New medical network tailored for migrant workers' needs
Aim is to ensure appropriate care for workers without overtaxing national healthcare system
By Kok Yufeng, The Straits Times, 1 Jul 2021
A new network of medical centres being set up for migrant workers here will be tailored to meet their medical needs, including their psychological and mental well-being, Manpower Minister Tan See Leng said yesterday.
The aim is to provide workers with appropriate care without overtaxing the national healthcare system, he said at a media briefing.
This came after The Straits Times reported on Tuesday that the Ministry of Manpower (MOM) had put out a tender seeking proposals for anchor operators to run six regional medical centres, and three on-site medical centres in large dormitories, that cater exclusively to migrant workers here.
Under the new system, expected to be rolled out as early as November, healthcare will be delivered in six geographical sectors that each house at least 40,000 migrant workers.
Each sector will be anchored by a regional centre and complemented by the on-site centres, at least two mobile clinical teams, and round-the-clock telemedicine consultations and ambulance and special transport services.
Dr Tan described this as a hub-and-spoke model. The nine centres will succeed 13 existing centres that have been up and running since last August.
While there will be fewer medical centres in future, their scale and comprehensiveness will be significantly greater than what exists today, Dr Tan said.
For example, they could have built-in facilities such as a physiotherapy centre.
Dr Tan said it is also important that the cost of primary care is kept sustainable for workers, employers and the Government.
The medical centres will charge for services provided to cover their set-up and operating costs, according to the tender documents.
Several suggestions for operators were outlined by MOM to keep migrant workers' out-of-pocket expenses low, while ensuring business sustainability.
Dr Tan said it is too early to say if any fee benchmarks will be set. "We're going out there to do a price discovery as well."
Dr Lam Meng Chon, medical director of MOM's Assurance, Care and Engagement Group, said the centres will complement rather than replace or duplicate existing primary care services.
Workers will be automatically enrolled, and each centre's operator will maintain a registry of the workers in its care and ensure there is a single clinical record for workers throughout their care journey.
Healthcare should also be provided in a way that minimises any cultural and language barriers, Dr Lam said. This could include having on-site conditionally registered doctors or healthcare associates from workers' home countries.
Dr Lam said the healthcare associates will be supervised by registered medical practitioners and will "focus on clinical care, like health education, basic infection prevention control measures, management of chronic diseases".
These associates are not meant to replace medical professionals here, but will help with the psychological needs of migrant workers, said Dr Tan. "I think it's important for them to have someone whom they feel comfortable with," he said.
New healthcare system to be set up for migrant workers in Singapore; 6 medical centres planned
By Kok Yufeng and Ng Keng Gene, The Straits Times, 30 Jun 2021
From as early as November, a new system will be rolled out to provide primary healthcare for migrant workers here and reduce the risks of future disease outbreaks through active surveillance.
Tender documents published by the Ministry of Manpower (MOM) on Monday (June 28) show that the new system will deliver healthcare in six geographical sectors, with each sector housing at least 40,000 migrant workers both in and out of dormitories. Healthcare providers may submit proposals to operate in one or more sectors.
Each of the six sectors will be anchored by a medical centre for migrant workers, complemented by onsite medical centres in three large dormitories, at least two mobile clinical teams, as well as round-the-clock telemedicine consultations and ambulance and special transport services.
One of the sectors, covering areas in the west like Bukit Batok and Jurong, will have its healthcare centre operated by a non-governmental organisation, which documents did not name. The sector has about 54,800 workers, of whom more than 82 per cent live in dorms.
Tender documents said that healthcare should be provided in a way that "minimises any cultural and language barriers to access healthcare services". Steps to ensure this may include having doctors onsite from workers' home countries and having multilingual translation capabilities.
Providers are also to deliver healthcare in a manner that keeps migrant workers' out-of-pocket expenses low.
Under the new system, each of the six medical centres for migrant workers will be the first-line outpatient facility for migrant workers. They are to be equipped with X-ray machines to facilitate diagnoses.
