KUALA LUMPUR: The issue of foreigners racking up millions in unpaid medical bills requires solutions that go beyond hospital walls, say health professionals.
There should be stronger insurance mechanisms, employers’ accountability, better coordination between the Home Ministry and the Health Ministry’s digital integration, and consistent enforcement, said Malaysian Medical Association president Datuk Dr Thirunavukarasu Rajoo said.
“Healthcare must remain ethical. Cost recovery must become systematic. Both objectives are achievable,” he said.
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In January, Health Minister Datuk Seri Dr Dzulkefly Ahmad was quoted in reports as saying that foreign patients in Malaysia have accumulated RM102mil in unpaid medical bills at public healthcare facilities since 2023. Undocumented migrants accounted for 73% of the outstanding amount last year.
The issue has come to the fore once more with social media postings, purportedly written by a nurse from the emergency department of a public hospital, about foreign patients misusing administrative procedures to avoid paying deposits.
Dr Thirunavukarasu said the situation would not be resolved by tightening emergency room practices or placing blame on doctors.
“Doctors and nurses are bound ethically and professionally to provide treatment to all patients who present themselves at emergency departments, regardless of nationality, immigration status or ability to pay,” he noted.
“Refusal exposes a doctor to disciplinary action and potential legal liability.”
As such, he said MMA cautions against narratives that shift responsibility to healthcare workers.
“They cannot function as immigration officers or debt recovery agents,” he said, adding that no ethical healthcare system can allow a critically ill patient to be denied stabilisation because of their inability to pay.
“Once stabilised, administrative verification, insurance activation, employer notification and structured billing recovery must proceed efficiently,” he said.
The issue, he said, is not the fee structure, but enforcement and system coordination.
Calling for systemic reforms, he said the Foreign Workers Hospitalisation and Surgical Insurance Scheme (Spikpa) requires urgent review.
“Coverage ceilings are often inadequate relative to treatment costs, verification at hospital registration counters is inconsistent, and certain vulnerable worker categories remain insufficiently covered.”
He said employers who recruit foreign workers must also bear financial responsibility for their healthcare.
“A mandatory healthcare bond or guarantee mechanism should be considered, and sanctions for non-payment must be enforced consistently. Cost recovery cannot rely solely on hospital administrators at the point of discharge,” he added.
He said there is also a need to strengthen a centralised foreign patient billing and recovery framework, coordinated with the Immigration Department, embassies and relevant agencies.
“Outstanding bills should be linked to work permit renewals and future recruitment applications.
“Hospitals should have real-time access to immigration and insurance databases to verify identity, employer details and coverage status at the point of registration. Technology exists to support this; it must be integrated across agencies,” Dr Thirunavukarasu added.
Former director of Sungai Bakap Hospital, Dr RA Lingeshwaran, proposed real-time biometric verification with the Immigration Department to identify patients who may actually possess valid work permits or passports, and cashless payments for those covered by Spikpa where the bill is directly paid by insurers.
“For documented workers, the Health Ministry shall be given the authority to seek payment from employers, including potential legal action or bank account deductions for persistent defaulters.
“We need to be aware that this is not a Health Ministry issue alone. It involves the Human Resources and Home Affairs ministries too,” he said.
Retired health ministry director Datuk Dr Zainal Ariffin Omar proposed that companies employing foreign workers provide bank guarantees.
“Deposits should be waived only for those with valid insurance. Tougher debt recovery mechanism is needed,” he said.
