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

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

resultsAccess 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.

conclusionsAlthough 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.