The six centres will also be used for public health surveillance, and equipped with testing capabilities and isolation facilities to prevent the spread of diseases like Covid-19. They will be staffed by at least one doctor, two nurses, two administrative support staff and a radiographer.
Onsite medical centres, which will be located in three large dormitories for a start - PPT Lodge 1B, Sungei Tengah Lodge and Tuas View Dormitory - will have similar capabilities to the medical centres but without X-rays.
Meanwhile, mobile clinical teams will be activated by MOM in the event of an emerging outbreak, where they will help execute public health interventions like swabbing and contact tracing.
Telemedicine consultations will cater to non-urgent needs like mental health counselling or medication refills, which will be delivered.
The new healthcare system for migrant workers follows the roll out of regional medical centres for workers since Aug 28 last year. There are currently 13, opened after all dormitories were cleared of Covid-19 on Aug 19 last year.
Tender documents did not state how or if these centres will fit into MOM's plans come November. The Straits Times has contacted MOM for more information.
As at Tuesday (June 29), about 87 per cent of Singapore's 62,563 Covid-19 patients were dorm residents, although no new cases have been detected in dorms in the past two weeks.
Dr Jeremy Lim, vice-chairman of migrant worker non-profit HealthServe, said it is not able to independently provide the services that MOM is asking for.
However, several private healthcare groups have approached HealthServe to ask if it would be willing to be part of a consortium for the tender.
"We have not made any commitments. We are guided by what is in the best interest of migrant workers," he said. "The question is, can we be useful to the ecosystem and workers by supporting one of the private health care groups?"
Dr Lim, who is also an associate professor at the National University of Singapore's Saw Swee Hock School of Public Health, said MOM's request for proposal has a strong element of proactive care, including preventive health screenings and education for workers. "If you read between the lines, it also emphasises the need for care to be coordinated," he added.
Infectious disease physician Ling Li Min said the pandemic showed the healthcare needs of migrant workers had been neglected, with many suffering from chronic conditions not seeking treatment here as costs are prohibitive.
Dr Ling said it will be important for doctors running the new medical centres to work together across sectors to recognise impending outbreaks.
Dr Lim said any future outbreaks should also be easier to manage because interactions between workers and healthcare providers should be limited to more specific geographic areas.
Mr Johnathan Cheah, managing director of S11 Capital Investments, which operates PPT Lodge 1B, said that the current medical centre at the dormitory in Punggol has served its residents well.
"The biggest benefit is that the centre ensures early detection and isolation of those with acute respiratory symptoms and there is no need for the worker to go into the community," he said.
Formal healthcare network for migrant workers in Singapore sends strong message to employers
By Lim Yan Liang, Assistant News Editor, The Straits Times, 30 Jun 2021
Healthcare providers are being sought to set up and run six medical centres across the island that cater exclusively to migrant workers' healthcare needs.
Another three centres will be located within large purpose-built dormitories, removing the need for their residents to travel to seek medical care.
The centres will be a major part of a primary healthcare ecosystem for these workers, supported by a network of partner general practitioners (GPs), mobile clinical teams and telemedicine services.
In essence, they will be like polyclinics for migrant workers: meant to provide cheap, good, and accessible care - both for acute illnesses like sore throats as well as chronic conditions like diabetes.
The Manpower Ministry (MOM), which called for proposals, previously said more than 300,000 migrant workers here live in dormitories, either purpose-built or factory-converted ones.
Importantly, this healthcare ecosystem will also provide proactive public health surveillance of migrant workers here to detect and curb disease outbreaks. This includes carrying out swabbing operations, and assisting authorities with contact tracing.
To better serve migrant workers, operators will be expected to minimise any cultural and language barriers, by using doctors and healthcare workers from countries such as Bangladesh, China and India, among other things.
Why it matters
The nine regional centres the authorities are looking to set up will succeed 13 existing centres that have been up and running since last August to serve the health needs of migrant workers.
