Association between health insurance status and care-seeking behaviors for tuberculosis diagnosis and full treatment among Myanmar migrants in southern Thailand

IntroductionMyanmar migrant workers in Thailand face elevated tuberculosis (TB) risk due to crowded living conditions, labor-intensive work, and limited access to healthcare. Health insurance may influence care-seeking behavior and treatment completion, yet evidence among this population is limited. The objectives of this study are: 1) to assess the extent to which health insurance status is associated with intended care-seeking behavior for tuberculosis diagnosis among migrants when developing symptoms, and; 2) to assess the extent to which health insurance status is associated with the intention to receive the full course of treatment for tuberculosis in Thailand if given the diagnosis MethodsWe conducted a cross-sectional study among 330 Myanmar migrant factory workers using a self-administered questionnaire written in Myanmar language. Key outcomes included intention to seek formal healthcare if TB symptoms developed and intention to complete the full course of TB treatment if diagnosed. We used logistic regression analyses to assess the association between the exposure and outcomes with adjustment for age, sex, income, education, marital status, length of stay in Thailand, and TB history. ResultsMost participants reported that they had health insurance (96.1%), and three-quarters (73.3%) reported that they would seek formal healthcare if they developed TB symptoms, and more than four-fifths (83.6%) reported that they would complete the full course of TB treatment in Thailand if diagnosed. Uninsured participants were more likely to not seek formal care (37.5% vs. 17.5%; Adjusted OR = 4.71, 95% CI = 0.60, 36.88). All uninsured respondents who answered the treatment question indicated they would complete the full treatment. ConclusionUninsured workers were less likely to seek formal care than insured workers when they developed TB symptoms, but were universally intent on staying in Thailand for the full course of treatment if diagnosed with TB. Limitations regarding the measurement question, selection bias, and information bias should be considered in the interpretation of the study findings.