The Southeast Asian region has long been a hub for labour migration, encompassing countries with distinct (and sometimes dual) roles as labour senders and receivers. Indonesia, the Philippines, and Myanmar are prominent labour-sending nations, while Malaysia, Singapore, and Thailand are notable recipients. This dynamic underscores ASEAN’s dual identity: an economically integrated region heavily reliant on cross-border labour while grappling with social inequalities.
As of July 2023, Malaysia hosted approximately 3 million documented migrant workers, constituting 15.3% of its labour force.1 Singapore’s non-resident workforce exceeded 1.5 million in mid-2024, comprising nearly 35% of its total labour force.2 Thailand employed about 3.9 million registered workers from Cambodia, Laos, Myanmar and Vietnam in 2019.3 These statistics underscore the essential contributions of migrants to ASEAN economies even as they face systemic inequities particularly in accessing healthcare.
Despite the ASEAN Declaration on the Protection and Promotion of the Rights of Migrant Workers (2007), social protections for migrant workers remain underdeveloped. The focus remains mainly on economic liberalisation, often sidelining the social dimensions of regional integration.
Strengthening healthcare for migrant workers
Following the COVID-19 pandemic, Singapore introduced the 2022 Primary Care Plan to improve healthcare for migrant workers. Employers are required to provide coverage for consultations, screenings, telemedicine, and transportation. Workers pay a minimal co-payment, ensuring affordable access. These reforms aim to boost health outcomes and build a stronger, more resilient public health infrastructure..
Photo: NurPhoto SRL / Alamy Stock Photo
UNIVERSAL HEALTH COVERAGE
ASEAN countries have made commendable progress in Universal Health Coverage (UHC), but inclusivity remains inconsistent. Malaysia and Singapore have long-standing systems that ensure comprehensive healthcare for citizens, supported by tax-funded mechanisms. Brunei extends generous health benefits to its citizens despite not imposing personal income taxes. Thailand’s UHC scheme, launched in 2002, now covers 99% of its population.4 This success is credited to Thailand’s “30 Baht Scheme,” which expanded healthcare access significantly for underserved communities.
The Philippines has also progressed through its National Health Insurance Programme (PhilHealth). By 2023, the programme achieved a coverage rate of 100%,5 partly driven by the Universal Health Care Act of 2019. Indonesia, home to the world’s most extensive single-payer healthcare system, has enrolled 235 million people under Jaminan Kesehatan Nasional (JKN) by the end of 2021.6
Despite these achievements, most UHC systems in ASEAN are citizen-focused, leaving migrant workers, refugees, and asylum seekers with limited or no access to healthcare. Labour-sending countries like the Philippines have consistently urged host nations to adopt more inclusive health policies. Its former Social Welfare Secretary Judy Taguiwalo once highlighted during an ASEAN meeting, “Our collective efforts are needed in the ASEAN to support reforms that will enable migrant workers to find safe, legal, and decent work and to work in dignity and with the support, not only of the government of their home countries but also of the government of their host countries.”
Indonesian migrant workers in Malaysia
Indonesian migrant workers make up the largest portion of Malaysia's foreign labour force. Despite social security for workplace injuries and mandatory health insurance, healthcare access remains limited. Undocumented workers face greater barriers due to high costs and fear of deportation. A 2022 Memorandum of Understanding aims to enhance protections, but implementation challenges persist.
Photo: Bazuki Muhammad/ REUTERS
Most UHC systems in ASEAN are citizen-focused, leaving migrant workers, refugees, and asylum seekers with limited or no access to healthcare.
TRICKLE-DOWN REGIONALISM?
