Barriers to public healthcare at affordable rates for non-citizen children

By:

Bina Ramanand

Affiliations:

Association of Family Support and Welfare Selangor and KL (Family Frontiers)

Policy Code:

3i Health

Problem Statement:

Non-citizen children (without a Malaysian birth certificate) with either parent Malaysian, and undocumented or stateless children are designated as foreigners in public medical facilities, which carry additional fees compared to citizens, as per the 2016 amendments to the Fees Act (Medical) 1951. For example, outpatient treatment for Malaysian citizens cost RM 1, while for foreigners it is RM 40. Services such as vaccinations and dental checks which are normally provided for free to Malaysian children in public schools are not extended to non-citizen children of Malaysians. Parents will have to pay an estimated total of RM 1,000 in vaccinations alone for their children—each vaccine costing RM40, and following the schedule set by the Ministry of Health for vaccinations, there are a total of 25 vaccines required from birth to the age of 15. Children with disabilities or long-term health issues will be faced with exorbitant medical costs.

Value(s) and Belief(s):

In the best interest of the child, and in line with Article 24 of the Convention on the Rights of the Child, all non-citizen children in Malaysia should have access to vaccinations and public healthcare at similar rates as Malaysian children.

Proposal of Solution:

Review and reform healthcare policies concerning children with either parent Malaysian to:
1. Allow all children (up to the age of 18) with either parent Malaysian to access public healthcare at the same rate as Malaysians, upon provision of the Malaysian parent’s IC. This includes children born overseas to Malaysians who may not hold a Malaysian Birth Certificate.
2. Ensure non-citizen children participating in the national school system are included in school-related health programs, including dental check-ups and other initiatives led by the Ministry of Health (MoH).
3. Grant vaccinations and immunisation programmes free-of-charge to non-citizen children and maternal care for their mothers.
Apart from the above recommendations concerning non-citizen children born to a Malaysian parent with valid documents, healthcare policies concerning undocumented or stateless, and adopted children should be reviewed and amended to allow:
1. Access to public healthcare services for undocumented or stateless children at the same rate as Malaysians.
2. All adopted children of a Malaysian parent to access public healthcare services at the same rate as Malaysians, upon provision of the parent(s) IC.

Additional Information:

Non-citizen children of Malaysians pay foreigner rates even when either parent is Malaysian. This is especially disadvantageous to those with children with disabilities or those who require long-term treatment.

Notable issues:
1. The unaffordable cost of healthcare makes it difficult for parents and children alike to access essential services, including immunisation programmes and maternal and child care.
2. Non-citizen children in the Malaysian national school system are not included in the mandatory general health and dental check-ups, booster shots and other initiatives overseen by the Ministry of Health.
3. Amidst a pandemic, access to healthcare becomes especially crucial. It must be guaranteed to every child. In such circumstances, a child’s life can be endangered when the cost of treatment is expensive.

Two classifications of non-citizen children who are allowed to enjoy health care services alike to citizens: those born in Malaysia under the age of 12, holding a Malaysian birth certificate and with at least one parent who is a citizen or PR holder, and those under the age of 18, adopted by Malaysian parents and with certified adoption papers.

Article 24 of the CRC stipulates that:

1. States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.

2. States Parties shall pursue full implementation of this right and, in particular, shall take appropriate measures:
…. (b) To ensure the provision of necessary medical assistance and health care to all children with emphasis on the development of primary health care;

Translation

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