Before that, public and private healthcare providers had been roped in on an urgent basis to provide medical support to workers, while the inter-agency taskforce that was formed to bring the outbreak in dormitories under control went about its work.
The move to make this temporary network of centres a more permanent fixture - for up to five more years in the first instance - is a strong signal of the government's commitment to meeting the healthcare needs of migrant workers, who form the backbone of the construction sector.
Executed well, the care ecosystem can also serve as an early warning system for any emerging clusters, enhancing the pandemic preparedness of the purpose-built dormitories that house thousands in close quarters.
The move also formalises an increased primary care capacity for migrant workers, and is a meaningful next step in removing barriers that prevent these workers from seeking medical attention.
In a 2020 survey of 427 doctors here published in the Singapore Medical Journal, more than nine in 10 respondents cited language and cultural barriers as a key factor affecting the care that migrant workers receive. For instance, a lack of clear information in their native language on their healthcare entitlements may deter a worker from seeking help, said the authors.
An earlier survey of over 400 migrant workers found that 6 in 10 were unsure of the scope of their insurance coverage.
Having healthcare providers in medical centres close to the dormitories who speak the workers' languages and who are culturally sensitive to their needs will go a long way in building trust and encouraging workers to seek the help they need, doctors have said.
The decision also sends a strong message that ensuring migrant workers' medical needs are met is also beneficial to employers, who might face both larger bills and reduced productivity if conditions are not treated early.
What lies ahead
If all goes to plan, the nine medical centres are targeted to be operational from this November.
But encouraging migrant workers to seek timely medical help will continue to be a work in progress, given workers' worries over high healthcare costs and lost earnings.
Manpower Minister Tan See Leng acknowledged this at the debate on his ministry's budget in March. "Often, migrant workers might delay or avoid seeking medical attention until the condition worsens significantly, with negative consequences for health, employment and work outcomes both for the worker as well as their employers," said Dr Tan.
This is borne out by the survey of doctors, with concerns over cost of healthcare cited as the second largest factor affecting their care, after language barriers.
Dr Tan has said that MOM knows managing the cost of medical care is critical to migrant workers, and the request for proposals outlines several suggestions for would-be operators of the medical centres to keep migrant workers' out-of-pocket expenses low, while ensuring business sustainability.
These include participating as a panel clinic to major insurance companies, and using generic drugs where possible to provide clinically- and cost-effective care.
As the current temporary system makes way for commercial arrangements under a contracting model, authorities have to put in safeguards to prevent charges from rising over time.
Separately, MOM is also reviewing medical insurance coverage for migrant workers to help employers better manage medical expenses and to give both employers and workers a greater peace of mind. An update is expected later this year.
Bringing healthcare closer to migrant workers
Network of on-site and regional care centres good step but systemic shifts also needed: NGOs
By Kok Yufeng and Ng Keng Gene, The Straits Times, 5 Jul 2021
For two weeks, construction worker Ronju, who goes by one name, has had the same routine.
Each day, he lines up outside the gym in the 14,000-bed PPT Lodge 1B dormitory in Seletar where he lives, gets his work permit and blood pressure checked, and is led into an air-conditioned area where he waits for his name to be called.
The Bangladeshi, 32, has been visiting the on-site medical centre in the dorm to change the dressing on an infected wound on his right foot.
Before the centre was set up last August, he would have had to make a daily trip to a clinic in Sengkang to get this done.
"It is good because there is no need to travel and no need to waste time," Mr Ronju told The Straits Times through a translator.
"I hope the clinic will remain here - it is better for everyone. The doctor talks to us nicely. We can come any time and get proper medicine and treatment."
Today, there are 13 such semi-permanent medical centres that serve migrant workers exclusively.
They provide simple care for acute and chronic conditions, similar to the outpatient services provided by general practitioners.
Set up last year after the Covid-19 outbreak in dorms was quelled, five of the centres are located onsite in the largest dorms, while eight are regional centres located in migrant worker recreation centres or industrial areas close to dormitories.
