Dr Samrit Srithamrongsawat, a community health researcher from Mahidol University’s Faculty of Medicine at Ramathibodi Hospital, announced the findings during a focus group seminar on universal health coverage, as part of the Prince Mahidol Award Conference 2017.

He said the study, sponsored by the Health Systems Research Institute (HSRI), investigated community health projects for vulnerable groups in Umphang in Tak, Ubolrat in Khon Kaen, Dansai in Loei, Khon Buri in Nakhon Ratchasima, Kuchinarai in Kalasin, Lam Sonthi in Lop Buri, Kongra in Phatthalung and Khlong Klung in Kamphaeng Phet.

“The study found vulnerable people face greater health risks than ordinary people and limited access to treatment. Although Thailand has universal health coverage, policy still has loopholes. Vulnerable people still cannot access what the state provides through this policy,” Samrit said.

Dr Borwornsom Leerapan, who was on the research team, said vulnerable groups had at least two out of three characteristics. The first group were marginalised people, such as the poor, stateless or tribal minorities, migrant workers, orphans, sex workers, drug addicts or former convicts.

The second group were in need of healthcare but had limited access to services such as those without health coverage or those residing in rural areas. The latter were at risk of abandonment or abuse if they had no long-term health care, such as the elderly, disabled, mentally ill or bedridden patients.

Despite universal health coverage existing for over a decade, Borwornsom said it was still uncertain whether all Thais had access to the state-provided service and whether it was good quality and catered to their health needs.

Although the government tried to reduce differences among the three main health schemes – universal healthcare, the Social Security Office fund and the civil service health scheme – not enough attention had been given to developing a system to care for vulnerable groups who subscribed to the three schemes, he said.

HSRI director Peerapol Sutiwisetsak said the study prompted the agency to call for a clear public policy to provide appropriate healthcare to vulnerable groups. Related agencies could use the group’s degree of access to assess the schemes’ quality and equity.

He said the ready-made, fit-for-all healthcare policy would not work for these people and he urged more diverse formats to support different contexts and each group.