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New @PLOSONE paper on Healthcare & social protection policies for migrant workers in Malaysia with @drtharaniL & @derrickzxc - headline findings https://bit.ly/33X7sDX /1
Enrolment in #SPIKPA private health insurance scheme for migrant workers is mandated by MOH. But there is very poor awareness of SPIKPA among migrant workers & employers. Many migrants have no idea if they’re enrolled, what entitlements are & how to make claims /2
What easy win can be done right now to increase awareness? Create a #SPIKPA insurance card + accessible flyers explaining benefits, claims processes, for migrants that insurers must distribute (crazy that migrants don’t have insurance cards! Low hanging fruit) /3
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 /4
User charges for non-citizens have tripled since 2016, to now huge disparity with citizen fees (described elsewhere: https://bit.ly/3gmEWR2 ). Most migrants will be on min wage 1,200 MYR/month. With fee increases, even the SPIKPA 20,000 MYR coverage limit is likely inadequate /5
Non-citizen fees collected 2014-18 increased 75% to 182 million MYR. But unpaid revenues tripled to 50 million MYR. Raises questions on utility of fee increases that migrants can’t afford to pay, and ++MOH admin time chasing unpaid bills. Is there a better way? /6
#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 /7
#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 /8
We urge @KKMPutrajaya to consider ++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 /9
#MigrantWorkerLevy generating nearly 3 billion MYR/year could be considered as potential source for outstanding bills among uninsured migrants. Feasibility study should also look at overlaps with #SOCSO. Many academics ready to assist with such studies @KKMPutrajaya /10
#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 rehab and disablement benefits: https://bit.ly/37JSbqX /11
But feasibility of implementing certain policy elements unclear, including how recurring worker payments & those to next-of-kin overseas can be done. Also unclear whether migrants are aware of SOCSO’s new entitlements & can make use of them /12
With #COVID, the inclusion of non-citizens in #plannedresponses is crucial for the containment of a #globalpandemic – the less friction there is in access, the more likely we’ll see improved #healthseekingbehaviours (i.e., #COVID testing) /13
