Monday, April 25, 2011


I read with great interest and agreement, the article by Dr HT Ong and company, on the planned 1Malaysia Healthcare transformation. This article appeared in " Fit for Life" column. A summary of this article ( by the same authors ) had actually appeared in " NST Letters to the editor" about 3 days earlier.
I have actually written about this year year ago when we were invited to attend by the YB Minister of Health. Even at that launch, when we broke up into discussion groups, we ( the Federation of Private Medical Practitioners Association ) had already protested that this Healthcare transformation of introducing a national health insurance, will not help patient care. In fact, it may retard patient care and cause the healthcare system to be " piratised". Of course, we hear that the government is going ahead.
Just to recap, in the proposed 1Malaysia Healthcare transformation :-
1. There will no longer be public and private healthcare. It will take the form of a national health insurance, almost like the UK, NHS system ( which by the way, is in trouble with long waiting list ).
2. All citizens will be tax by way of a consumption tax, maybe GST + 7% for healthcare? I think the form of taxation or subscription ( a very sensitive issue ) has not been firmly decided, as it will certainly raise a large hue and cry.
3. All residents will be allocated to their GP in their locale, and given a number. They must see the GP in their locale should they require medical help. The GP will act as their primary doctor and if necessary, will refer them for a specialist opinion and tertairy care.
4. All hospitals ( no longer demarcated as private of public ) will treat the patients referred and charge the national health insurance who will re-imburse on a " fees schedule ".
5. Patients can buy additional private insurance should they wish.

The official reasons to justify this healthcare transformation is :-
1. The inefficiencies in the present healthcare system, especially the long waiting list.
2. Of course, there is the forever issue of rising healthcare cost, that the government can no longer afford.
3. Of course to solve the brain drain to the private sector.

What we doctors fail to see ( and we have discussed this extensively amongst ourselves ), is how can this transformation solve what it was planned to solve ( unless there are hidden agendas that we suspect, but are not told. Not to forget that the healthcare industry is a multi-billion dollar industry ) )
1. What is planned will only increase waiting list. Look at UK as a prime example, where it is recently reported in the BBC news, that elective surgery waiting list is in the months ( like waht we have now ).
2. The healthcare cost will surely rise, because you are now creating another layer ( the health insurance payers ) who must add some extra " admin cost " so that they can profit. I am sure that this national insurance company or corporation are not doing it for free. The CEO needs a pay of tens if not hundreds of thousands a month ( look at the CEO of "Syabas" ).
3. The rakyat is burdened with more taxes, whether direct or indirect.
4. Of course the government will decide on the success of this healthcare transformation, by their KPI, KRA or what ever government indices, non of which have to do with patientcare. Take for example, the KPI for the home ministry and police. Their KPIs are all glorious, and yet every feels even more unsafe, so unsafe that they all have their gated, and guarded communities.

The solution suggested by Dr HT Ong and company is what we also suggested. Increase the present government healthcare budget to 6-7% and that will improve the efficiency of the present public sector, which will prompt more patients to stay in the public service and control the extravagant charges of the private sector. Once the public sector is more efficient, more people can be taken care of at lower cost. It is true, that the standard of patient care in some public hospital is good. This waiting list problem can also be solved with more budget and less bureaucracy and redtape.
If at all the government wish to control the rising cost, control the rising cost in the private hospitals, as we suggested. by having a private hospital fees schedule. But the government is dragging their feet on that, as the Association of Private Hospital has a very strong say. As the saying goes, they are on very good terms with the Minister, who is their friend.

As I tell all my colleague, if there is a change of government at the next GE, then all this will be transformed too. If the present government wins the next GE, I am sure that they will go go for the " Billion dollar booty". So let the rakyat decide.

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