These centres are set to be replaced by a formal network of six regional centres and three on-site centres. Last Monday, the Ministry of Manpower (MOM) put out a tender seeking proposals from healthcare providers to run these nine centres for up to five years, from as early as November this year.
This is under a new structure that will deliver healthcare in six geographical sectors, with each sector housing at least 40,000 migrant workers both in and out of dorms.
Each sector will be anchored by a regional centre, and complemented by the on-site centres, at least two mobile clinical teams, round-the-clock telemedicine consultations, and ambulance and special transport services.
Manpower Minister Tan See Leng described this as a "hub-and-spoke" model when he spoke to reporters last Wednesday.
He said MOM's experience running the current centres has helped it to identify gaps the future centres will address. For example, having healthcare professionals who speak the same language is important for managing workers' psychological and mental well-being.
With migrant workers still largely restricted to their dorms and not allowed to interact with the larger community, the centre at PPT Lodge 1B saw an almost constant stream of patients when ST visited last Friday afternoon.
Dr Ho Lik Man, 36, a Healthway Medical general practitioner stationed there, said the centre gets a daily average of 50 to 80 patients.
The centre provides services that are more targeted to workers, such as wound care and the administration of tuberculosis medication.
He said the common ailments are fairly similar to those at any other general practitioner's clinic.
"You have the usual diarrhoea, vomiting, tummy pain and so on.
"We also see those who have chronic conditions like hypertension, hyperlipidaemia, diabetes and asthma. In this dormitory setting, we also see more work-related conditions like rashes and dermatitis."
This was similar at the regional medical centre at 63 Loyang Way, which was set up within a vacant industrial building, and the one at Cochrane Recreation Centre in Sembawang, although both were much quieter.
The Loyang facility gets about 10 to 20 patients a day, while the one at Cochrane Recreation Centre gets about 30 to 50 patients daily.
Patients may walk in, or they are taken to these centres in dedicated vans after they call to report sick.
To minimise common touch points at both centres, patients are required to carry their own chairs throughout the centres.
Those who have acute respiratory symptoms are also kept away from other patients.
Dr Yan Shi Yuan, the primary doctor at the Loyang facility, said operations have had to adapt to the evolving pandemic situation.
"When we first started, we didn't know how long this would last.
"We worked based on day-to-day instructions. It was quite reactionary. For instance, when we first started last year, we were assisting with the mass swabbing exercise for migrant workers. In the morning we'd do swabbing, and then see patients in the afternoon."
With the Covid-19 situation now stable, Dr Yan and his team now have to deal with other outbreaks such as dengue fever.
Dr Yan, who owns Edgedale Medical Clinic, said communication with migrant workers is not as difficult as some may think.
"Most can speak basic English... You may need to speak very slowly and be very patient, perhaps repeat yourself to make sure they understand. Usually for those who can't speak English, a manager or fellow worker will accompany them to help with translation."
Dr Lee Yizhi, 40, the lead physician of the medical centre at Cochrane Recreation Centre, said he has also picked up on the vernacular and terms workers use.
Dr Lee said he has seen a spectrum of patients and they mostly come for more acute conditions.
But there have been incidental cases where workers come for other problems, only to find that they have chronic illnesses.
His centre, which is run by Fullerton Health, caters to workers in northern Singapore. It has a night clinic - one of three islandwide - that caters to those in Choa Chu Kang, Mandai and Sungei Kadut.
This regional approach has allowed for closer collaboration, Healthway Medical's Dr Ho said.
"The beauty of this system lies in the interdisciplinary approach to medical care," he told ST.
He cited an example of a worker who had a rare and painful joint inflammation.
Dr Ho was able to expedite an appointment with a specialist at the nearby Sengkang General Hospital, but the worker did not turn up for his appointment and was uncontactable. Working with the dormitory operator and the worker's employer, Dr Ho's team was able to locate him and help him get the care he needed.
Dr Ho said workers at PPT Lodge 1B have also grown to trust him and his medical staff, and are more willing to seek medical attention.
