Sick and Sent Away
A migrant domestic worker (MDW), Siti, asked for two things:
To transfer to a new employer to escape an abusive work environment.
To receive medical treatment for suspected gallstones.
She was denied both.
The Case
Siti had been in Singapore since 2013. She is an orphan and the sole provider for her adopted five-year-old daughter who lives in Indonesia.
She began working for her most recent employer in late November 2025. From the outset, she experienced an abusive work environment. She described to us daily verbal abuse and degrading treatment:
Crushing working hours; she was made to wake at 4am and sleep at 10–11pm daily
Being called “anjing” (dog in Malay), “stupid”, and “bastard”. She was never addressed by her name.
Prodded with her employer’s daughter’s foot to wake her up late at night to clean her bathroom
Made to put on shoes for the employer’s 15 year old son
Required to repeat cleaning tasks up to 15 times a day
She had already asked to transfer two months into her employment, well before her illness began.
The Medical Emergency
In late January, she experienced severe stomach pain. She initially asked only for Panadol. She was afraid to seek medical attention as she felt that her employer would not pay for it. An ambulance was eventually called.
At the hospital, she was suspected to have gallstones and advised that an ultrasound was required. Her doctors also recommended that she undergo a cholecystectomy (surgery to remove gall bladder) if the ultrasound confirmed the presence of the gallstone. Siti wanted to remain in Singapore to access this treatment and thereafter transfer to a new employer. She had no insurance in Indonesia to be able to seek this treatment.
Here is where the situation escalated.
The employer allegedly answered medical questions on Siti’s behalf, refusing treatment in Singapore.
The employer later told her she could undergo ultrasound and surgery in Singapore only if she agreed to continue working for them.
Siti could not transfer without the employer’s consent, as is required by Singapore law.
Her employer threatened her that if she still wanted to transfer, she would be sent home and blacklisted instead.
Since 2007, Migrant workers have not been covered by health care subsidies in Singapore. Her one visit to the hospital racked up a bill of $2,100. Despite this amount being covered by medical insurance, the employer reportedly demanded immediate repayment from her and discouraged further treatment.
Faced with the choice of remaining in an abusive household to receive medical treatment, or being repatriated without treatment, she chose to run to HOME’s shelter to seek help. Despite our best efforts with the Ministry of Manpower, her case was assessed as not being eligible for a transfer despite the overwork and verbal abuse. As she was assessed to be fit to travel, the final decision was left in the hands of the employer. She was eventually repatriated to Batam.
The Structural Problem
This case highlights a systemic vulnerability within Singapore’s work pass framework for migrant domestic workers:
Even with employers being required to purchase mandatory hospitalisation insurance for migrant workers, they are still able to act as gatekeepers and prevent workers from accessing medical treatment, simply by repatriating them.
When a worker’s employment status is tied to a single employer, healthcare can become conditional. Treatment becomes negotiable. Dignity becomes optional.
This is not how access to healthcare should function.
MOM estimates that with the hospitalisation insurance coverage of $60,000 yearly, 99% of bills will fall within this coverage.
However, this statistic cannot account for cases in which employers repatriate workers before giving them the opportunity to seek medical treatment. The extent to which migrant workers are affected by this practice remains unknown.
HOME’s Policy Recommendations
To prevent cases like this from recurring, HOME calls for the following reforms:
1. Restore Healthcare Subsidies for Work Permit Holders
Healthcare subsidies for work permit holders were removed in 2007 to provide clearer distinctions between citizens and non-citizens. Yet in 2026, the government is targeting to raise $7 billion dollars from foreign worker levies.
Without subsidies, medical costs escalate quickly, creating financial anxiety for employers and increasing the risk of premature repatriation, despite having mandatory hospitalisation insurance.
2. Implement Outpatient Insurance for Migrant Domestic Workers
While the Primary Care Plan provides structured outpatient coverage for other migrant workers, MDWs remain excluded from equivalent outpatient protection. An outpatient insurance framework would prevent delayed treatment and cost disputes.
MDWs who are sick may be prevented from seeking treatment as employers do not want to incur costs, or they may have to bear such costs themselves.
3. Introduce a Right to Change Employers with Notice Periods
Workers should have the ability to change employers with reasonable notice, without requiring employer consent. This would reduce the leverage abusive employers hold and ensure workers can access medical treatment without fear of forced repatriation.
4. Remove the 25% Co-Payment Requirement Above $15,000
The current requirement that employers co-pay 25% of medical bills exceeding $15,000 may discourage employers from allowing treatment to proceed. This creates uncertainty for employers when serious illness arises.
5. Increase the Medical Insurance Cap
The current $60,000 cap is insufficient in a system without subsidies. Raising the cap to $80,000 to $100,000 without a requirement for co-payment would provide more meaningful coverage and reduce incentives to repatriate workers before treatment.
A Broader Question
No worker should have to choose between:
Remaining in an abusive environment
Or returning home without medical care
Singapore has made improvements in migrant worker healthcare, including the introduction of the Primary Care Plan for non-domestic workers. But migrant domestic workers remain uniquely vulnerable due to the live-in requirement and employer-tied work pass structure.
This case is not only about one worker. It is about the system that allowed this to happen.
HOME continues to advocate for policies that ensure migrant workers can access healthcare, justice, and safe employment, without fear of retaliation or forced repatriation.