Sunday, July 29, 2007

Part Privatisation (Piratisation) of Government Hospitals

Malaysia at the moment has one of the best healthcare system in the world. As we have posted earlier, we spend only about 3.6% of our GDP on healthcare and yet achieve standards better then many of our ASEAN neighbours. Yes, there are deficiencies in services rendered, but nothing that cannot be remedied with some relatively cheap revamp. Alas, the politicians are very keen on a total change to the system. They have already employed eight healthcare consultants to advise them on how to, but the last one (final report handed to the cabinet in April 2007) has failed to impress the politicians or fulfilled their (the politicians) objective.

Yesterday, in one of the dailies, we read of the hon. minister of Health, announcing a minor privatisation of the government hospitals. The newspaper tells us that w.e.f. from 1st August, patients seeking treatment at the Putrajaya Hospital or the Selayang Hospital, will be allowed to choose whether they wish to be treated by their own specialist. Of course they will be admitted to the first class ward, and they will pay "private" rates. Supposedly, the specialist will get to keep all or part of the professional fees, thus boosting their income. All this sounds great, right?

This dream sounds so great until you wake up and the truth gets in the way. It has already been proven terribly wrong for the other patients. We need look no further then our own University of Malaysia Medical Center and the University Kebangsaan Medical Center where patients can chose to be treated in the public wing, or the private wing. This started probably some five years ago. It has not stopped specialist leaving to private practice, at best one could argue that it slowed it down. The only problem is that these "advances" came at the expense of patient care and it was a terrible price to pay.

If you need some elective surgery at UMMC, and you see the specialist, he will tell you that if you choose the public wing, the surgery will be scheduled 3-4 months later (we have one report of an elective gastroscopy scheduled for 7 months later). If you choose the same specialist and the private wing, it could be done this evening, or tomorrow. How can they not learn? This can only worsen the government hospitals, or is the Hon MOH wanting to worsen the government hospital so badly that he can quickly approve a whole privatisation (read piratisation) process? Or is he secretly working to promote patient movement to private hospitals? Worse of all, it's an election year where politicians need to be seen to be doing something even if the patient has to pay for a bad choice. Can you imagine what the patients at Selayang Hospital will face come 1st August. All those opting for "private" care, will be seen and taken care of by the specialist and all the rest of the public patients will be seen and under the care of the junior doctors. Is that better for healthcare? Only the Hon. MOH seems to know.

We proposed, ages ago, that the Hon MOH should seriously consider charging all first class patients (presumably these patient have the means to pay the rates) the full private rates, and the second class patients, half subsidised rates and the third class patients fully subsidised rates. This will allow the MOH to improve their coffers. Specialist should get a pay rise across the board (and not on a per case basis so that they will continue to care for all patients), and encourage to go for courses, perhaps once a year, to improve themselves (some consultants are going on conference leave almost monthly). Putrajaya should reduce calling consultants for meetings all so often too. No going home, or playing golf at 3.30pm on Fridays, please.

1 comment:

Michel said...

A bit of a late comment but better lete than never.

I have to get it off my chest!

I have a comment on the matter of part-privatisation of government hospital. I went through the local Masters program and did a year in HUKM in 2003-2004. I saw flaws in the system in HUKM, at least as far as anaesthetists are concerned. The system was abused from the start. I wanted to raise this matter to the authority but being a government servant "my lips are sealed". Now that I have passed the exam & moved on, I am gonna reveal ALL for everyone to judge!
Anyone who is conscientious would not do what HUKM anaes dept consultants & specialists did (though not all of them). When it comes to a private patient list, the anaesthesia was given by the registrars (specialists-to-be) sometimes without any specialists who were paid to do it in sight. The income generated from anaesthesia service was pooled and divided between consultants & "eligible" specialists". I am not sure if it still happens now in 2008 but this was the situation in 2003. WAIT.....they did give something back....nasi lemak on Tuesdays. Hah...we "worked for peanuts" (in this case nasi lemak!)