1Malaysia Healthcare – Transforming For The Better Or Worse

Tuesday 3.5 2011
Steven KW Chow/Ng Swee Choon


We read with great interest and agreement, the article by Dr HT Ong and others, on the planned 1Malaysia Healthcare transformation (The Star 24.5.2011).

When this plan was revealed three years ago, the FPMPAM had cautioned that introducing a national health insurance, will not necessarily improve patient care and lower cost of delivery. In fact, our contention is that it may disrupt the continuity of the present patient care.

Our proposal is instead of a transformation is to allow the system to evolve paying particular attention to areas of weaknesses which causes the under-performance and poor delivery in the existing system.

To our information, the proposed transformed system is supposed to be modeled from the NHS system of the United Kingdom. A brief view of the essential changes is as follows:

1.         There will no longer be separate public and private healthcare funding..

2.         All healthcare cost shall be met by way of a central fund that is in the process of being designated.

3.         All residents will be allocated to their GP in their locale, and given a number. They must see the GP in their locale should they require medical help. The GP will act as their primary doctor and if necessary, will refer them for a specialist opinion and care.

4.         All hospitals (no longer demarcated as private or public) will treat the patients referred and charge the national health insurance/fund who will reimbursed based on a " fees schedule "

5.         Patients can buy additional private insurance should they wish.

Among others, the reasons given to justify this healthcare transformation are :-

1.         The inefficiencies in the present healthcare system, especially the long waiting list.

2.         The never-ending issue of rising healthcare cost and that the government can no longer afford.  to subsidize it.

3.         The new system solves the brain drain to the private sector.

What we doctors fail to see (and we have discussed this extensively amongst ourselves), is how can this transformation solve what it was planned to solve

1.         Firstly, the proposed model will only increase waiting list as clearly exemplified by NHS-UK which is the model for this transformation. Public complaints of unduly long elective surgery waiting list in terms of many months in many cases, have been substantiated by the recent reports in the BBC news. Clearly at the end of the day, that is no different from what we have now . In addition, the NHS-UK is in trouble with many cases of the GP “gate-keepers” being sued for unacceptable delay and denial of secondary care.  The question is “Why are we heading that way?”.

2.         Our prediction is that the healthcare cost will surely continue rise and at a more rapid rate. This is exactly what is happening despite many decades of the NHS. The system has failed to contain cost. Healthcare cost in the UK continues to increase year by year resulting in more and more cuts which in turn is aggravating the ability of the system to efficiently deliver the care that it was designed for.

The creation of another bureaucratic layer in the form of the health insurance payers (another business entity) will add substantial cost item to healthcare delivery. This is the middle-men that will be appointed to administer the cost in healthcare .We have already seen this happening in many other examples of privatization in Malaysia. The additional cost involved will eventually be paid by the rakyat. So, why use this business model again?

3.         With the proposed plan, the rakyat will be burdened with more taxes, whether direct or indirect. What seem to be bussing around is perhaps a GST + 7% for healthcare?  The contention that the patient need not pay is not correct as at the end of the day, the payment comes from the patients and the public alike. The difference is you pay whether you fall sick or not.

What is clearly needed is for the government to increase the present budget allocation for healthcare. We are merely committing 4.3% of our GDP as healthcare expenditure compared to UK (8.2%), Australia (8.7%) and USA (15.3%). To be realistic we need to be increased to 6 to 7 %. In keeping with the increasing demands and cost of advances in healthcare today.

This together with stringent and meaningful cost-efficient measures to improve the productivity of the public healthcare system will provide the patients with a system far better than what the NHS-UK has to offer. The excellent standard of care that many public hospitals should be made available to all needy patients by cutting red tape at all levels. At the same time the cost of private hospital care should be closely monitored and controlled with the appropriate market forces and regulatory machinery.

There seems to be a strong desire to have this transformation in motion within the next three years.

This is a unrealistic expectation and will surely upset the continuity of our present healthcare delivery.. One must not forget that even the NHS-UK system took more than 30 years before it could be fully implemented by which time all the so called cost-cutting measures had been overtaken and neutralized by the rapid advances in medical technology, costly treatment modalities and patient-population demographic changes.

We propose that we evolve rather than transform our system which has been acknowledged by WHO as one of the best around. This claim has been regularly promoted by the Ministry of Health itself. Our exemplary healthcare performance indices have been duly documented and acknowledged in the yearly National Healthcare Accounts.

Are we in the throngs of a “new car syndrome”, where everything seems wrong with the old car once we have decided to buy a new one?  Will appropriate servicing and change of parts to more than sufficient to keep it in pristine condition?

Should we transform the system or fix only what is broken.

We do feel that it is time for a public referendum on this issue as it eventually involves the rakyat’s money and welfare.

This letter has also been published on malaysiakini. Click here to get there.


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