健康是本钱 - Health is my capital: a qualitative study of access to healthcare by Chinese migrants in Singapore

Abstract

BackgroundSince the 1970s, Singapore has turned into one of the major receiving countries of foreign workers in Southeast Asia. Over the years, challenges surrounding access to healthcare by Chinese migrant workers have surfaced globally. This study aims to explore the experiences of Chinese migrants accessing primary and secondary/tertiary healthcare in Singapore, and the opportunities for overcoming these barriers.MethodsWe conducted 25 in-depth interviews of 20 Chinese migrants and five staff from HealthServe, a non-governmental organization serving Chinese migrants in Singapore from October 2015 to January 2016. Interviews were transcribed and analysed inductively adopting thematic analysis.ResultsChinese migrants in Singapore who were interviewed are mainly middle-aged breadwinners with multiple dependents. Their concept of health is encapsulated in a Chinese proverb “健康是本钱”, meaning “health is my capital”. Health is defined by them as a personal asset, needed to provide for their families. From their health-seeking behaviors, six pathways were identified, highlighting different routes chosen and resulting outcomes depending on whether their illness was perceived as major or minor, and if they sought help from the private or public sector private or public sector. Key barriers were identified relating to vulnerabilities during the migration process, during their illness, when consulting with healthcare providers, and during repatriation. A transactional doctor-patient culture in China contrasts with the trust migrants place in Singaporean’s public health system, perceived as equitable and personable. However, challenges remain for injured migrants who sought help from the private sector and those with chronic diseases.ConclusionsPolicy recommendations to increase patient autonomy enabling choice of healthcare provider and provide for non-work related illnesses are suggested. Partnerships between migrant advocacy organizations and various stakeholders such as hospitals, government agencies and employers can be strengthened.

Accessing health services in India: Experiences of seasonal migrants returning to Nepal.

“…These ndings are similar to those of a study conducted among Chinese migrants in Singapore, which found that most of the interviewed migrants paid to see a private doctor or return to China for long-term treatment completely on their own [20]. The high cost of medical treatment for basic health services is also well documented in the literature [21,[22][23][24].…”

Accessing health services in India: experiences of seasonal migrants returning to Nepal

“…These findings are similar to those of a study conducted among Chinese migrants in Singapore, which found that most of the interviewed migrants paid to see a private doctor or return to China for long-term treatment completely on their own [ 20 ]. The high cost of medical treatment for basic health services is also well documented in the literature [ 21 – 24 ].…”

“…Many participants reported that not having an Aadhaar card was one of the structural barriers to accessing healthcare services in India [ 21 ]. A previous study with Nepali migrants in India also reported a limited access to health and social care services by Nepali migrants due to their inability to prove their identity [ 25 ].…”

Barriers to health care services in migrants and potential strategies to improve accessibility: A qualitative analysis

“…One study found a correlation between health insurance coverage and lower health service utilization among internal migrants in Hanoi, Viet Nam, with seasonal migrants using services the least, followed by migrants working in private small enterprises and migrants in industrial zones (104). Chinese migrant workers in Singapore experienced difficulty getting their work injuries reported, receiving compensation (including for medical costs) or obtaining wages while on medical leave (105).…”