Analysis | Baby delivery charges: Government price plan raises legal uncertainties

Alexis Tam

Responding to an outcry over a ninefold hike in non-resident delivery charges, the Secretary for Social Affairs and Culture may have been confident last week that his behind-closed-doors assurance to domestic helpers would quell the brewing discord over the issue.

Alexis Tam may have thought his concession, a threefold hike for some of the lowest earners in Macau, was the ideal compromise between dissatisfied migrant worker groups and a Health Bureau intent on raising the charges.

But his intervention has raised far more questions than it could possibly answer.

Under the proposal’s latest incarnation, non-resident expectant mothers who face “financial difficulties” will be asked to pay a discounted rate for delivery services at the public hospital.

If implemented, the proposal would affect an unknown fraction of the approximately 200 non-resident mothers who give birth at the public hospital each year, according to official statistics. The 200 non-resident mothers account for just 8 percent of all pregnant women served by the hospital.

Migrant worker groups welcomed the partial exemption, without which their members would have faced charges equal to up to four months’ salary, depending on the delivery procedure.

But for lawyer Sérgio de Almeida Correia, the move is still highly discriminatory and possibly unprecedented.

A HOUSE DIVIDED

The public sector is also divided over the proposal as several entities have offered contradictory accounts of what it will entail and presented markedly different visions for its implementation.

It began with a statement from the Health Bureau in late February which revealed that non-resident expectant mothers would soon have to pay fees nine times higher than the current rate for giving birth at the public hospital.

This prompted an outcry from migrant worker groups who claimed that the move was discriminatory, “cruel” and would cause some women to opt for cheaper, unsafe deliveries.

Then Secretary Tam, meeting with several of the groups, advanced that the ninefold increase was never intended to be applied to domestic workers and promised that they would face a threefold hike instead.

But a statement released by the Secretary’s Office earlier this week seemed to acknowledge that the decision to exempt some non-resident workers had come about in response to public opinion. It said that the Secretary, after consideration and consultation with local organizations, had decided to lower the increase in delivery charges – not just for domestic helpers, but for all low-income non-resident workers.

There are ever more questions to be answered at this critical juncture in the policy’s formulation and ever fewer government representatives willing to answer them.

Replying to a Times enquiry, the Health Bureau said this week that it was unwilling to comment further on the proposal. The Office of the Secretary for Social Affairs and Culture did not reply at all.

PROMISED TOO MANY,

TOO MUCH

At the center of the confusion is Secretary Tam. His promise to migrant workers initially caused several days of uncertainty as the media attempted to verify his comments with representatives of government departments who were themselves unsure of them.

“I wonder if there is any plan from Secretary Alexis Tam, because the image that comes out after everything that was written by the Health Bureau and said by the Secretary is that we are facing a movement of total indefiniteness [uncertainty],” Correia told the Times this week.

Correia’s comments bring to mind a 2016 evaluation of the social affairs commentator Larry So, who said that Tam had “promised too much […] and now can’t live up to those promises.”

“I sincerely hope that he thinks before he speaks [in future],” added So at the time. “In fact, he should think twice.”

Speaking to the Times yesterday, So said that he still holds this view.

“To a certain extent, he [Tam] has promised quite a lot without much thought behind it. He is trying to make a sound bite, [but] behind the sound bite there needs to be more detail,” he said. “Tam needs to be more transparent.”

UNANSWERED QUESTIONS

As to what constitutes low- income, the government has not disclosed the threshold level, nor specified whether it will be applied to income alone, or some combination of income and savings. It is also unclear whether the means testing will only reflect the mother’s financial situation, or whether the income or capital of a spouse will also be taken into consideration.

What is known from the Secretary’s comments is that non-resident workers with financial difficulties would have to apply to the Health Bureau and the Social Welfare Bureau in order to benefit from the lower rates. This means that the situation of applicants and their entitlement to reduced hospital charges is likely to be assessed on a case-by-case basis.

For Correia, the policy raises larger questions about the future of Macau’s healthcare. He said the discriminatory approach threatened to affect more than pricing at the public hospital, and could even affect the availability of medicines and quality of medical care.

HEALTHCARE FOR ALL, FREE OF CHARGE

It is also not known whether low-earning non-residents would actually be charged one-third of the cost borne by other non-residents, or whether they would be charged the full amount with the government covering the two-thirds balance.

There is an important difference.

While the governments of many jurisdictions subsidize important services in health and education for those without the means to pay for them, charging different rates to people who hold the same legal status in Macau (all of whom are non-residents) constitutes discrimination.

This can be avoided only if all non-residents are charged the same amount, with the government stepping in to to cover the financial difference between a default rate and a reduced rate for low-earners.

Unless this is the case, Tam’s amendment to the Health Bureau’s proposal may breach several international agreements.

For example, it may be in contravention of at least the ‘spirit’ of the International Covenant on Economic, Social and Cultural Rights, to which the Macau SAR is a party. Article 2 of the Covenant states that parties should guarantee such rights “without discrimination of any kind as to race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.”

The article continues with a proviso that, “developing countries, with due regard to human rights and their national economy, may determine to what extent they would guarantee the economic rights recognized in the present Covenant to non-nationals” – but makes no mention of intra-group discrimination among non-nationals.

Further, a 2001 report submitted to the United Nations’ International Convention on the Elimination of all Forms of Racial Discrimination – by China, but based on information supplied by Macau – states that the MSAR will guarantee “universal and free health care for the entire population of Macau” as per Decree-Law 24/86/M.

It also specifies that health care should be free of charge for certain groups of people – including pregnant women – and that “emergency health care provided at the Conde S Januário Hospital (a public hospital) is completely free of charge.”

Correia told the Times that in his opinion the “price should be the same for everybody and the government should pay the difference for those who cannot afford it.”

Though “the principle should be [that] those who can [pay], pay according to their earnings,” he continued, “in Macau, according to the reports sent by China to international organizations, access to health services [is] free to [the whole] population.”