While Malaysia's health system is often the talk of the region for being affordable, the government has deemed fit to take another shot at revamping the system in anticipation of rising healthcare costs and patient demands.
Those who have watched Sicko-- a Michael Moore documentary on the flaws of the billion dollar US healthcare industry-would, however, be more wary.
"It is the most disastrous system in the world where at least 14 to 15 billion people are not insured, and when you are not insured, it means you will be pauperised in the event you are sick.
"You will have to get into a charity based hospital which will also ration out healthcare to you as much as they can," said Dr T Jayabalan, the spokesperson for Citizens' Healthcare Coalition (CHC).
Jayabalan, (right) who has been a public health consultant and consumer advocate for the past 30 years, observed how such a scheme implemented around the globe has drastically affected the lives of those without comprehensive financial protection.
First mooted in the Fourth Malaysia Plan (1981-1985), the health insurance scheme blueprint has been revived and repackaged as "1Care for 1Malaysia" under Prime Minister Najib Abdul Razak in 2009 to trim public hospital funding.
Supposedly modelled after Britain's National Health Service (NHS), the 1Care scheme is to replace the current two-tier healthcare system, with one that integrates both private and government medical institutions, in hopes of "ensuring healthcare is accessible to all Malaysians" across the socioeconomic strata.
The 1Care scheme will be managed by the national healthcare financing authority (NHFA) and includes an insurance-like funding system.
Universal coverage for healthcare
It will be compulsory for individuals to contribute about 10 percent of their household incomes to the scheme, although it only offers selected public health services, said Jayabalan, who used to be invited to past consultation processes.
Health Ministry justifies 1Care, on the grounds that a restructured national health system would be "responsive, provide choice of quality health care and ensure universal coverage for healthcare needs of population based on solidarity and equity".
But Jayabalan, recounting experiences with "restructuring" schemes in the past, feared that 1Care will deliberately result in the escalation of costs to the people and the outsourcing of contracts to those with vested interests - financed by public funds.
"The whole move is to create an authority, and you know how these government-linked companies will be. They will be a source of funding and then a whole hierarchy of bureaucracy (will exist) who will be paid by people like us," said Jayabalan, who is also the Occupational Safety and Health consultant at Universiti Sains Malaysia.
"Out of the 70 percent who access healthcare, 90 percent are from rural areas and they have no definite income. They are the ones who will be affected the most," he said.
Under the present system, patients who do not want or cannot afford private healthcare can opt for medical treatment at government clinics or hospitals, where they only have to pay a nominal fee for basic and specialised healthcare as it is subsidised by the government.
Last week, the Health Ministry assured critics that the 1Care scheme will not burden the public with undue costs, adding that
discussion on the financial arrangements and its impact on the government and taxpayers were ongoing.
"Any assumption or conjecture on the mode of financial impact for the individual taxpayer is very premature at this stage, as discussions are being held at the moment to ensure a positive and workable model," director-general of the ministry, Dr Hasan Abdul Rahman had said.
But if the government had wanted to do something good, Jayabalan argued, consumer groups and the public would have been consulted.
"There was minimal consultation...everything was done stealthily. This time around they are pushing it at all costs," he said.
Those who have watched Sicko-- a Michael Moore documentary on the flaws of the billion dollar US healthcare industry-would, however, be more wary.
"It is the most disastrous system in the world where at least 14 to 15 billion people are not insured, and when you are not insured, it means you will be pauperised in the event you are sick.
"You will have to get into a charity based hospital which will also ration out healthcare to you as much as they can," said Dr T Jayabalan, the spokesperson for Citizens' Healthcare Coalition (CHC).
Jayabalan, (right) who has been a public health consultant and consumer advocate for the past 30 years, observed how such a scheme implemented around the globe has drastically affected the lives of those without comprehensive financial protection.First mooted in the Fourth Malaysia Plan (1981-1985), the health insurance scheme blueprint has been revived and repackaged as "1Care for 1Malaysia" under Prime Minister Najib Abdul Razak in 2009 to trim public hospital funding.
Supposedly modelled after Britain's National Health Service (NHS), the 1Care scheme is to replace the current two-tier healthcare system, with one that integrates both private and government medical institutions, in hopes of "ensuring healthcare is accessible to all Malaysians" across the socioeconomic strata.
The 1Care scheme will be managed by the national healthcare financing authority (NHFA) and includes an insurance-like funding system.
