REPLY TO DG MOH DOCUMENTARY ON HEALTHCARE REFORM IN STAR 3rd Dec 2011

Letter to the Editor, STAR. 3^rd Dec 2011.

I read with great interest the documentary article by the DG of Health in STAR 3^rd Dec 2011.It is so true, that the present Healthcare system, though good by all health outcomes standards measured, needs some improvement. Having said that it is fair to say that, the present system is good compared to some of the developed and developing countries around us. See ( Fig 1 ).

Fig 1. WHO report 2007

What is even better was that even spending 4.75% of GDP on the Total Healthcare ( Public and Private ) in 2009, we are equally good health outcomes. “Syabas” to the government and to all the Healthcare providers. The DG stated that the government spends only 55% of the total expenditure while 45% is from private funding. That means that the government expenditure is only about 3% of GDP. This is far from the OECD average of 9.7% of GDP.

There is no guarantee that transforming the whole system to an NHS-like system will improve things. Taking care of our people is to take care of our workforce, so that we have a healthy workforce to achieve vision 2020. It is absolutely vital that the government of the day give more emphasis and more money to provide good healthcare for a stronger workforce.

Fig 2. PUBLIC & PRIVATE HEALTH EXPENDITURE AS % OF GDP, 1997-2008. MNHA 2009

From what I understand from the DG’s article, a few points may have been lost in translation. It is important to note that all health insurance system work on rationing care. The system provider have to see which condition to re-imburse and which not to re-imburse. That means that some condition will not be covered. That is how they cut cost. Besides choice of conditions covered, patients also lose their choice of consultants / specialist to take care of them. They are assigned specialist and consultants. That to them is cost savings. This cost cutting in turn pays for the management overhead of the insurance providers. Healthcare providers get more forms to fill, and the National Health Financing Authority gets more staff to push more papers. Admin cost will surely go up commensurate with admin paperwork. Admin paperwork usually results in delay in providing care. Whether or not the National Health Financing Mechanism have a profit incentive or nor, remains to be seen. Basically, healthcare cost will not go down. It will at best remain the same, and at worse go up, without improvement in health for the country.

It is also not pointed out, that with this transformation, more money have to be collected from the “rakyat”. What the DG is saying is that the tax that we are providing now, is insufficient ( although we are only using 2.5% of government revenue on Healthcare), and so they need to collect more money from the rakyat ( in the form of direct or indirect taxation ), to park the money in a National Healthcare Financing Mechanism, for use in a transformed healthcare system. For the information of the public, that means to collect more taxes, to raise RM 35-40Billion dollars for the National Healthcare Financing Mechanism. Can you imagine what will happen to the RM 35-40 billion? Are you prepared to put your money into a common pool, having slogged to build up your own savings? Why should one put their money into a common pool and everyone draws out at your expense? This has happened in some western countries and the system has failed. If we really need to raise a fund for healthcare ( when the need arises ), individual Medisave accounts where whatever you earn is yours and if you do not use it, you can leave it to your children or whoever you like, is more practical. It works better. The government must always look after those who cannot afford. That is their social responsibility. They do collect taxes afterall.

We, the FPMPAM feels that the present healthcare system, though good by all outcome measures does have deficiencies that need to be improved and corrected. All these can be done if the government of the day, will increase healthcare allocation from the current less than 5% of GDP to the WHO recommended or OECD country average of 8-9%. Better healthcare delivery, at no greater expense to the “rakyat”, can be achieved. Healthcare is the responsibility of the government and should not be privatized. It is also an inalienable human right. It is not a privilege.

If the table ain’t broken, why fix it?

Dr Ng Swee Choon

Federation of Private Medical Practitioner’s Association of Malaysia ( FPMPAM ), Medical Affairs Committee.

I am trying very hard to insert the two figures that I attached in my letter. So far, I have been unsuccessful. I do not know how.