Monday, March 19, 2012


I left to take bath and a break.

I stopped at point 5, which dealt with mandatory contribution. Without all contributing, the project will not be viable. Ask your insurance experts, and those who know risk management.

Point 6. The NHS model. Of course, no country will follow another country 100% exactly. We have to customise it to our Malaysian culture, and what is pre-existing. But, it is true to say, that internationally speaking, if you have a socialise insurance system ( in UK, it is national health insurance actually) with a GP gate-keeper and strictly referred tertiary care, with separation of prescription and dispensing, that model is commonly called the UK NHS model. That does not mean that we borrow it lock stock and barrel. We will adapt it. Luckily for us, we know, only too well, the failings of the UK NHS model. We have already study the Australian system ( Karol Consulting 2006 ) and the Taiwan and Korean system. I wonder why we never study the Cuban system, which works quite well if you wish equitable access and equitable standard of care. The story goes that a VVIP went to UK and was very impressed with the UK NHS, and decided to adopt it. Anyway, deny as much as Datuk Maimunah will, it was she who presented to us on 2nd Feb 2010, the UK NHS like model that was the basis of 1Care for 1 Malaysia Healthcare Transformation under the 10th Malaysia Plan.

Point 7. Doctors of your choice. I remember that we discuss that you can, after filling plenty of paperwork, change your GP. You are allowed one change. What she did not say was, if your GP is in your home area, like Cheras, but you developed a headache, or diarrhea after lunch, now you have to go back to Cheras to be seen and not seen by the nearby GP in Kepong. Ah, this was not highlighted. However, you cannot choose your specialist. Your GP will refer you. If you wish to chose your own specialist, then you leave the system, and pay out of your pocket. The GP manage your care through a fund by capitation, If she over spends on refers and expensive drugs and investigation, he / she will be asked to account, write reports to justify, and he / she can be blacklisted or removed from the panel. Every year the most "SHI unfriendly" GP will be asked to go for refresher, until they "behave" properly. That is how they control cost. By controlling visits, controlling investigations, controlling drugs, controlling referrals. This is healthcare insurance.

Point 8 - Generic drugs. Following from the previous point, of course they will choose the cheapest drugs to use. Save cost, increase profit for insurance company. Drugs tested by bio-equivalence is only one aspect. Bio-equivalence means that the imitation drugs is biochemically equivalent ( in the laboratory ) to the real drug. Doctors prefer drugs that are tested by bio-efficacy, which means that they are tested in humans are found to be as effective in the condition, compared to the real McCoy. Of course, bio-efficacy is expensive to carry out, and increase cost of drugs, Bio-equivalence is a short cut. Drugs are produce from many chemicals, the active ingredients, the stabilisers, the coating agents, the eluting barriers, All these chemicals have expiry dates. Of course if one uses grade A ingredients with long expiry dates, they are more stable and can last longer. But it will also cost more. So many local companies cheat. The batch that is send for approval gets all the first grade chemicals. Once they pass the test, the subsequent batches, uses chemicals that are almost near expiring and so soon loses their potency. That is why many local generics, when used in public hospitals do not work. It is well known that MOH had to resort to buy back the originals because specialist complain about lack of response. Under the propose 1 CARE system, you can chose the originals, but you have to pay out of your pocket.

Point 9. Admin cost. Of course the concept paper quotes 5%. WHO suggest 10% admin cost. She quotes that Taiwan is low cost. She forgot to say that Taiwan Social Health Insurance has gone bankrupt and have failed. Malaysia has not been know for low admin cost. In fact judging by our track record in building bridges, Hwys, stadiums, IPPs and even ancilliary healthcare services, low cost has never been our strong point. Cost over-runs in fact is the usual. Not for profit is a nice term, before they see the RM 44.23 billion. Once they see the RM 44.23 billion ( the largest GLC ), profit for company may give way to self profit. There are so many examples of piratisation to quote that I will not bore you. We guess that the final admin cost ( maybe after 1 year ) will be 15-17%. First year must be good boy wa.......

Point 10. It will cost less. Of course not. Our present healthcare budget is about RM 37 billion ( 4.6% GDP and 7% of Federal budget ). The projected cost of 1Care is RM 44.23 billion based on 28 billion population in 2008, and 4.3 persons per household. Should either number change, the cost will go higher then RM 44.23 billion. Now, you tell me if that is less than present?
Presently, although the Healthcare Expenditure is 4.6% GDP, the government portion is only 2.3% GDP, what a poultry sum.

Anyway, this is another way of looking at the questions posed to Datuk Dr Maimunah Hamid, Deputy DG MOH, Research and Technical Support Division.

If I find enough time, I will try and write a review of improving the present system to be as good as 1Care with less burden for the poor Malaysians.


Palmdoc said...

I think you mean "paltry sum" in point 10 but then again your England is correct too as poultry sum implies it is chicken feed ;)

hmatter said...

Its true, palmdoc,
I noticed that as I grow older, my spelling is getting worse with the occasional thought block.

pilocarpine said...

LOL. chicken feed.