Wednesday, December 10, 2008


I spend my afternoon today, at Putrajaya, Ministry of Health, block E1, listening to Datuk Dr Hisham discuss the government's plans to liberalise the medical sector by 2013, in line with the ASEAN Free Trade Agreement, which is in line with the WTO, Uruguay round ( 1994 ) and the DOHA round ( 2004 ). Tun Dr Mahathir signed the agreement in 1997, committing us to opening our medical borders, to out-side doctors from ASEAN and around the world, to come and practice here. The ASEAN Framework Agreement on Services ( AFAS ), with healthcare as the priority, will be fully liberalised by 2010 ( now pushed to 2013 ).
Globalisation sounds so very good, and seem to be the catch phrase nowadays. I am of the opinion for alongtime that globalisation only help the rich and powerful nations get richer and richer, at the expense of the poorer third world nation, who are not so well organise, and have no economy of scale to fight the richer more powerful nations. Sub-Saharan Africa will always be poor, even in the face of globalisation. With the severe credit crunch in Sept and Oct 2008, we still have not learn that globalisation can be bad. Globalisation is what cause all of us to become drawn into what essentially started as an American economic meltdown. We are not as much affected as Singapore, in this current economic recession, because, we are less global then Singapore. We learn that globalisation has a severe downside too.
Now back to my story. Of course, at Datuk Dr Hisham and his staff briefed us on what has happened from 1994-2008. Basically, the target date is 2013. By 2013, the ASEAN medical market will have no borders. So we better get our act in order.
When discussion time came, I raised a few points. I asked the Ministry to consider patient-care, and not health tourism and profit margin, as the aim of opening the medical market. We doctors see healthcare as helping patients get well.Whatever we do as doctors, it must be for the better of patientcare. But, businessmen, and now also politicians, see healthcare as dollars and cents. It is all about money, unfortunately.
I also reminded the meeting that at the moment, West Malaysian doctors cannot even set up shop in East Malaysia. If we as Malaysians do not have an open medical market for Malaysians, how can we even think or talk about opening the Malaysian market to non-Malaysians, Such logic only make sense to the people who live and work in Putrajaya ( somehow, the air there must be different, perhaps they are breathing 21% carbon dioxide ). If Malaysia is not flat, how can we talk about a flat ASEAN, or a flat world? Thirdly, we have not got all the laws in place to safeguard good medical practice in Malaysia, in the 21st century. We have not amended Medical Act 71, to regulate good conduct of medical practice and also to define who is a medical specialist. We have half done the amendments to the Private Healthcare Facilities and Services Act, The medical devices Act is still not in place, the pathology bill is still not enacted, the Traditional and Complementary medicine Act is still not in place. How can we open the borders? Only politicians can understand that. We have another 4 years to get all the above Laws and Regulations in place by 2013.
Of course, the dateline for us to hand in our suggestions is the 31st Dec 2008 ( in another 20days ). We have of course ask for a meeting with the Minister.
Many in MOH, felt that they must protect medical specialist from the challenge of foreign doctors when borders are opened. On behalf of the Federation of Private Medical Practitioners, I assured them that specialist in Malaysia are competent, and can stand the competition. Thank you for your concern, but no thank you. We are able. However, we object to the liberalisation, because, in our opinion, it will be detrimental to patientcare, unless all the relevant regulations are in place.
Can you imagine, Singaporeans can own 70% of a private hospital in East Malaysia, while west Malaysians cannot? Does that make sense to anyone? Can you imagine the many "sinsehs" who will be here on a sessional basis?
Well, as usual, we are fighting a losing battle. As my colleague put it, " the porridge is already cooked, ready to be serve, and now they ask for our opinion and suggestions " . That is how things are done in Malaysia, over and over again. Malaysia is certainly a great country. Malaysia boleh.

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