"For migrant workers, there are certain barriers to seeking medical care. They may feel they cannot communicate with the doctor. There are fears about costs, and they may also be afraid of missing work," he said. "Some are new, so they are not sure how the Singapore medical system works.
"Being on-site, in some ways, we are reaching out to them. When they come in with friends or fellow residents, they are less fearful. They are more willing to speak up."
Migrant workers ST spoke to said that before the pandemic, the common practice was to approach their employers if they wanted to report sick, and to visit designated clinics.
Mr Ahmed Monzur, 39, who was at the PPT Lodge 1B medical centre, said: "Before, if I want to take MC, I need to go to their company, take a medical paper and then go to the doctor. I have to go by taxi or MRT, and wait in a long queue.
"Now, if I am sick, I just inform my supervisor and I can visit the doctor here. It is easy," the construction worker said.
Still, advocacy groups say more needs to be done to give migrant workers assurance of access to healthcare. High costs are just one barrier that migrant workers face.
"Last year, we saw many instances where accessing care without a prior appointment became almost impossible for migrant workers confined in dormitories," the Humanitarian Organisation for Migration Economics (Home) told ST.
"Workers who have been to these centres told us that they were still required to pay for treatment and medication upfront. Those who did not have enough money had to borrow from friends. This is the exact same perennial barrier migrant workers have faced for years."
Employers are legally responsible for the cost of medical treatment for their migrant workers.
Before the pandemic, they had to cover costs for workers' visits to GPs, although currently, consultation at the existing medical centres is free. Workers with acute respiratory illnesses also get medical care at no cost for the time being.
Medication and basic treatment costs at the centres range between $14 and $18 for acute conditions, $33 and $40 for a single chronic illness, and between $43 and $55 for multiple or complex conditions.
Employers must also buy and maintain medical insurance coverage of at least $15,000 per year for each work permit holder they employ, covering inpatient care and day surgery at hospitals.
There may be a co-payment option not exceeding 10 per cent of the worker's monthly salary.
Employers must also buy work injury compensation insurance for their workers.
This could create a situation where employers sometimes act as gatekeepers, advocacy groups said.
One example is refusing to provide a letter of guarantee promising to pay for the medical costs.
This is something that needs to be addressed even as MOM looks to provide more easily accessible primary care for workers, said Mr Alex Au, vice-president of Transient Workers Count Too (TWC2).
Many workers are also worried about seeking medical treatment for chronic illnesses, as they are worried they will lose their job if their employer finds out, he said.
Edgedale Medical's Dr Yan noted: "It's far cheaper for those with chronic illnesses to buy medicine from their home countries. That needs to be worked out."
Dr Walter Lim, medical director of clinical services at Fullerton Health, said after the Covid-19 outbreak was contained, "it became apparent to everyone that there was a primary care gap to be filled".
"A migrant worker is no different from a patient like you and me. They need a seamless patient experience," Dr Lim said.
Decentralised medical posts were thus moved into centralised hub locations.
MOM's future plans are a natural evolution from this, and moving towards privatisation is the logical next step, Dr Lim said, adding that Fullerton Health plans to participate in MOM's tender.
He said one benefit of the new model is better information flow.
For example, Fullerton Health was able to study data patterns and change its drug supplies when acute respiratory infection cases last year started to decline.
"If you don't know the situation, you cannot react to it. It is also better to react at a primary care level than to wait for it to become a bigger problem," Dr Lim said.
"For example, if we have many diarrhoea cases, this may indicate that something needs to be looked at with the food or catering. It may also be an advance warning for other conditions."
Dr Yan said that the upcoming medical centres will allow policy changes from MOM to be enacted quicker. Trends on the ground can also be fed upwards quickly.
Given the size of the migrant population, Dr Lim suggested having a few anchor players with a diversity of approaches but with enough critical mass.
MOM will need to engage the payers in the system, be it employers or insurers, in a way that results in more sustainable financing, he said. There is also room to further extend the insurance coverage for migrant workers, Dr Lim added.
