Health Issues Faced by Migrant Workers and Measures to Ensure Their Access to Proper Medical Treatment

7 Ms Yeo Wan Ling asked the Minister for Manpower (a) what are the key health issues faced by migrant workers in Singapore; and (b) how are these health issues being addressed to increase workplace productivity while ensuring that medical costs to employers are kept affordable in the long term.

8 Mr Melvin Yong Yik Chye asked the Minister for Manpower (a) what measures has the Ministry put in place to ensure that migrant workers have access to proper medical treatment and that they seek timely medical attention; and (b) how has the Ministry ensured that healthcare costs remain affordable for migrant workers.

The Senior Minister of State for Manpower (Dr Koh Poh Koon) (for the Minister for Manpower): Mr Speaker, may I have your permission to take Question Nos 7 and 8 together, please?

Mr Speaker: Yes, you do.

Dr Koh Poh Koon: Sir, the Ministry of Manpower (MOM) has put in place several measures to ensure that migrant workers have access to the medical treatment they need. Under the Employment of the Foreign Manpower Act, employers are required to bear the cost of medical fees incurred by their Work Permit and S Pass holders. To better protect employers from large hospitalisation and surgical expenses, MOM enhanced the mandatory medical insurance for Work Permit and S Pass holders in 2023 by increasing the annual claim limit to $60,000, up from $15,000.

In addition, to enhance accessibility and affordability of outpatient care for migrant workers, MOM implemented the Primary Care Plan (PCP) in April 2022. Medical Service Providers offering these Primary Care Plans operate in-dorm clinics and outpatient medical centres in the vicinity of migrant worker catchment areas to ensure that workers can see a doctor promptly when they are unwell.

The PCP benefits both employers and migrant workers. Employers pay a fixed annual capitation rate, giving them clarity of cost and protection against unexpected healthcare bills. Migrant workers pay a low co-payment fee of $2 and $5 per telehealth and in-person session respectively, so that they are not deterred from seeking medical care when they need it.

A study conducted by the National University of Singapore (NUS) Saw Swee Hock School of Public Health, published in September 2024 in a peer-reviewed journal, found that 96% of migrant workers surveyed were able to access primary health services in Singapore. Migrant workers sought medical attention mostly for acute respiratory infections and musculoskeletal conditions. About 4% of them self-reported to have at least one chronic disease, with hypertension and diabetes being the most prevalent.

Recognising that good health management starts from preventive health and chronic disease management, MOM launched Project MOCCA in 2021. Project MOCCA, which stands for "Management of Oral and Chronic Conditions and Ailments", is a preventive health framework that aims to encourage early detection and management of common chronic and oral health conditions among our migrant workers. To raise preventive health measures, MOM set-up an online Health Library on health education materials in several native languages for easy access by the migrant workers. We also produced physical health booklets for distribution to migrant workers at health roadshows, conducted with community partners and the PCP doctors. With the support of corporate donors and non-government organisation (NGO) partners, workers can also receive low-cost basic dental treatments at some NGO-run dental clinics.

MOM has made significant efforts in recent years to enhance the quality of healthcare for migrant workers. We will continue to work with our partners to ensure that quality care is provided at an affordable cost. We also urge employers to encourage their migrant workers to make use of the available resources and healthcare services designed for them, as good health management helps employers manage healthcare costs in the long term and increase productivity at work.

Mr Speaker: Ms Yeo Wan Ling.

Ms Yeo Wan Ling (Pasir Ris-Punggol): I thank the Senior Minister of State for the reply. I note that telemedicine is an important component to primary care plans available to our migrant workers and I thank the Ministry on this move as it will, no doubt, bring more accessibility and convenience to our migrant workers.

However, given that telemedicine will be an increasingly popular option and that not all our migrant workers are fully conversant in English, how would the Ministry ensure that quality healthcare continues to be provided through telemedicine channels when it is scaled up? Also, what are the standard operating procedures of reporting back to employers on chronic or serious illnesses detected through the PCPs, particularly if these illnesses have impact on work and medical insurance claims, while protecting the privacy of our migrant workers at the same time?

