Monday, October 26, 2009


In passsing, just let me say that after my last posting, President Obama has declared a state of national emergency in USA resulting from A H1N1 infections in epidemic proportions in USA. I am made to understand that it is a bureaucratic manuever to allow the heathcare providers to bypass certain bureaucratic requirements, in trying to provide urgent heathcare to suspected A H1N1 patients. Nonetheless, it also means that there are more then the usual number of ILI cases in USA for this season.
Anyway, lets come to the issue in this blog. I wanted to discuss the issue of whether we can provide equitable, equivalent healthcare to all? Is that a realistic aim?
I think that we should always strive to provide equitable heathcare for all. Everybody, should have access to healthcare. I am very proud of our present healthcare system because it does provide equitable healthcare. I have always appreciated the fact that should I happen to need medical help, even if I am in the deepest jungle in West Malaysia ( probably a bit more delayed in the jungles of East Malaysia ), I can approach a health clinic who will take care of me, and if necessary, transport me out to a district or general hospital, for almost no cost.
Equivalent healthcare for all is a different matter. I would like to approach standard of care from the point of universally accepted criteria of healthcare like the infant mortality rates, the maternal mortality rates, quality of life expectancy rates, etc. Malaysia, being a free market economy, allows people with different financial background and affordability, to buy themselves different health therapies. In 2008, 45% of patients pay for their healthcare, out of pockets. Health insurance is still not very popular,and accounts for 10-20%, although it is getting more popular. For out of pocket payments you pay for what you wish or can afford. For example, some patients wish for hospitalisation with comfort, and all the frills of therapy, because they can afford it, while others do not mind sharing a double room, and not having the extra scan, if it is not absolutely necessary. Comforts are but one example of how healthcare may not be equivalent.
The more difficult ( ethically speaking ), is the rationing of care to those who cannot afford it or who are paid for by health insurance. A few examples may highlight the point. Rich patients with severe headache may get a CT scan of the brain done much earlier, then those who cannot afford it, although CT scan of the brain is not required as the initial investigation in headaches. That is an easy and safe analogy. How about treatment for terminal cancers with very expensive chemotherapy which may only serve to prolong life for 6-8months. Should we give chemotherapy to patients with terminal cancers to prolong life for 6-8 months. I am sure, some will say yes, because life is precious and must not have a price tag. However, in the real world where healthcare has a cost and especially if you are covered by insurance, the insurance company may assess that prolonging life of a terminally ill cancer patient at the cost of RM 100K per cost may not be worth it and so they will ration. Is that wrong? Must we give equivalent care to all who are sick. It is a nice uthopian idea, but certainly difficlut to implement in the real world. For if we do, we will help some ( probably the minority ) and leave many deserving cases untreated, as there is a physical limit as o how much money you have to spend on healthcare.
I wanted to highlight the fact that at the moment, Malaysia have a good healthcare system, and although healthcare cost is rising, as people are living longer and better. That whatever system we reform to, we must always work towards equitible healthcare for all, but not necesarily equivalent healthcare for all. At some point, there will need to be some rationing. Those things that are " nice to have " may have to be curtail, only for those who can pay out of their own pockets. I think that President Obama will soon find that out too.

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