Healthcare Financing and Social Protection policies for Migrant Workers in Malaysia – focus on SPIKPA and COVID

Sharing a new @PLOSONE paper on Healthcare Financing and Social protection policies for migrant workers in Malaysia authored by Dr Tharani Loganathan, Derick Z Chan and Dr Nicola Pocock.

The following is a summary of key findings and points for action.

Enrolment in #SPIKPA private health insurance scheme for migrant workers is mandated by MOH. However, there is very poor awareness of SPIKPA among migrant workers and employers. Many migrants have no idea if they’re enrolled, what entitlements are and how to make claims.

And easy win that can be done right now to increase awareness. Create a SPIKPA insurance card and accessible flyers explaining benefits and claims processes for migrants that insurers must distribute. It is crazy that migrants don’t have insurance cards! Low hanging fruit.

SPIKPA has other limitations. Unlike other sectors, employers are not mandated to enrol plantation and domestic workers, who at over 400,000 are 20% of all documented workers @StatsMalaysia. Leaving these workers at the mercy of employers for healthcare.

SPIKPA does not provide outpatient care or preventive care, only coverage for hospitalisation and surgical fees of  20,000 MYR at public hospitals. As such migrants pay for their out-of-pocket for healthcare at outpatient setting, and this would delay care-seeking due to cost.

User charges for non-citizens at public healthcare have tripled since 2016, to now huge disparity with citizen fees (described elsewhere: Most migrants earn minimum wages of 1,200 MYR/month. With fee increases, even the SPIKPA 20,000 MYR coverage limit is likely inadequate, making healthcare unaffordable.

Non-citizen fees collected from 2014 to 2018 had increased by 75% to 182 million MYR. But unpaid revenues tripled to 50 million MYR. This raises questions on the utility of fee increases that migrants can’t afford to pay, and the MOH admin time chasing unpaid bills. Is there a better way?

#SPIKPA is currently provided by 25 private insurers. Claim-loss ratios are reportedly extremely low, e.g. 10% of premium revenues in 2015. With low claims rates (linked to lack of awareness on enrolment, entitlements), these insurers are making SIGNIFICANT profits.

#REMEDI, an innovative private health insurance scheme for refugees by #UNHCRMalaysia is currently suspended as loss-making due to high claims rates & low enrolment. Refugees are likely part of the non-citizen group who are unable to pay user fees which aren’t being recouped. Non-citizens groups not covered include undocumented migrants, refugees, asylum-seekers, domestic and plantation workers.

We urge @KKMPutrajaya to consider the potential cost savings from integrating both #SPIKPA and #REMEDI schemes. Bringing all low-income non-citizens into one big risk pool, possibly under MOH remit. This would help MOH recoup unpaid bills. We need a feasibility study to do this.

#MigrantWorkerLevy generating nearly 3 billion MYR/year could be considered as potential source for outstanding bills among uninsured migrants. Feasibility studies should also look at overlaps with #SOCSO. Many academics ready to assist with such studies @KKMPutrajaya

#SOCSO is an injury compensation scheme, changes by @PERKESOofficial in Jan 2019 to include migrant workers very welcome step towards parity (not fully) with citizen protections. Workers now have access to rehabilitation and disablement benefits:

However,  the feasibility of implementing certain policy elements of SOCSO is unclear, including how recurring worker payments to injured workers or next-of-kin overseas can be done. Also unclear whether migrants are aware of SOCSO’s new entitlements and can make use of them

During the COVID-19 pandemic, the inclusion of non-citizens in governments planned response is crucial for the containment of a global pandemic – the fewer barriers there are in access, the more likely we will see improved health-seeking behaviours (i.e., coming forward for contact tracing and COVID testing  etc.)