Monday, July 26, 2010

NATIONAL HEALTH FINANCING MECHANISM: MALAYSIAN HEALTHCARE TRANSFORMATION UNDER 10th MALAYSIA PLAN

On saturday, the STAR newspaper wrote a feature article on the National Healthcare Financing mechanism, the Malaysian Healthcare transformation under the 10th Malaysia plan. Well one thing is for sure, I do not think that there will be any transformation in the next 5 years. The minister did say that there are four essential steps ( in his opinion ). By the time the 4th step is in plave, I rather suspect that this present minister will be gone and so will many of us. In the immediate future, I expect that there will be some improvement in public hospital services and rise in fees in private hospitals.
Anyway, I was rather disappointed in the research done by the Star investigative team. It is tru, that at the moment, whatever the Minister of Health had announce was vague, but I felt that the Star team could have done a better job looking into the proposed plans, because, those details are known to many in the industry as the ministry of Helath had systematically called meetings with many of the stakeholders to brief them, including ourselves. Dr David Quek ( President of MMA ), was at the meetings and ( unless he had forgotten ) know many more details. Interviewing fresh young specialist in the healthcare industry serves only to get personal opinions, but not help the bigger picture of what is coming ahead for the nation. Many of us from the profesional societies have dealt with these issues an know the many pros and cons.
It also seem to be the opinion of the writer of the articles that the present system is so very poor that transforming it is the only way out. Nothing can be further from the truth. As we have said over and over again, the present system is basically good and needs to be primed with a greater injection of funds ( increase healthcare expenditure from the present 4% of GDP to 8% GDP ) or from the present 7% of total national budget 2009 to 14% of national budget 2010. No need new taxes ( that is what this new scheme requires ), just make better use of what you have now. Cut down the leakages.
There seemed to be a thinking that we can have equal standards of healthcare for everyone. Nothing is further from the truth. Whatever you do, and wherever you go, the rich who can afford it will get better care, and the poor, lesser care Sad to say, that is the fact of the matter. BUT we must strive that all will have equitable care. All Malaysian must have access to good basic healthcare.
The article on saturday began by giving examples of patients in desperate financial needs, trying to get public sympathy and donations for treatment of some rather complicated condidtions. Well, I sat through some meetings on the previous, proposed national health finaancing mechanism ( there were many previously ), when we had to work out ( should there be national health insurance ) which conditions should be covered. There is no blank cheque to cover and pay for all medical conditions. We had to categorise payments for conditions which must be covered ( MUST HAVE ), conditions where payment may be necessary ( SHOULD HAVE ) and conditions where payments which may not be covered ( NICE TO HAVE ). So not all medical conditions will be covered. That is health insurance, they teach me. If insurance were to cover ALL conditions, a few complicated cases can blow the whole budget.
Undoubtedly, with all health insurance, there have to be rationing, and the decision can be very emotive. Those deprived will make those who deprive them of cover, look like butchers. The fact of the matter is, there is a fixed amount of money to take care of the naton's health. If you have RM 1 million, would you rather use it to treat 10 complex cases ( who may or may not recover ), or treat 1,000 cases and restore them to good health so that they can be productice to society?
Would you use your money, to prolong life for another 9 months, someone suffering from cancer ( who have a high chance of recurrence ), or use it to treat curable childhood diseases?
Yes, rationing sounds so bad, but those are the facts of life.
10th Malaysia plan healthcare re-structuring and transforamation, well we have written about it in February when we were briefed, lets see, what happens.