1Care: Prioritise, not privatise patient care

Dr Ng Swee Choon
12:12PM Dec 24, 2011


We refer to the letter from the Director-General, Ministry of Health: 'Gov't not abdicating responsibilities thru 1Care' on Dec 17.

We fully agree with the need to improve the quality and delivery of health services for the rakyat, provide more choice to patients and preserve the strengths in our current health system.

Our pubic healthcare system has been inherited from what the British left behind but it is historically not the NHS of the UK

Over the years, Malaysia has improved its own system and adapted it to cater for our needs.

Our robust one-stop GP clinics are the backbone of our primary care system providing basic medical care for more than 60% of outpatients in the nation.

Unlike in the UK, Malaysian patients can walk in to see their GPs without appointment and be attended to in a reasonably short time.

In the UK, to see a GP requires prior appointment which can be two or three days later even if you are down with fever.

To see a specialist in the UK NHS often requires waiting time of up to two months. This is not so in Malaysia. Thus, the Malaysian healthcare system today and the NHS UK are poles apart.

However, the concept paper of reforming our Malaysian HC system (1-Care) tells us that the proposed system is a mirror image of today's NHS which is a system that have failed to deliver and also failed to contain cost.

It has resulted in serious accessibility issues at primary and secondary care. Even the British citizens themselves are upset over the inadequacies of their system.

They are travelling to Europe and even as far as South Africa and India for treatment and surgery.

The proposed transformation will greatly affect the patients and the rakyat and we are naturally deeply concerned with its implications.

The current UK NHS itself undergoing more reforms upon previous reforms.

We have asked many times, why are we heading that way?;

  • Reforms but at what cost?;
  • How much will this whole 1Care for 1 Malaysia cost the rakyat?
  • How will it be financed?;
  • Will it mean more taxes, direct or indirect ( as in GST / VAT) ?; and,
  • Will the government still be responsible for Healthcare or will it be privatized to government linked companies?

These are all important questions that must be openly addressed.

Past experiences at privatization in Malaysia have been not particularly encouraging. Naturally we are very fearful when it involved healthcare.

Representation of Stakeholders

The Federation has indeed been invited to sit in on the Technical Working Group (TWG) meetings. TWG, as the name suggests, does not deal with the big issues but on nitty gritty details.

The terms of reference TWGs involving the doctors are very limited, and deal mainly with clinical governance, how to charge and what to charge and operational issues of clinics and doctors.

The fact is that the proceedings of the TWGs will be part and parcel of the final blueprint of the proposed system which we believe has already been decided, contrary to what we are told.

Moreover, TWG meetings are often called at short ( sometimes one to two days) notice, making it virtually impossible for many to attend.

However it does give the public the impression that we were invited but did not bother to attend

On the other hand, there are also the TWGs deciding on this healthcare transformation on which conflicted stake holders like private hospital chains, pharmaceutical manufacturers, insurance companies and MCOs meet and decide on the "big money issues".

These meetings are not privy to the patients, doctors, public and the taxpayers.

1-Care will cost more

We expect the cost of proposed reformed healthcare system to push up costs because of the increased administrative cost at the expense of patient care cost.

The 1-Care concept paper has already allocated 5% of the expected total healthcare cost of RM 44.24 billion as administrative cost.

This comes up to a whooping RM2.2 billion each year on administrative costs alone. As doctors we believe that this money should be better spent directly for patient care.

Dr Ng Swee Choon
Medical Affairs Committee Member
Federation of Private Medical Practitioners' Associations Malaysia



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