Why Migrant Workers in Northeast Thailand Lack Adequate Dental Services: A Confluence of Instrumentality

Background: Despite Thailand's reputation for universal health coverage and ASEAN's stated commitment to expand regional social protection, migrant workers in the kingdom experience poorer access to dental care than Thai citizens. This paper presents qualitative findings on dental provision collected in 2016-2017, which, given the largely unchanged institutional and policy framework affecting migrant dental services, may help explain why care remains limited, uneven, and under-prioritised. While we cannot be sure that behaviour and practices affecting dental provision remain the same nine years later, recent studies of migrant worker access to general healthcare suggest that they are unlikely to have changed greatly.

The research involved 61 interviews with policymakers, administrators, dental professionals, and employers, alongside 11 focus groups completed with migrant workers.

Access to dental care was constrained by structural barriers: complex registration pathways, disconnected multiple insurance schemes, and employer non-compliance. However, these factors alone did not fully explain sub-optimal service utilisation. Although there was variation in opinion within each stakeholder group, perspectives were typically characterised by instrumental reasoning: calculations of cost, convenience, and perceived need. Many policymakers viewed existing arrangements as a good-enough interim solution pending eventual enrolment in the Social Security Scheme; most dental professionals framed migrants as low-value patients with limited entitlements; employers weighed administrative burden and worker turnover when deciding whether to fund insurance enrolment; and migrant workers themselves frequently delayed care, normalised dental pain, or sought cheaper treatment across the border. These intersecting orientations formed a "confluence of instrumentality" and collectively suppressed demand for reform, keeping dental care peripheral within migrant health policy.

Although the delay in publishing our data is a major limitation, the findings of the study provide potentially valuable insights into the present situation. Everyday reasoning among key stakeholders can reproduce and accentuate structural inequities. Policymakers need to address both systemic constraints that affect migrant access to dental care and the pragmatic calculations that mediate how such constraints affect utilisation.