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I READ with great interest “Better healthcare for all” (The Star, Dec 3). Our present system is good compared with that in some of the developed and developing countries.

What is even better is that in spending only 4.75% of GDP on total healthcare (public and private) in 2009, we have equally good health outcomes.

Health Director-General Datuk Seri Dr Hasan Abdul Rahman stated that the Government spends only 55% of the total expenditure while 45% is from private funding.

That means that government expenditure is only about 3% of GDP. This is far from the OECD average of 9.7% .

There is no guarantee that transforming the whole system to an NHS-like system will improve things. It is absolutely vital that the government of the day places more emphasis on, and gives more money to provide, good healthcare for a stronger workforce so that we have a healthy workforce to achieve Vision 2020.

It is important to note that all health insurance systems work on rationing care. The system provider has to see which condition to re-imburse and which not to re-imburse. That means that some conditions will not be covered. That is how costs are cut to pay 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. Administrative costs will rise, commensurate with administrative paperwork, which usually results in delay in providing care.

It was also not pointed out that, with this transformation, more money has to be collected from the rakyat.

What the Health 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 more money has to come from the rakyat (in the form of direct or indirect taxation).

The money to be raised, RM35bil to RM40bil, will be parked in a national healthcare financing mechanism for use in a transformed healthcare system. The bottomline is the Government wishes to privatise healthcare delivery.

How much of this RM35bil-RM40bil will be directly translated into actual healthcare delivery is our big question.

We note that the present healthcare system, though good by all measures, does have deficiencies that need to be corrected.

It is clear that the government of the day will need to increase healthcare allocation from the current less than 5% of GDP to the WHO recommended or OECD country average of 8%-9%.

There is a need to urgently improve the present public healthcare system – e.g. heart bypass for the ordinary folk cannot have a waiting time of six months or more, the old who are blind from cataract cannot be made to wait until they have enough money to buy their own lens implant.

These are basic needs that privatisation cannot address.

The challenge is to deliver better healthcare for the achievement of Vision 2020 at no greater expense to the rakyat by first plugging the leakages in the system and improving public sector delivery.

Healthcare is the responsibility of the Government and should not be privatised. It is also an inalienable human right. It is not a privilege. Fix what is broken, not break up what is working.


Dr NG SWEE CHOON
Medical Affairs Committee
FPMPAM

published in the Star Online on Tuesday December 6, 2011