COMMENT The government has announced that medical fees for non-citizens will increase by 70 percent when the government stops subsidising them beginning Jan 1, 2016.

This policy development is very disturbing. It comes on the heels of other equally troubling policies including the 30 percent increase in medical fees for non-citizens in government hospitals earlier this year.

The restriction of the prescription of medication to a five-day supply from government hospital pharmacies which was introduced last year, has limited access to care for migrants with chronic conditions.

In 2014, the arrest of undocumented women in some public hospitals, just after they had delivered, contrasted starkly with the good practice in maternal health care for which Malaysia has received global accolades.

Going by previous studies in Malaysia and elsewhere, the new policy development is likely to lead to greater avoidance of treatment, delay in obtaining treatment, self-medication, and not completing required treatment regimens, by this population. All these health behaviours would exacerbate their own medical condition and also increase the health risks that confront Malaysians, especially in the case of infectious diseases.

Good public health maintains an approach of universal access to testing and treatment to protect the health of all.

The new policy also raises questions of fairness on a few grounds. Documented migrants pay a significant amount of tax in the form of annual levies. As per universally accepted principles of health care financing, in such cases, they must also be able to access subsidised health care.

Moreover, documented migrants and now refugees are covered by a private health insurance. In the case of documented migrant workers, the mandatory health insurance (Foreign Worker Hospitalisation and Surgical Scheme or SKHPPA) only covers hospital and surgical fees. It does not cover outpatient treatment costs.

The benefits in another statutory insurance scheme for migrant workers, the Foreign Workers’ Compensation Scheme falls short of the compensation available to citizens under the Social Security Act (Socso). This means that in spite of purchasing two private health insurance policies, migrant workers in Malaysia are not covered for out-patient care, health promotion, and prevention.

Putting their health at risk

This exacerbates their problems of access to care. The lack of access to heath prevention and promotion also means that they are unable to make informed decisions regarding their health, which puts their health and the health of Malaysians too at risk, especially for infectious diseases.

It is true that public hospitals have been confronted with unpaid hospital bills by non-citizens. With about 1.7 million having registered under SKHPPA since its launch and contributing an annual premium of RM120.00 per worker per annum, the revenue generated by SKHPPA could be around RM200 million. This far exceeds the unpaid hospital bills which were reportedly in the range of RM64 million between 2005 and 2009 and RM18 million as at November 2010.

Another universally accepted principle in health care financing is the principle of cross-subsidisation. Based on the principle of social solidarity, it means that the rich subsidise the poor, the healthy subsidise the sick. Even the conservative application of the principle of cross-subsidisation to the migrant population alone in Malaysia means that unpaid bills of non-citizens should have been comfortably resolved with the revenue generated from SKHPPA.

Another flaw in the current discourse around migrant health care is the lack of consideration of the robust contribution migrants make to the economy.

Contrary to popular opinion that migrants take jobs from locals, depress local wages, and lower labour productivity, the World Bank reported that for every 1000 migrant workers who enter a given sector in a given state, 836 new full-time jobs and 169 part-time jobs are created for Malaysian workers.

The report also stated that by providing cheap labour, migrant workers increase the competitiveness of Malaysian firms, helping them to expand and create jobs for Malaysians. Finally, increased immigration to a state was associated with a reduction in crime and the number of crimes committed in that state.

Access to healthcare imperative

In the present time of epidemics such as Sars and Ebola and when drug-resistant strains of tuberculosis are making a comeback globally, it is no laughing matter to be without access to health care. Protecting the health of non-citizens, especially the undocumented, is imperative to the protection of health of Malaysians. This is good public health.

This needs to be supported by a coherent and effective migration policy that strikes the optimal balance between the country’s economic needs, human resource availability, security concerns, and global health challenges confronting the world community today.

There needs to be more cooperation between countries linked by migration. There needs to be more cooperation between different sectors - government, civil society, academia, international agencies and migrant communities themselves. There needs to be a multidisciplinary and considered approach to the different dimensions of the problem. Only then can we achieve security of health for all. Undoubtedly, this requires long-term strategic planning.

DR SHARUNA VERGHIS is director of Health Equity Initiative.