**5. Conclusions**

The results showed that most of the Western husbands in the northeast of Thailand were in their retirement age, and had NCDs, health risk behaviors, and mental health problems. Most of them did not purchase health insurance and were not proactive in planning for their long-term health as they believed that they were did not need any healthcare services. Furthermore, many of them had certain negative impressions toward the quality of care at Thai public hospitals and this was a major barrier to accessing health care services. Other barriers to accessing healthcare included the high cost of treatment commonly charged by private hospitals and language issues. While the improvement of the quality of healthcare as well as the provision of friendly health services are of utmost importance, public communication with international migrants and especially male expatriates is highly recommended to increase understanding and positive impression towards the Thai health care system. A regular population-based survey on the health and well-being of expatriates in Thailand, a cost study of a health insurance package for this group, a survey study on willingness to pay for health insurance premiums, and a feasibility survey to explore the opportunity of establishing, either voluntary or compulsory, health insurance among this group of people should also be conducted.

**Supplementary Materials:** The following are available online at https://www.mdpi.com/article/10 .3390/ijerph182111017/s1, Supplementary File S1.

**Author Contributions:** Conceptualization, S.J., N.P. and R.S.; data collection S.J., N.P., M.P., P.S., A.K.; formal analysis, S.J. and N.P.; methodology, S.J., N.P., and R.S.; project administration, S.J., P.S.; funding acquisition N.P.; supervision R.S.; validation S.J. and N.P.; writing—original draft, S.J. and N.P.; writing—review and editing, N.P. and R.S. All authors have read and agreed to the published version of the manuscript.

**Funding:** This study received funding support from the Health Systems Research Institute, Thailand (HSRI 63-163). The funder had no role in study design; data collection, analysis, or interpretation; the writing of this manuscript; or in decisions to submit this article.

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institute for the Development of Human Research Protections in Thailand (IHRP 036/2563).

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Data Availability Statement:** Ethical restrictions are imposed by the Institute for the Development of Human Research Protections, Thailand. The provision of complete interview transcripts is prohibited as these transcripts contain potentially identifiable and sensitive information of the participants.

**Acknowledgments:** We are very grateful for support received from IHPP, HSRI, Thailand. We thank all key informants, especially the son-in-law Westerners, for their participation in this study. In addition, we thank the support of data collection by district health offices, namely Suwannakhuha, Nong Bua Lam Phu, Kumphawapi, Udon Thani, Khuean Ubolratana, Khon Kaen, and Ban Koeng Health Center in Khon Kaen, and all local public health personnel in the studied sites.

**Conflicts of Interest:** The author reports no conflicts of interest in this work.
