Monday, March 19, 2012


I must have heard and replayed this radio interview, which is all over the internet numerous times. They have now spun it so well, that it is almost believable, until you see the details of what she said.
Datuk Dr Maimunah Hamid, is the deputy director in the Ministry of Health, Research and Technical Support division. She is the one who briefed us on the 1 Care for 1 Malaysia Healthcare Transformation, under the 10th Malaysia Plan.
I would like to give you all the other side of the story, point by point.
She made about 10 important points.

Point 1. - Transparency and concept paper. It is true that we did attend some initial meetings from 2009 to 2010. These were mainly top down meetings where we were asked our opinions on detail technical issues. No one ever asked us whether we need to transform or not. They ask you how to categorise diseases, and how to what diseases needed to be covered. The concept paper is now being discussed as a prelim paper to see if it is viable. It was presentaed to the National Economic Committee. That must mean that the numbers are serious as the economist must see to the viability of the project. Those are the most important facts. The numbers, namely the 10% household income, the average of 6 visits, the capitation principle, the average household of 4.3 persons, the basic 28 million population in 2008 used as the basis for the calculation. Now that the population is more, the numbers would have to increase accordingly. Yes, there is some more number crunching to be done, but I believe that they were very near implementation, until we let the cat out of the bag. Now they have to spin what we say. Basically, they have never refuted our details, but sometimes they try to play down their own concept paper. Actually before the 1 Care Concept paper 2009, there was a Roadmap paper 2008, on the same subject, prepared by the MOH.

Point 2. Privatisation of Healthcare. This is said to be following what other develop countries are doing. What she forgot to say, even the examples given, were that those countries have now gone into trouble. Taiwan was mentioned a few times. The Social Insurance there have pushed the country to near bankruptcy and they are about to revamp their system. Australia charges a high tax to take care of cradle to grave, The Dutch system is also under much stress and they are cutting back. The UK NHS system we know is being re-vamp, the USA system is different, but privatising healthcare is driving Obama-land to near bankruptcy. I will say more of this later.

Point 3. The existing system is two tier, and she claim that we wish to equalise healthcare for all, so that the poor can get so called " private standard" care. This is a fallacy. We all believe in equitable access to care. Everyone who need healthcare must get care, but there is no country in the world who can give the same standard of care. It is NOT a nice thing to say, but it is a fact of life. All Socialised Insurance Healthcare system rations care. All must get what they need, but those who can afford it will get what they want. Although they enrol with the social health Insurance, as it is mandatory, but because they can afford it, they will but extra insurance, to get what they want - eg their own doctors, surgery at their convenience, drugs from multi-nationals, etc. No social Health Insurance can give every rakyat whatever they want. It will blow the budget. We sat through a whole day of Technical Working Group meeting to decide on " what we must have" ( all must get ), "what we should have" ( can get with some co-payment ), and"what is nice to have" ( pay by yourself ). There must be ration with social health insurance. So if you think far enough, we come back to what we have now. The public system for all, and the private system for the rich who can afford it. These are facts of life. OR we go to the Cuban system. Even the Chinese ( Socialist ) system, have two tiers.

Point 4. The Infamous 9.5% or we round-up to 10%. She had a lot to say. I will quote the line and you all interpret. " SHI premium as % of average household income - 9.5%." You decide! It is true, that household who are working, their mandatory contribution is paid in part by the employee and partly by the employer, almost like EPF contribution although it is not called as such. I am sure that we all know that whatever the employer pays for you, the employer will deduct accordingly from your pay, so it comes from you too. It is true that the government will also contribute from our direct taxation, for those who cannot afford, or who are not working. She is silent on the illegal migrant workers, and collection from the legal migrant workers employers.

Point 5. She said that it has to be mandatory so as to cover everyone. Such a good spin. Obviously healthcare must include all, even illegals. When a sick person reaches your hospital, you cannot turn them away. All country must take care of everyone, but they can decide only to give them the most basic of care. NO NO. It has to be mandatory, so that many many contribute to form a large kitty to pay for those who are with longterm illness, or who use the system alot. If they do not make it compulsory, the whole system cannot work. If anyone opt out, the system falls apart. That is how they calculate insurance risk. Ask any of your insurance colleagues. If a health insurance company only insures those who require care, that company will go bankrupt. She made it sound so nice " so that we can cover everyone and no one is left out". What this will them happen is, those who are well and who contribute will begin to want to get their money's worth and misuse the system as we see if the other social health insurance countries. The system eventually goes under.

Let me take a pause. I am very afraid that I msy lose all, should the system here fail.

To be continued.

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