Friday, September 18, 2009


We are constantly reminded that healthcare cost is rising and society ( any society ) cannot afford to pay for the rising cost. President Obama is having a very hardtime trying to push through healthcare reform, which will see less people not insured, and also in his own way, try and cut down healthcare cost.
Malaysia has been looking to reform her healthcare system,for as long as I can remember ( since the early 80s, I think ). We are reforming, on the premise that privatising healthcare will reduce cost and improve efficiency. In my opinion, both assumptions are wrong and it may end up, after one year ( initial feel good 1 year ), that the whole Malaysian Healthcare Reform had been piratised.
To this end, I wish to write a few blogs and share how, in my opinion, healthcare cost can truely be reduced, and the healthcare dollar stretched. The first point is that " prevention is better then cure " . This cliche has been repeated so often that I sometimes think that it has lost its meaning. Well, in health and disease, this saying is very true.
The Sept-Oct 2009 issue of the American Journal of Health Promotion, carried an article by Drs Kartika Palar and Roland Sturm on " Potential societal savings from reduced sodium consumption in the US adult population" ( Am J Health Promot 2009; 24: 49-57 ). This study was carried out by the RAND Pardee Graduate School at Santa Monica. What the authors found out was that if the US population will consume less salt, ( they were consuming 3.4gms/day of sodium when the recomended amount was 2.3 gms/day ), then they could reduce the number of patients suffering from hypertension and save direct healthcare cost for HBP treatment and also improve " Quality adjusted life years - QALYs ). Using the National Health and Nutrition Examination Survey (NHANES 1999-2004) as their basis, they estimated the salt consumption in the population and also that 30% of Americans suffer from the kind of hypertension that can be prevented by reducing salt consumption. Putting all these in dollars and cents, they estimated that the US government could save USD 18 billion in direct healthcare cost and USD 32 billion in QALY cost ( from the complications of hypertension and loss of QALYs. In total, the US government could save about USD 50Billion a year, for their population of 270million people. All this just by consuming 1.1 gm less salt a day.
Translated to Malaysia, it would mean a cost savings of RM 5 billion a year, if Malaysians would consume 1.1 gm less salt a year. This number can be enhance if we will eating more green veges and fruits to increase our potassium intake, and drink enough water. Such simple lifestyle changes can help to save so much money and also give all of us a better " quality adjusted life years ".
So yes, healthcare dollars can be saved, if we as a nation, is prepared to make some sacrifice. Of course the government can help, by labelling food and controlling the amount of salt additives sold. When there were rumours of sugar shortage, the government should have taken the opportunity to encourage everyone to cut down carbohydrate consumption and sugar consumption, to reduce obsity. Another very important strategy to save healthcare dollar. Instead, our YB minister of tourism is trying to encourage eating as a important way of bringing in the tourism dollar, of course at the expense of the healthcare dollar.
It is often said, in the coffee shops, that this government is somewhat schizo., on the one hand they wish to make tourism dollar to the detriment of good health, and on the other they complaint about rising healthcare cost, which we all know, is due to eating all the wrong things.
Anyway, we will keep discussing the issues. Maybe along the way, some will listen. If not for the country's sake, at least for your own good health sake.

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