Sunday, September 30, 2012


I was asked to comment on the Prime Minister's budget announcement on Friday. So I thought I might as well post on this blog, in case it does not come out right.
A few items in the budget affects healthcare.

       1. RM 19B public expenditure on Healthcare  is just 11% increase from 2008. In 2008, the Public HC expenditure was RM 17B. So it is 11% increase in 5 years. barely enough to cover inflation.
       2.The  RM 20M for 70 new 1M clinic is very small. A quick calculation will show that it works out to be about RM 280K per new clinic. The  amount is barely  enough to set up a clinic. If the clinic were to have  5 staff at salary of RM3K per staff per month, with doctor at RM 8K per month, will set you back RM 240K per year. What about rental, electricity, equipment, etc. etc... ALL FOR SHOW.
       3. Public response to 1Malaysia clinic is  good, because they know that  they have a choice, at least for cough  and cold, and cheap medication. They know that should they need more than that, they can go to hospital. basically if 1M clinic is run by doctors, not so bad. If just by staff nurse and HA, then - firstly, it is not in compliance with PHCFS Act and secondly, public is being misled.
       4.In the issue of cholesterols and glucose testing is not wrong, except that it comes with responsibility. Who does? Who interprets? Will the explanation be accurate? Will it create false alarms and produce dysfunctional patient?
       5. Why duplicate when such facilities are already available? Why not support the existing private clinic, work with them on a agreed sum, and enhance private clinics. That will improve Public/Private relationship, or as they say in HC transformation - integrate the two, bring them closer.
       6. More money is allocated to upgrade present clinics. That is good. It is the staffing and responsibility. More hemodialysis  machines are good, if there are adequate qualified manpower to manage. we hope that these additional hemodialysis machines are in areas of need and not to compete with established centers, leaving large areas of need elsewhere.
       7. SOCSO money for check  it is a good move. We proposed the idea along time ago. It can help to pick up lifestyle diseases early. Perhaps some of these check-ups could be outsource to private clinics and centers, who meet a certain criteria. We need the Pathology Act to regulate these check-up centers.
       8. Increasing allowance for Healthcare staff is fine. BUT, it must be tied to performance. We should not give more money to people as vote buying. With more pay, productivity must increase. We should not pay more to staff who powder their face, take tea-breaks, do private businesses  and take half of Friday off, all on government time. Pay / allowance must be tied to performance, not to votes.

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