1Care medical scheme – a crony treatment?

Private practioners nationwide are concerned about the government scheme, which they fear will only benefit a few private companies.

TAWAU: A proposed medical insurance scheme by the government has raised concern among private practioners here and across the peninsular.

Suspicion has risen over the 1Care scheme which many believe will only benefit a few private companies at the expense of patients and doctors.

The doctors fear that healthcare expenses will increase as 1Care will become a monopoly through a giant managed-care organisation (MCO).

Although the government is yet to reveal the full details of the 1Care scheme, initial disclosures have raised concerns.

According to doctors here, in theory the scheme appears to save money for the consumers but in reality it is otherwise.

“It should save consumers from having to pay out of their pockets for their primary healthcare and thus protect them from excessive healthcare expenses, but in reality 1Care will come under a new company and thus a middleman.The middle man will profit from patients and their caregivers.

“This will result in healthcare costs going up, the standard of treatment may drop and the public will be burdened with a new healthcare tax,” said a private doctor who requested anonymity.

The doctor said most fraternity members are worried that their ability as medical practioners to provide quality medical care will be compromised by the scheme which will collect fixed funds from all working adults and their employers.

They are also preparing to face criticism from the establishment who may see their opposition to the plan as trying to protect their income first.

Scheme may lead to ‘undertreatment’

Meanwhile in a letter obtained by FMT, a group of doctors from the peninsular have also listed their concerns and are urging the government to engage all parties, including patients and the public before deciding to introduce the scheme.

They said it is important that dialogues be intiated and stakeholders respond to valid questions on the scheme.

Spelling out their concerns and worries, former Penang Medical Practitioners’ Society (PMS) presidents Dr Ong Hean Teik and Dr Haniffah Abdul Gafoor along with ex-Penang branch leader of the Malaysian Medical Association Dr SP Palaniappan, said the scheme is being promoted as having an immediate impact on improving the country’s healthcare system while also addressing the poor government medical facilities in Sabah and Sarawak.

“The experience worldwide is that a fixed capitation fee per patient will lead to inadequate and under-treatment since physicians tend to conserve resources to prevent financial loss.

“Although patients do not directly pay for their treatment, they are still indirectly paying since a portion of their income will automatically be deducted and given to the insurance company running this programme.

“Instead of spending only for their healthcare, patients are actually contributing to finance the operation of a private insurance corporation,” the doctors noted in their letter.

The doctors believe that to qualify for the scheme, they may have to buy computers and software from a designated supplier and also pay for certification.

“This appears to be a business model guaranteeing profit for the computer programme seller and the body providing education/certification of doctors.

“Patients don’t pay for drugs, which will be prescribed by doctors only from a standard list, and can also be dispensed at participating designated pharmacies. Clinics and pharmacies will then collect payment from the insurance corporation.

“Patient treatment will be limited to only these approved drugs, and any other drugs used will be paid fully by the patient out-of-pocket,” the letter noted.

Patients may pay more

The doctors said that while patients need not pay, quality of treatment will drop since the range of drugs will be limited.

“There is a monopoly in deciding which drugs get onto the approved list and profit will be guaranteed for the company supplying and manufacturing these drugs. Patients will be registered with a particular doctor and treatment must be only from this doctor.

“If a patient chooses to see another primary care doctor or if specialist treatment or hospitalisation is needed, patients will again pay out-of-pocket.”

The doctors said patients will no longer be able to seek a different primary care doctor, even if they travel to another town or if the initial treatment is ineffective.

“Since the scheme does not cover specialist and hospital costs which are far higher than primary care charges, patients may actually end up paying large out-of-pocket fees despite contributing to the new insuring company.”