# Equity of Social Health Insurance Coverage for Migrants in Thailand: A Concentration Index Analysis
## 4 Discussion  
Overall, this study is probably among the first studies in Thailand that examined deeply the relationship between SSS coverage and the provincial economic status. The importance of this research is that it will help the government prioritize areas with certain economic status if policy makers wish to expand the SSS enrolment for migrant workers. The SSS is part of social protection for workers. This concept is implemented not only in Thailand but also in many countries which rely on a labour-intensive economy. For instance, the Malaysian government introduced the Employment Injury Scheme under the Social Security Organisation (SOCSO) to provide health protection for occupational injuries and diseases, including free treatment at SOCSO panel clinics and government hospitals since January 2019 [15]. For Indonesia, the BPJS Ketenagakerjaan Social Security Scheme was implemented for migrants who worked in Indonesia for at least six months and paid contributions, and it included their family members [16]. Employee registration was required for all social security schemes in the three countries (Indonesia, Malaysia and Thailand); however, penalties for employers who failed to register their employees in the system were clearly written only in Thailand and Indonesia's Acts. Singapore, another Southeast Asian country, also had an Employment Foreign Manpower Act (EFMA) that regulated employers' obligations to provide migrant workers with health insurance under social security [16; 17]. This study points towards some worthwhile learning and messages. First, though the employment law imposes a penalty on employers who leave their migrant employees uninsured, in some areas the insurance enrollment is still far from complete. Second, the enrollment in the insurance is not subject to the law enforcement alone as the contextual economic environment also matters. The above findings indicate that the distribution of migrants in the SSS scheme (SSS coverage) was mainly equitable across provinces in Thailand (CIs are close to zero) with some variations from year to year. Some potential explanations of this phenomenon are as follows. In mid-2014, there was a major change in Thai politics. First, the coup took place and at that time there was a major change of the migrant registration policy (namely, the One Stop Service (OSS) policy). The military government launched a leniency period to allow undocumented migrants to register with the government [6; 18]. The registered migrants (in the formal sector) were later insured with the SSS as stipulated in the bylaws. As a result, the number of total migrants registered in the system increased exponentially. Note that the OSS policy began in the border areas which were mostly the less well-off provinces. This would explain why the CC lay convexly above the equality line (CI showed negative values) in the early years (2015-2016). The second explanation was related to the change in the employment law in 2017. In the past, the employment regulation on migrants followed the \"Working of Aliens Act, B.E. 2551 (2008) Section 54\", which mentioned that if an employer of migrants did not have his/her employee registered for a work permit, he or she would be fined for 10,000-100,000 baht (US$330-3300) per an unregistered migrant [19]. Then, in 2017, the new law was promulgated. The essence of the law was the same except that the government raised the penalty to 400,000-800,000 baht (US$11,766-US$23,532) per unregistered migrant. Moreover, the government also increased jail time for undocumented workers and their employers to a maximum of five years [20]. The law was imposed on all types of migrants. In addition, areas that were most affected by the new regulation were likely to be the economically well-off provinces where the provincial economy heavily depended on industrial and service sectors. This might help explain why the CI converged (from negative values) to close to zero in all business sectors in 2018.