While ASEAN countries are making strides in UHC, labour-receiving nations increasingly prioritise medical tourism. Malaysia, a leading medical tourism destination, generated over RM 1.7 billion in revenue in 20237 and aims to exceed RM 2 billion by 2024.8 Singapore remains a hub for high-value medical procedures, drawing over 500,000 international patients annually.9 Thailand, with its largest medical tourism market in Southeast Asia, has also capitalised on its reputation for affordable and quality healthcare, achieving a strong growth in medical tourism of 24% above the pre-COVID level.10
Defining medical tourists remains problematic. According to a 2011 OECD publication, estimates of global medical tourists vary widely due to inconsistent definitions and reporting mechanisms. The category often conflates genuine medical tourists with expatriates, foreign students and labour migrants seeking routine healthcare. For example, 60–70% of Malaysia’s inbound medical tourists hail from neighbouring Indonesia,11 and they should not be confused with the large population of Indonesian migrant workers in Malaysia who also need healthcare services.
MIGRANT RIGHTS AND RESPONSIBILITIES
Migrant workers often find themselves excluded from public healthcare systems. In Malaysia, they face significantly higher hospital fees than citizens and are required to purchase mandatory insurance with limited coverage. For instance, the Foreign Workers’ Health Insurance Scheme costs RM 120 annually but caps benefits at RM 10,000.12 Similarly, while robust for residents, Singapore’s healthcare system offers limited provisions for non-residents unless privately insured.
On the other hand, migrant workers often contribute heavily to host countries’ public finances. In Malaysia, annual levies for migrant workers range from RM 640 to RM 1,850,13 alongside other administrative fees, which add up to RM 1,121–2,331 annually. These levies are a regressive de facto income tax on migrant workers. For example, a migrant earning RM 1,000 per month would pay an effective tax rate of 9% to 19%, compared to less than 1% (more likely zero after tax deductibles) for a Malaysian citizen earning the same amount.
This disparity highlights systemic inequities that need to be addressed. Migrants are indispensable to ASEAN economies, yet they remain marginalised when it comes to accessing fundamental rights, including healthcare. Some improvements were introduced in individual countries after the COVID-19 pandemic. For example, Singapore reformed its healthcare policies and practices for migrant workers to make them more structured and holistic, introducing new services like mental health support and telemedicine. However, more needs to be done in the region as a whole.
Migrants are indispensable to ASEAN economies, yet they remain marginalised when it comes to accessing fundamental rights, including healthcare.
United for rights
On 1 May 2024, thousands of workers across Thailand rallied on International Labour Day to advocate for better working conditions. Their main demands included better welfare benefits, higher minimum wages, equal rights for all workers, and fair access to inclusive healthcare, especially for migrant workers who face systemic barriers.
Photo: Pongmanat Tasiri / SOPA Images via ZUMA Press Wire
TOWARDS AN ASEAN SOCIAL CHARTER?
To address these challenges, ASEAN must adopt a more inclusive framework. A regional social charter could align contributory systems with healthcare and social benefits, ensuring equitable treatment for migrants. Such a charter could incorporate flexible mechanisms tailored to the diverse economic and social policies of ASEAN member states.
For example, host countries could extend their mandatory social security schemes to include migrants, granting them access to healthcare and other benefits. In return, migrants would contribute to these systems under terms similar to those of local citizens. This approach, rooted in reciprocity, would more likely gain traction among policymakers and citizens alike.
Moreover, establishing minimum standards for healthcare access across ASEAN would ensure that migrants receive consistent and fair treatment, regardless of their host country. These initiatives could also mitigate public concerns about “freeloading” migrants by demonstrating their significant economic contributions.
BALANCING INTEGRATION WITH EQUITY
ASEAN’s integration journey must balance economic aspirations with social justice. Migrant workers, who play an integral role in sustaining the region’s economic growth, deserve equitable healthcare and social protections. Simultaneously, the region’s booming medical tourism sector should be leveraged to generate revenue that could partly fund inclusive healthcare initiatives.
By embracing an inclusive integration model, ASEAN can become a global exemplar of equitable economic and social development. This approach would not only enhance the region’s economic resilience but also foster stronger social cohesion and trust among its diverse populations. ∞
The region’s booming medical tourism sector should be leveraged to generate revenue that could partly fund inclusive healthcare initiatives.