Dr Koh Poh Koon: Sir, I thank the Member for her two questions. First, on telemedicine. The design of our PCP programme is such that the primary care providers, the doctors and the clinics that are providing these services, are given a dispensation to employ doctors who are able to speak in the native languages of the migrant workers so that there are less language barriers when the migrant workers seek care, whether in person or via telemedicine. Of course, telemedicine runs 24 hours. So, during certain hours, they may not be able to get a particular doctor who can speak that native language because our migrant workers do come from a very diverse range of different source countries. So, this is something that the providers will look at and see how they can best enhance the care to be delivered to these workers in the most appropriate manner.

But we must recognise that telemedicine can be a useful adjunct to this because, as I said earlier, the bulk of the conditions that the migrant workers report to the medical centres are really for minor ailments, acute respiratory conditions as well as musculoskeletal aches and pains, which generally do not require very intensive or in-depth medical consultation. This is something which telemedicine can fill a gap to strike a balance between accessibility of care, cost affordability and also convenience for our workers, so they have less hesitation to step up and seek help when needed.

On the second question of whether there are ways to report back chronic medical conditions to employers, I think we have to be very careful here because medical information is very much confidential to the individual. And unless there is consent given by the individual, including migrant workers who have the right to their own medical confidentiality, it will not be reasonable for us to report some of these conditions back to the employers.

But there are ways in which we can help the migrant workers to manage their chronic conditions better, which is why I mentioned earlier about the health booklet, so that these things are documented in the booklet and, through the regular consultations at the clinic by the migrant workers, counselling can be given to these workers to encourage them to take a more proactive stance in managing their chronic medical conditions. Other things like roadshows that are conducted at places like the recreation centres where the migrant workers go on their days off, can help to strengthen this understanding of how they should take better care of their chronic medical conditions. So, we do need to strike a balance between ensuring privacy, but also making sure that the workers are able to gradually, over time, take care of their chronic health conditions better.

I must also say that the approach to manage chronic care conditions is no different from what we do in our general population. As we know, generally, most people, when they do not feel anything about the high blood pressure or their diabetes, they may not take proactive actions. So, it is not an unusual mentality in our migrant workers. It is quite common in all of us to procrastinate sometimes when we have a chronic condition that may not produce immediate symptoms. So, public education, health education and continued encouragement are the way to go, and we hope to do so through many of our NGO partners as well.

Mr Speaker: Mr Melvin Yong.

Mr Melvin Yong Yik Chye (Radin Mas): Sir, I thank the Senior Minister of State for his reply. A 2020 study published in the Singapore Medical Journal found significant barriers to the delivery of healthcare to migrant workers. They face difficulties navigating a foreign and sometimes complex healthcare system, and lack adequate knowledge about their healthcare coverage and entitlements. I would like to ask what are MOM's plans to ensure that our migrant workers are aware of the various medical schemes that are available to them?

Dr Koh Poh Koon: Sir, I thank the Member for raising this concern. In fact, I think the Singapore Medical Journal article that the Member cited was published in 2020 and that predates the more recent one that has been published in September 2024, conducted also by the NUS Saw Swee Hock School of Public Health in the peer-reviewed journal.

When I replied earlier in my main reply, I did say that this study, which surveyed migrant workers, found that 96% of them were able to access primary health services in Singapore, partly because we designed it in such a way that it is located either in the dormitory itself, where there is an in-dormitory clinic, or the PCP providers have a facility located around where migrant workers actually stay, where the dormitories are co-located. So, it is really sited in a physically accessible place and in proximity to where the migrant workers congregate, to make sure that there should be as little barrier or challenge as possible for them navigating and finding that physical location. We also disseminate some of this information on how to get into telehealth through the dormitory operators and many of our NGO partners. So, migrant workers, as long as they use the MOM app, would be able to get information on the nearest PCP medical facility that is available to them.

The other way which we try to make sure that the migrant workers are aware is through regular roadshows, as I said earlier. So, we will continue to do so. But I think the initial study and survey by the Saw Swee Hock School of Public Health has shown us that even with the initial roll-out in a short couple of years since we started the PCP programme, it has reached a good penetration and the workers themselves are aware.