Is healthcare the modern-day Goliath for migrant workers?

Lynzy Valles

Healthcare is often described as a basic right, but in practice, it is frequently experienced as a calculation, especially for migrant workers in Macau.

Recent experiences, particularly the passing of overseas workers who reportedly delayed or avoided medical checkups due to financial concerns, have made me question: how can healthcare still become inaccessible despite its supposed accessibility?

This is not about assigning blame.

Individuals have a responsibility for their own health, including seeking timely medical attention. But responsibility does not exist in a vacuum. It sits within systems, wages, cultural expectations, and economic constraints.

And, for many migrant workers in Macau, the decision to see a doctor is not simply about health, but rather about survival budgeting.

When someone earns around MOP5,5000 a month, even a routine consultation can feel like a risk calculation rather than a preventive measure. The fear is not only of diagnosis, but of the bill that follows it. In some cases, that fear becomes more paralyzing than the symptoms themselves.

Not everyone who lives in this lavish city has the luxury of immediately consulting a doctor.

For many low-income earners, healthcare is not treated as a priority, not because they do not value their well-being, but because survival comes first.

For migrant workers, the very reason they come to Macau is to work, earn, and send money home.

Missing a day’s wage for a checkup, paying consultation fees, or risking additional medical expenses can feel financially devastating.

As a result, health concerns are often postponed until symptoms become unbearable. What may begin as fatigue, pain, or discomfort is endured quietly, with the hope that it will simply pass.

This then creates a dangerous cycle where preventive care becomes inaccessible not only economically, but psychologically.

It’s always important to acknowledge that migrant workers are not a marginal footnote in Macau’s story. They are part of the city’s daily functioning: supporting households, construction sites, hospitality services, and essential sectors that keep the economy moving.

Yet sadly, their access to affordable healthcare often remains disproportionate.

The quieter cultural reality of many migrant workers normalizes endurance, something that will never be easily changed. It’s what they are used to: to endure.

This is not unique to Macau; it is a global pattern. Migrant populations frequently sit at the edge of systems designed primarily around citizens, residency status, or formal protections.

But acknowledging that this is “not new” should not lead to a “new norm.”

Macau is a wealthy city by regional standards, with strong fiscal capacity and well-developed infrastructure. Hence, supporting nearly 185,000 workers is not like defeating Goliath.

In Taiwan, those with legal work permits or Alien Resident Certificates (ARCs) are automatically enrolled in Taiwan’s heavily subsidized National Health Insurance (NHI) program, thus making medical visits highly affordable.

While the system does not provide entirely free healthcare for non-residents, it makes medical access attainable for these workers – whether they are employed in households, factories, or white-collar jobs.

But, that said, policy alone is not the only layer. Employers, recruitment structures, and information access all play a role.

If a society measures its progress by how it treats its most vulnerable, then healthcare access becomes one of its clearest indicators.

For now, healthcare may exist physically within the city, but for many workers at the margins, it still feels out of reach.