CHAN CHEE KHOON
Dr Chan Chee Khoon is an independent researcher and health policy analyst based in Kuala Lumpur, Malaysia. He graduated from the Massachusetts Institute of Technology (MIT) with Bachelor’s and Master’s degrees in life sciences and a Doctor of Science in epidemiology from Harvard University. He has served as consultant and technical adviser to the World Bank, European Commission (EC-INCO expert evaluator for health sector research), WHO (global consultations on Genomics & Health; IDEAHealth advisory board), UNRISD, UNESCAP (Expert Group Meeting on Health & Development, 2004), UNESCO (Bangkok regional consultation on ethics of scientific knowledge and technology, 2006), IOM (2nd Global Consultation on Migrant Health, 2017), Japan International Cooperation Agency (third-party evaluator). Dr Chan has authored and reviewed chapters for Global Health Watch (volumes 1–3), and his current research interests include health systems in transition, emerging infectious diseases, migration, rights and health, and environmental health.
FEBRUARY 2025 | ISSUE 13
MIND THE GAPS; BRIDGING THE GAPS
- “Malaysia.” International Organization for Migration, www.iom.int/countries/malaysia#:~:text=Labour%20migrants%20in%20these%20corridors,skilled%20and%20semi%2Dskilled%20jobs.
Accessed 23 Dec 2024. - “Foreign Workforce Numbers.” Ministry of Manpower Singapore, 12 Sep 2024, www.mom.gov.sg/foreign-workforce-numbers.
- “Labour Mobility and Social Inclusion: IOM Thailand: IOM Thailand.” IOM Thailand, thailand.iom.int/labour-mobility-and-social-inclusion. Accessed 23 Dec 2024.
- “Enhancing Convenience: 22nd Year of UCS.” National Health Security Office, 11 Jan 2024, eng.nhso.go.th/view/1/DescriptionNews/Enhancing-convenience-22nd-year-of-UCS/587/EN-US#:~:text=Over%2099%25%20of%20Thai%20citizens,healthcare%20coverage%20in%20the%20country.
- “Stats and Charts | 2023.” Philippine Health Insurance Corporation, www.philhealth.gov.ph/downloads/. Accessed 23 Dec 2024.
- “Balancing Incentives in Performance-Based Capitation for Chronic Care: The PROLANIS Programme in Indonesia.” WHO Centre for Health Development, 2023, wkc.who.int/docs/librariesprovider24/wkc-projects-documents/2-6-case-study-rep-of-korea.pdf?sfvrsn=158712f4_1.
- Siddharta, Amanda. “Malaysia: Revenue from Medical Tourism 2023.” Statista, 2 Aug 2024, www.statista.com/statistics/1013817/medical-tourism-revenue-malaysia/.
- “Malaysian Private Healthcare, Medical Tourism Sector to Take in RM 2.2 Billion Revenue This Year.” MIDA, 10 Nov 2024, www.mida.gov.my/mida-news/malaysian-private-healthcare-medical-tourism-sector-to-take-in-rm2-2-billion-revenue-this-year/.
- Statista Research Department. “SEA: Annual Number of Medical Tourists by Country.” Statista, 10 Dec 2024, www.statista.com/statistics/1477909/sea-annual-number-of-medical-tourists-by-country/.
- DBS Group Research. Equity. “ASEAN Healthcare.” DBS, 24 Jul 2024, www.dbs.com/content/article/pdf/AIO/072024/240724_insights_asean_healthcare_medical_tourism_a_battle_of_two_asean_cities.pdf.
- Md Zain, Nur Adilah, et al. “Intra-Regional Medical Tourism Demand in Malaysia: A Qualitative Study of Indonesian Medical Tourists’ rationale and preferences.” Malaysian Journal of Medical Sciences, vol 29, no 2, 21 Apr 2022, pp 138–156, https://doi.org/10.21315/mjms2022.29.2.13.
- “Foreign Worker Medical Insurance.” Federation of Malaysian Manufacturers, www.fmm.org.my/Industry-@-Foreign_Worker_Medical_Insurance.aspx. Accessed 23 Dec 2024.
- “Levy Payment Rates.” Ministry of Home Affairs, www.moha.gov.my/index.php/en/bahagian-pa-dasar-dasar-semasa/kadar-bayaran-levi-visa-plks. Accessed 23 Dec 2024.