MOM has said that it is reviewing medical insurance coverage for migrant workers. An update is expected later this year.
"The question is what is a reasonable cost that different stakeholders - from employers, insurers, and to some extent the Government - are willing to underwrite to sustain a system that is fit for purpose," Dr Lim said.
At last Wednesday's media briefing, Dr Tan said MOM is exploring ways to keep costs down.
MOM told ST it is working on a partnership with a non-governmental organisation (NGO) with medical expertise to run one of the new regional centres, with support from philanthropy funding.
This will allow MOM to compare the performance and operating model of an NGO to that of medical service providers that will operate in the other sectors.
The new medical centres will charge for services provided to cover their set-up and operating costs. These charges will take into account the size of the migrant worker population in each geographical sector and the rate at which workers report sick.
Dr Jeremy Lim, vice-chairman of non-profit HealthServe, hopes MOM will re-examine the financials of healthcare delivery, and more strongly emphasise preventive health services.
"The financial model will be challenging but it is something necessary to get right," said Dr Lim, who is also an associate professor at the National University of Singapore's Saw Swee Hock School of Public Health.
Both Home and TWC2's Mr Au suggested removing employers from the equation, with the former advocating direct billing facilities between healthcare providers and insurers.
Citing past cases of private doctors prioritising profits and employer interests, Home said public healthcare institutions should be operating the new centres as they would be more objective.
It also expressed concern that a network of dedicated medical centres would create a parallel healthcare system that segregates migrant workers.
To this, Healthserve's Dr Lim said: "Isn't it already today's reality? In an ideal world, there should be one health system for all of us. But anything that allows the workers to achieve better health and better healthcare access is a step in the right direction."
Taking better care of migrant workers
The Straits Times, 1 Jul 2021
From November, a new system will be rolled out to provide primary healthcare for migrant workers here and reduce the risks of future disease outbreaks through active surveillance. The new system will deliver healthcare in six geographical sectors, with each sector housing at least 40,000 migrant workers both in and out of dormitories. Each of the six sectors will be anchored by a medical centre for migrant workers, which will be complemented by on-site centres in three larger dormitories, at least two mobile clinical teams, round-the-clock telemedicine consultations, and ambulance and special transport services.
Essentially, each of the six medical centres will constitute the first-line outpatient facility. Also, they will be used for public health surveillance, and be equipped with testing capabilities and isolation facilities to halt the spread of diseases such as Covid-19. It would be a mistake to see in this move an attempt to isolate foreign workers socially. Instead, its intention is to provide for the well-being of workers in a way that suits their financial and cultural needs. For example, it is not feasible to staff polyclinics with doctors and healthcare workers from countries such as Bangladesh, China and India, which would minimise linguistic and cultural barriers with workers from those nations. That would be possible with the setting up of the dedicated facilities serving a far smaller segment of the population than polyclinics do. Adding capacity to the health system to provide these services also eases the already heavy load on polyclinics.
It is workers who would benefit from the move. Indeed, the new ecosystem will be tailored to meet their medical needs in the broadest sense by including their psychological and mental well-being. The new system should provide workers with appropriate care without overtaxing the national healthcare system. Given the way in which Covid-19 threatens to become endemic here, future outbreaks should be easier to manage because interactions between workers and healthcare providers would be limited to more specific geographic areas.
The new system is an incremental move to assure migrant workers that their health, like their labour, is valued by the Government and society at large. It bears remembering that about 87 per cent of Singapore's 62,563 Covid-19 patients were dorm residents, although no new cases have been detected in dorms in the past two weeks. The dorm outbreak led to a swift rectification of living conditions, particularly proximity, that could have contributed to the extent of the disease there. Public attitudes to foreign workers displayed signs of frightened rejection till the gradual curbing of the outbreak restored confidence in Singapore's ability to handle the crisis. The new system is a pre-emptive one.
No comments:
Post a Comment