Breaking down the barriers: Understanding migrant workers’ access to healthcare in Malaysia

Abstract

Background Malaysia is widely credited to have achieved universal health coverage for citizens. However, the accessibility of healthcare services to migrant workers is questionable. Recently, medical fees for foreigners at public facilities were substantially increased. Mandatory health insurance only covers public hospital admissions and excludes undocumented migrants. This study explores barriers to healthcare access faced by documented and undocumented migrant workers in Malaysia. Methods We use qualitative data from 17 in-depth interviews conducted with key informants from civil society organisations, trade unions, academia, medical professionals, as well as migrant workers and their representatives. We interviewed doctors working in public hospitals and private clinics frequented by migrants. Data were analysed using thematic analysis. Results We found that healthcare services in Malaysia are often inaccessible to migrant workers. Complex access barriers were identified, many beyond the control of the health sector. Major themes include affordability and financial constraints, the need for legal documents like valid passports and work permits, language barriers, discrimination and xenophobia, physical inaccessibility and employer-related barriers. Our study suggests that government mandated insurance for migrant workers is insufficient in view of the recent increase in medical fees. The perceived close working relationship between the ministries of health and immigration effectively excludes undocumented migrants from access to public healthcare facilities. Language barriers may affect the quality of care received by migrant workers, by inadvertently resulting in medical errors, while preventing them from giving truly informed consent. Conclusions We propose instituting migrant-friendly health services at public facilities. We also suggest implementing a comprehensive health insurance to enable healthcare access and financial risk protection for all migrant workers. Non-health sector solutions include the formation of a multi-stakeholder migration management body towards a comprehensive national policy on labour migration which includes health.

Accessing health services in India: experiences of seasonal migrants returning to Nepal

“…Discrimination, too, has been reported elsewhere: two studies on minority populations in the United States (US) and a study on immigrants in Spain also highlights that these groups experienced discrimination within healthcare settings [ 26 , 29 , 30 ]. Another in-depth study conducted in Thailand found that Sub-Saharan African migrants living in Bangkok experienced a high level of dissatisfaction with the services provided by health professionals [ 31 ].…”

“…A few migrant workers in our study were not confident in Hindi or otherwise failed to understand the language used during their consultation. Other studies, too, have identified language as a barrier to accessing good-quality healthcare while working abroad [ 20 , 22 , 26 – 28 ].…”

Epidemiology of tuberculosis in Sabah, Malaysia, 2012–2018

“…Sabah's migrant population, especially those who are refugees, from stateless minority groups and illegal or undocumented migrants face substantial challenges to accessing healthcare and social protectionincluding nancial, legal, language and physical access barriers. [19][20][21] The nding that non-citizens were signi cantly more likely to have advanced disease on chest X-ray and be sputum smear positive at presentation, supports the hypothesis that these groups face additional barriers to receiving timely diagnosis and treatment. We found that monthly household income of TB cases in Sabah (MYR 1000 or USD 250) was around one-quarter the median monthly household income across Sabah State (MYR 4110 or USD 1031 in 2016).…”

Moving towards culturally competent health systems for migrants? Applying systems thinking in a qualitative study in Malaysia and Thailand

“…Anecdotally, migrants in both countries have reported discrimination by health providers [21,22]. Refugees also face significant difficulties accessing the health system.…”

“…Delayed healthcare seeking is associated with financial constraints in Malaysia [22], where migrant workers are required by the Ministry of Health to enrol in a private insurance scheme, the Hospitalization and Surgical Scheme for Foreign Workers (SPIKPA). However, the total coverage amount is low (20,000 Malaysian ringgit/USD 4,741) relative to foreigner fees charged in public hospitals (which saw 100% increases in 2016, linked to MOH budget constraints), and only documented migrants can enrol [30,31].…”