MALAYSIA: Medical Bills to Soar for Migrant Workers

By IPS Correspondents Reprint | | Print |

Anil Netto

PENANG, Nov 17 2005 (IPS) - Beginning next year, foreigners will have to pay much higher charges for medical treatment in Malaysia’s state-run hospitals-a move that will hit the country’s two million migrant workers the hardest.

Health Minister Dr Chua Soi Lek announced recently that foreigners would no longer enjoy health subsidies given to locals. Instead, they would be regarded as ‘full payment patients’. He said the new rates would be based on the Malaysian Medical Association schedule of fees for private practitioners and hospitals.

Migrant workers are already paying substantially higher fees than Malaysians at state-run hospitals. From June last year, they have been charged the same rate as local ‘first class’ patients, which can be about 10 times higher than what most other Malaysian patients pay.

The first-class rates in state-run hospitals are, however, still much lower than private sector fees. A caesarian section procedure in a private hospital, for instance, would cost 600 US dollars compared to the state-run hospital’s first-class fee of 267 dollars. (The usual rate that most local patients would pay at a state-run hospital is 26 dollars.)

By comparison, the average take-home pay of a migrant worker ranges from 133-160 dollars per month, inclusive of overtime (assuming a 12-hour work day).

Chua said the government decided to impose full payment after discovering that foreigners had cheated to get treatment as well as to reduce the “flooding” of foreign citizens in government hospitals.

He pointed out that, after first-class charges were imposed in government hospitals, the number of outpatients dropped from more than 500,000 to 337,000. But the number of patients warded rose from 50,000 to 64,000; many of these, he said, had used false documents and vanished before settling their bills.

“We must move away from our total dependence on foreign workers,” he was quoted as saying. The Malaysian government spends two percent of Gross Domestic Product (GDP) on health care. Total spending, both public and private, hovers around three to four percent of GDP – well short of the minimum five to six percent recommended by the World Health Organisation.

Employers have expressed alarm at the prospect of even higher medical fees for migrant workers. They are afraid that higher costs will scare off both investors and foreign workers as well as increase their operating costs.

Even without the new higher rates, migrant workers still have to pay a string of charges upon entering Malaysia. First, they have to pay for a medical check up in their source countries. According to one employment agent, these usually cost between 20–30 dollars, depending on the source country.

When they arrive in Malaysia, they are required to take another medical test at a clinic approved by FOMEMA Sdn Bhd, a private firm awarded a government monopoly concession for the “monitoring and supervision” of the mandatory medical checks of foreign workers in Malaysia.

These medical checks are usually carried out by private general practitioners, who are paid by FOMEMA for the work they do.

FOMEMA bills employers 48 dollars for the medical tests for each male worker and 50 dollars for each female worker. In most cases, the employers deduct these charges from wages, says the employment agent.

One experienced private general practitioner told IPS he receives 15 dollars from FOMEMA as reimbursement for the medical check-up of each worker and another six dollars for the X-ray he carries out. He says FOMEMA also pays third parties for laboratory tests, which, he says, would probably not amount to much.

‘‘Previously I was charging only 24 dollars, in all, for the workers’ check-up,’’ he complained. ‘‘Doctors used to do the checks for half the price (that FOMEMA is now charging employers).’’

He was also unhappy about FOMEMA’s role as a “middle-man” in supervising the medical tests of foreign workers. ‘‘We do not need FOMEMA to tell us what to do,’’ he grumbled. ‘‘Who are they? They are just a profit-making entity.’’ He said doctors should be able to deal directly with the Ministry of Health without FOMEMA’s involvement.

Previously, migrant workers were required to have their medical check-up in their own countries and, upon arrival in Malaysia, undergo annual medical tests. But from Oct.1 this year, according to the agent, migrant workers will have to undergo an additional medical test at FOMEMA-approved clinics within one month of arrival in Malaysia.

Work permits can be issued only after the annual check-ups are done.

‘‘My preference is that as soon as they come here and before they start work, do it (the medical check-ups) once,’’ says the general practitioner, who declined to be identified as his is a FOMEMA-approved clinic. Once they are here, he says, medical check-ups every two years, rather than annually as is the current practice, should be sufficient.

In addition to charges for medical check-ups, employers pay an annual foreign worker levy for each worker, ranging from 115 dollars for plantation workers to 355 dollars for factory and construction workers.

From Oct 1, the levy for service sector workers was hiked from 355 dollars to 515 dollars. In most cases, employers pass on these levies to the migrant workers through wage deductions.

‘‘Part of this levy can be used by the authorities to fund the health care cost of migrant workers,’’ says Dr Subramaniam Pillay, coordinator of the Coalition Against Health Care Privatisation.

Political activist Jeyakumar Devaraj, a physician, says higher fees at hospitals could make migrant workers more reluctant to seek prompt treatment for the many infectious illnesses they are prone to because of the unhygienic conditions they are often forced to live in. ‘‘This delay will definitely lead to the spilling over of these infections to the general public-the ordinary Malaysians,’’ he warned.