“And therefore never send to know for whom the bell tolls, it tolls for thee”
John Donne
Back in March, Professor Victor Hoe of the University of Malaya kindly invited me to listen to Singapore Management University’s Professor Phua Kai Hong speak on “Migration and Healthcare” as a part of a series of lectures on global health.
The crux of the matter was healthcare policies for immigrants. An interesting topic? Is it even important?
If you were in doubt, a walk through the heart of Kuala Lumpur on a Sunday evening may change your mind.
It may be politically incorrect to say so, but there are opinions flying around that question the use of taxpayers’ money to look after migrant workers. That doesn’t however mean that these opinions are in any way true. In fact, The Asia- Europe Foundation (ASEF), upon studying access to healthcare among migrants in Austria, Italy, Hong Kong and Singapore reports that exclusion of migrants from primary healthcare causes unnecessary loss of human capital, and raises social costs due to delayed and denied care - which is not just a human rights issue, but also a socio-economic dilemma.
Having worked nearly 12 years as a medical and public health doctor with the Malaysian Ministry of Health and as medical advisor for FWHS Medik Sdn Bhd which handles upwards of half the national SPIKPA medical claims (Health Insurance Protection Scheme for Foreign Workers), I am only too aware of the scenarios faced by foreign workers seeking healthcare assistance after unfortunate events at the workplace.
The first obstacle is getting registered as a non-local labourer at a counter at the nearest government hospital registration counter. The web of complex policies may be legally valid, but prevents them from receiving reimbursement for medical fees.
Professor Phua explained that relying on private medical insurance alone is not sustainable as the health costs of migrant workers are actually paid by 3 parties - 50% by the workers themselves, 27% by the community and 23% by the employer. In Singapore, whose workforce is 40% migrant, the estimated total lifetime cost for migrant workers in 2011 was $4 billion.
But what about foreign workers in Malaysia? Are we on the same page as Singapore? Do we even know how many foreign workers grace our shores? A conservative guess would be about 6 million out of the 16 million that make up the total workforce- that is, 2.5 undocumented workers for each legitimate foreign worker. Calculator in hand, that again works out to billions in healthcare costs.
A knee jerk solution would be to reduce our dependency on low-cost foreign labour. But these workers are mainly employed jobs deemed too dangerous, difficult, dirty or undesirable by local workers. Taking foreign workers out of the equation will thus not solve anything until technology and automation negate the need for human beings to run these industries, and so - for now at least, employers are ‘addicted’ to low-cost labour, and we haven’t any choice but to look their socio-economic problems in the eye.
As a public health provider, I will echo that education and empowerment is the key. Most migrant workers arrive at our borders as healthy individuals, and should be kept so by their employers arming them with a safe working environment, conducive (not cramped, unhygienic) living conditions, adequate nutrition and reasonable working hours. Investments in physical and psychosocial health of these workers yield returns in reduced potential healthcare costs, high worker retention rates and far more productive workers.
Government and non- governmental agencies, public health providers, employers and the migrant workers themselves obviously need to hold hands and work together to improve the health of migrant workers and subsequently reduce healthcare costs among this group. Prevention is better than a cure is only a cliché because it repeatedly rings true. Our road to attain first world infrastructure should not be paved with the lifeless bodies of our foreign workers. For if it is, it’s only a matter of time till we follow.
I just came across this article about my talk on Migration and Health, given at the University of Malaya's Department of Social & Preventive Medicine on 14 March, 2019. Little did I now then that this topic on the neglect of foreign workers was going back to haunt us a year later in the current Covid-19 pandemic. In addition, the little study that was done of the occupational health problems of foreign workers was prescient to the larger problems related to the health of the population and of the economy.
Fast forward to the continuous waves of uncontrolled epidemic spread of infectious diseases and the seeming loss of public health control within the community. Apart from a lack of epidemiological…