Migrant workers in Singapore are more frequently admitted to hospitals for nontrauma conditions than for trauma, a study has found. Moreover, nontrauma and nonworkplace injury (NWI) admissions can result in large bills that exceed the mandatory insurance coverage.
“Recent changes to healthcare policy governing migrant workers to allow copayment of large bills and better access to primary care are timely,” according to the researchers, who conducted this retrospective observational study aimed at examining emergency department (ED) triage acuity and bills related to admissions among migrant workers for nontrauma, workplace injury (WI) trauma, and NWI trauma.
All work permit holders admitted to hospital via the ED of three public health institutions from 1 May 2016 to 31 October 2016 were included in the analysis. The research team obtained data from medical records, including demographics, triage acuity, and bill information.
A total of 1,750 unique patients (median age 33 years, 67 percent male) were analysed, accounting for 1,788 admissions. [Singapore Med J 2026;67:559-567]
“The male preponderance of the trauma group was driven by higher number of male migrant workers in the construction, marine, and process industries,” the researchers said. “However, nontrauma complaints affected MW of both genders more evenly.”
Trauma comprised 595 (33 percent) hospital admissions, of which 433 (73 percent) were caused by WI. NWI admissions were more like to present as high acuity P1 cases (43 percent vs 24 percent; p<0.001), be transported by ambulance (49 percent vs 24 percent; p<0.001), and lead to trauma team activations (29 percent vs 7 percent; p<0.001) than WI admissions.
Insurance claims
Compared with WI admissions, more NWI admissions had gone over the insurance claim limit under existing healthcare policies (22 percent vs 3 percent).
“Trauma admissions due to NWI are not covered by the increased Work Injury Compensation Act (WICA) payout of SGD 45,000 in 2020. Under prevailing insurance caps, 22 percent of this subgroup in our study had bills exceeding insurance claim amounts for NWI,” the researchers said.
“It is possible that NWI occurs more frequently in the community, but migrant workers with less-disabling NWI may anticipate difficulties with insurance claims and are reluctant to present to the hospital. Thus, the profile of a migrant worker with NWI presenting to a hospital is that of higher acuity, where the patient is compelled to seek medical care,” they added.
Notably, WI trauma could be severe. Each of the two outlying cases of outstanding bill size in this cohort required more than 30 surgical procedures for severe WI burns injury, highlighting the importance of a strong coverage under WICA, according to the researchers.
Workplace safety
Another hospital in Singapore published data in 2021 showing a 5-percent prevalence of WI admissions in the migrant worker population. This finding suggests that for each WI resulting in admission, about 19 other injuries were sustained at the workplace. [BMJ Open 2021;11:e042427]
“Workplace safety efforts appear to have resulted in a drop in admissions for WI over the years and must continue to be emphasized,” the researchers said.
“Nevertheless, intentional efforts to support illness prevention should be taken and health literacy should be improved in the migrant worker population, given the large numbers of nontrauma admissions,” they added.
“Migrant workers should have access to primary care for early detection and treatment of chronic conditions, without perceived penalty for seeking medical treatment even for low-acuity conditions,” the researchers said.