A hospitalised migrant worker speaks to his wife and son on a video call
Medical care in Singapore is excellent, actual costs are high, but Singaporeans are relieved from paying the full cost through subsidies. On 30 September 2024, Singapore’s Ministry of Health announced enhancements of these schemes with upcoming healthcare subsidies that will benefit up to 1.1 million Singapore residents. This is definitely news to celebrate.
All Singaporeans will receive subsidies of at least 50% (up from the previous 30%), and up to 80% for inpatient and rehabilitative care, while permanent residents will receive subsidies of up to 50%. In addition, to reflect the rising cost of medical care, the monthly PCHI (per capita household income) threshold to qualify for subsidies for key schemes has been raised. This allows those with higher monthly incomes to qualify for increased subsidies.
The revised subsidies are meant to make healthcare more affordable for patients, improve the accessibility of palliative and community care, and to provide lower-income households with greater financial support.
But why not migrant workers?
Migrant workers have the lowest incomes in Singapore. These low-wage workers include of about 428,000 men working in the construction, marine shipyard, and process (CMP) sectors; and about 279,000 women employed as domestic workers. They may spend all their working years in Singapore, as the sole breadwinner for a large number of family members back home. During these years, they would naturally face injuries and health issues along the way. The hazards to their health and well-being are typically attributed to long working hours, and are compounded by insufficient food, rest, and lack of social life.
Their lives here revolve around their jobs and the demands of their employers. They have no chance of relaxing with family, little time apart from their workplace, and limited freedom to choose adequate and healthy meals. All this contributes to negative health outcomes.
It is not uncommon to hear workers explain that when they arrived at the start of their job, they were strong and healthy. After many years of strenuous work, health problems arise that require testing and long-term treatment. Some of these are diet-related (e.g. diabetes, high cholesterol); others are a result of toiling for long hours (e.g. high blood pressure, arthritis). When they are left alone to deal with these ailments, it is easy to understand why some workers feel that they are being treated as expendable, and that employers care nothing for their personal welfare.
Aren’t their employers required to pay for their medical expenses?
This is true, but the astronomical medical costs indirectly make it difficult for workers to actually use their medical insurance when illness or accidents occur.
In 2007, government subsidies to foreigners were removed and employers were required to buy compulsory medical insurance for their employees. Now, employers of workers in non-domestic sectors must purchase insurance both for work-related injuries, and for non-work-related medical conditions. Employers of female domestic workers must also maintain medical insurance for their employees. The minimum insurance coverage amounts were raised over the years, but because medical care for migrant workers is unsubsidised, the costs can exceed the coverage amounts. These amounts are equivalent to those charged to wealthy medical tourists. Unsurprisingly, the costs seem astronomical to the workers, and unreasonable to the Singaporean employer.
This is especially devastating when a workplace injury occurs. Employers are required to provide insurance that pays up to up to maximum of $45,000, or up to one year from date of accident, whichever comes first. Yet, migrant workers in the CMP sector have told us how employers use various tactics to hinder treatment.
Employers may accompany the injured worker to a small clinic, rather than the Accident & Emergency department, even when the injury is serious. Sometimes, these clinics might be a “company clinic” where, workers tell us, supervisors can influence the way the doctor prescribes medication and medical leave. At these clinics, the patient’s (injured worker’s) words and physical condition are largely ignored, and medical certificates (MCs) and medical records are withheld from them. Some employers also refuse or delay payment to government hospitals, denying the injured worker needed diagnostic tests, and treatments that may be urgent (here).
Employers may also deny the validity of the work injury claim, resulting in long investigations by the insurance company that leave injured workers in an indeterminate period of uncertainty and financial stress (here). Workers have also told us about employers who try to persuade the worker to return home to seek cheaper treatment elsewhere, either by trying to repatriate them before they can seek treatment, or by pressuring them to withdraw the insurance claim (here). Given the unsubsidised costs in Singapore, the unscrupulous actions of employers is not an entirely surprising consequence.
Why not make use of the insurance policies?
For non-work injuries, it could be that the employer sees the problem as the worker’s personal issue, and would prefer to repatriate the worker. Tapping into the insurance policy would also raise the cost of premiums. For work injuries, the employer’s reluctance could also be due to a fear of incurring demerit points when a work injury claim is filed. Denying that there was a workplace accident may then be the preferred strategy, which explains why the employer’s failure to validate the injury claim and reluctance to pay medical bills is a common feature among injured workers seeking advice from TWC2.
This system is especially problematic because it causes migrant workers to be heavily reliant on the employer’s timely compliance on legislation in order to access the medical care they need. Consider their salaries. Female domestic workers in Singapore earning about $530/month are the lowest paid migrant domestic workers among Asian countries. Male workers have similar salary levels, but are able to earn more by working overtime. Typical salaries with overtime for male workers would be about $800/month. Given the need to repay recruitment fees and to provide for the family’s needs, migrant workers can hardly be expected to fund their own medical treatment in Singapore. When employers attempt to evade drawing on their insurance coverage to cover these costs, the bodies of injured workers suffer the consequences.
Are low-wage workers really welcomed as key contributors to Singapore’s economy? Or are they viewed with disdain and suspicion, as problems that can be easily shipped back to their own countries, out of sight and out of mind? Singapore’s denial of affordable medical care points to the distancing of this large group of people. While ensuring that migrant workers continue to sustain the rate of economic growth, Singapore gives little consideration to their personal health and well-being. How a society treats those who are different, or non-resident, is telling of its values (or lack thereof) of inclusivity, kindness and empathy.