote areas means that access to basic healthcare amongst them has been uneven in spite of the introduction of various facilities bringing about numerous changes to the lives of these people.

Generally residing in mountainous areas for any population makes it difficult to access healthcare services. Reaching the closest healthcare facility can take hours, if not days for those living deep in the mountains: with the rainy season making it even more difficult for them to receive timely and relevant healthcare when needed (Yingtaweesak et al. 2013). Although all Thai citizens are eligible to free healthcare under the Universal Healthcare System, those living in remote areas still have to incur costs such as for transport and food if they wish to access healthcare services. In essence, healthcare is not exactly completely free for them.

Aside from geographic location, numerous other barriers continue to exist for the ethnic minorities in Thailand since many, especially for the elderly amongst these ethnic minorities, do not speak the Thai language. Indigenous communities also face health disadvantages linked to social deprivation because of having lower levels of education (Moonpanane et al. 2022), leading to lower levels of health literacy among them compared with the general Thai population. During times of crisis such as  COVID-19, their marginalization was pronounced when their movements were curtailed further, impacting on healthcare utilization. Furthermore in Thailand, access to healthcare is uneven across rural and urban areas although there is no difference in healthcare values amongst urban and rural residents (Ikai et al. 2016).

It is clear that structural inequalities are the principal factor for many marginalized communities in their access to equitable healthcare. This is more pronounced for many economically disadvantaged countries because of poor infrastructure. Although some have “made strides toward improving healthcare access, rural regions continue to face significant barriers due to socio-economic disparities, geographical challenges, and insufficient healthcare infrastructure” (Sato 2024).

Discuss the following questions based on your research of primary and secondary materials:

A. Review the barriers to healthcare services among urban and rural populations in a less affluent country such as Thailand. (25 marks)

B. In light of Andersen’s model of healthcare utilization, appraise why a multifaceted approach is needed to improve healthcare access, comparing Thailand and a developed country such as the United States. You may cover a total of three concrete solutions their governments have undertaken in responding to barriers their citizens may face in accessing healthcare. (35 marks)

C. As a small country, in contrast to Thailand and the United States, Singaporeans do not face the structural barrier of geographical distance in accessing healthcare services although they might encounter other barriers. In your essay, discuss the common barriers a Singaporean may face in accessing healthcare services. Is ethnic minority status a determining factor in healthcare access or would you say income is a greater barrier in accessing healthcare services in Singapore? (40 marks)

For Part C, you are also expected to undertake face-to-face interviews with two (2) Singaporeans on their views on healthcare access in Singapore. Your respondents may or may not be employed (which could influence their views on how income may impact on healthcare access); they should be from an ethnic minority group in Singapore; and they could be from different income groups – one middle and the other lower income group (for the latter, housing could be used as a proxy). Your essay should incorporate their responses, in particular their self-reported responses on healthcare access in Singapore, as well as their observations of the health policies and programmes the Singapore government has formulated and designed to meet the needs of different groups of Singaporeans.

Nursing Assignment Answers: Expert Answers on Above Healthcare Inequalities Case Study

Barriers to health care services in Thailand

An analysis of the barriers to health care services in Thailand indicates the major barriers as geographic barrier, economic barrier, language and cultural barriers, educational and social barriers and structural inequalities. In Thailand, the rural and Highland communities stay far away from hospitals, and its accessibility to poor rural populations is restricted even after having a Universal health coverage policy in Thailand. The health literacy is also very low because many minorities do not speak Thai.

Andersen’s model and comparing Thailand and the US

According to the model, the accessibility to health care depends on many factors including enabling resources such as income and insurance, and need factors such as perceived health needs. In respect to Thailand, it has a Universal coverage scheme with the objective of providing low cost access to care, and there are mobile clinics across rural regions for better accessibility. But the issues like limited resources and language barriers often create difficulties in ensuring complete access to health care. However, in respect to the United States, it has an affordable care act with the objective of expanding insurance coverage, and the rural barriers are addressed through community clinics. However the issues with healthcare access are still there in the US because of racial inequities.

Need for a multifaceted approach

A multifaceted approach will help in ensuring access to Healthcare, and by way of combining financial support, education and technology, it can be possible to improve the access to healthcare and thereby ensuring equity.

Healthcare Access barriers in Singapore

When it comes to Healthcare access barriers in Singapore, the most common barriers are cost, elderly and migrant workers, and huge waiting time because of long queues in public hospitals. In addition to this, the ethnic minorities face the risk of systemic exclusion, and the income factor is also a major barrier in accessing Healthcare by lower income households in private care. The interview with two respondents, one from Malay indicates the struggles with the cost of medication and long waiting time whereas the second respondent indicates the cost pressure as a major burden in getting quality care.

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