Nearly half (44.2%) of doctors surveyed said that they had encountered situations where a migrant worker patient self-discharged from a hospital ward against medical advice. About two in five (39.4%) said they had seen patients who did not receive the treatment procedure or surgery that was needed.
These and other shortcomings in delivering healthcare to migrant workers were revealed in a survey of 427 doctors conducted in 2016 – 2017. The research paper was published in the online edition of the Singapore Medical Journal in September 2019 and can be found at this link: http://www.smj.org.sg/sites/default/files/OA-2019-038-epub.pdf
The surveyed doctors were from four public hospitals, with a median experience of ten years. Almost all indicated that they have had migrant worker patients under their care.
The survey asked doctors whether they have ever encountered seven situations wherein healthcare for a migrant worker was compromised. The seven are shown as C1 to C7 in the chart below and explained in the legend below that.
Respondents could add further details of their experiences if they chose “Other”. Some of their experiences make for disturbing reading. For example:
– “Employer sent him back to home country before any treatment”
– “Patient repatriated after initial condition stabilised”
– “Was sent back to own country the day of discharge”
– “Financial issues (as employer did not insure the workers)”
– “Medical decisions made based on cost considerations”
– “Patient refused for dialysis when he was admitted to ICU. Eventually died next
day; at one point he was still alert and able to give his opinion regarding dialysis;
money was the main factor that held him back”
– “Rehabilitation needs not fully supported by employer”
– “Lack of proper care facilities and support for patients with disability in terms of
walking and self-care post discharge”
– “Not brought to hospital as employer refused to bring (him); had to be brought in
by colleague when he had persistent severe pain”
– “Delayed surgery as employer not in agreement”
– “Employer sought to downplay extent of injury and causality stating it was not an
industrial accident and occurred at own time in dormitory”
Again and again there is mention of employers and their cost considerations getting in the way of appropriate and necessary medical treatment.
The survey also polled doctors about their knowledge about migrant health policies. Six statements were provided in the survey and respondents were asked to rate each as True, False or Unsure. The median was only four correct answers out of six.
The best knowledge scores were for the statements:
“Employers are required to provide migrant workers food and lodging should they suffer a work-related injury and are awaiting their case to be closed by the Ministry of Manpower” where 82% of doctors correctly rated this statement as True.
“Migrant workers have compulsory health insurance” was a statement where 78% of doctors correctly rated as True.
Not so good scores:
“Migrant workers are eligible for subsidised health care” — a False statement, and only 73% of doctors knew this was False.
“Employers are ultimately responsible for migrant worker’s healthcare costs, whether work-related or not” — only 67% knew this statement was True.
Pretty bad scores:
“Migrant workers can be repatriated by employers if they are unable to work due to an injury/illness but only after outstanding bills/payments/cases are settled” — 56% of respondents said this was True. However, in TWC2’s opinion, this statement had too many elements and the “bills/payments” part of the sentence is confusing.
“Migrant worker’s health insurance typically cover outpatient healthcare costs” — this statement is False, but only about 50% of doctors knew this with certainty.
The researchers noted that among the barriers to migrant workers accessing healthcare, the “degree of knowledge/healthcare advocacy among healthcare providers” is also a factor.