Universal coverage for healthcare
It will be compulsory for individuals to contribute about 10 percent of their household incomes to the scheme, although it only offers selected public health services, said Jayabalan, who used to be invited to past consultation processes.
Health Ministry justifies 1Care, on the grounds that a restructured national health system would be "responsive, provide choice of quality health care and ensure universal coverage for healthcare needs of population based on solidarity and equity".
But Jayabalan, recounting experiences with "restructuring" schemes in the past, feared that 1Care will deliberately result in the escalation of costs to the people and the outsourcing of contracts to those with vested interests - financed by public funds."The whole move is to create an authority, and you know how these government-linked companies will be. They will be a source of funding and then a whole hierarchy of bureaucracy (will exist) who will be paid by people like us," said Jayabalan, who is also the Occupational Safety and Health consultant at Universiti Sains Malaysia.
"Out of the 70 percent who access healthcare, 90 percent are from rural areas and they have no definite income. They are the ones who will be affected the most," he said.
Under the present system, patients who do not want or cannot afford private healthcare can opt for medical treatment at government clinics or hospitals, where they only have to pay a nominal fee for basic and specialised healthcare as it is subsidised by the government.
Last week, the Health Ministry assured critics that the 1Care scheme will not burden the public with undue costs, adding that
discussion on the financial arrangements and its impact on the government and taxpayers were ongoing."Any assumption or conjecture on the mode of financial impact for the individual taxpayer is very premature at this stage, as discussions are being held at the moment to ensure a positive and workable model," director-general of the ministry, Dr Hasan Abdul Rahman had said.
But if the government had wanted to do something good, Jayabalan argued, consumer groups and the public would have been consulted.
"There was minimal consultation...everything was done stealthily. This time around they are pushing it at all costs," he said.
NHS an agent of destruction
The NHS model from which 1Care is fashioned is also "becoming regressive", added Jayabalan, as an "internal market" has emerged to take a dominant role in the one-time "socialised system".
"The private initiative was introduced into the NHS... as a result, there has been escalating cost, the comprehensiveness of the NHS has come to a lot of crisis, and the equity - we are talking of rights of the infirmed, rights of the old...are now being denied or destroyed,"he said.
The NHS model from which 1Care is fashioned is also "becoming regressive", added Jayabalan, as an "internal market" has emerged to take a dominant role in the one-time "socialised system".
"The private initiative was introduced into the NHS... as a result, there has been escalating cost, the comprehensiveness of the NHS has come to a lot of crisis, and the equity - we are talking of rights of the infirmed, rights of the old...are now being denied or destroyed,"he said.
Introducing a system like that is asking for trouble because it has been proven that the healthcare cost has been escalating in the UK and the idea is to keep the cost down, so how do you first resolve the contradiction ? he asked.
But is the government really paying too much for healthcare?
Policymakers, he said, tend to view healthcare as a commodity to be sold for profit, he said, hence further subsidies are often regarded as a loss to the country's revenue.
"Like education, health care is a social good," he said, adding that the government should be prepared to provide healthcare for the people.
He said while our system is not the best, it is pragmatic and coping well and not "bursting at the seams" as claimed.
"(The government) is not really burdened, we have had a very good outcome - our life expectancy has improved, our infant mortality rate reduced - these are good statistics, there are numbers that show that we have a reasonably good system.
Malaysia's total health expenditure for 2009 was approximately RM33.7 billion, a discernible increase from RM31.87 billion in 2008, reports World Health Organisation's (WHO) National Health Accounts.
According to the Economist Intelligence Unit (EIU)'s 2011 report, the private sector is paying more today at 50 percent for the total healthcare expenditure compared with 24 percent in 1985.
Although the report attributed the spike partly to medical tourism, it pointed to the lack of a compulsory national health insurance plan as a contributing factor.
"The public sector accounts for some 45 percent of total healthcare expenditure, and we expect this proportion to remain the same in the forecast period (until 2015)," it stated.
1Care is extremely brutal
These numbers indicate that patients are paying for health services from their own pockets, with total out-of-pocket spending for health in Malaysia doubling every five years.
Also, under 1Care, pharmacies will be dispensing medicine, unlike the current practice where patients are able to get their medicines from public clinics and hospitals.
This is "in a sense good", said Jayabalan, but pharmacies will only be allowed to dispense some medicines while those off the list will require partial payment from patients.
The same restrictions apply for medical care.
"Say....you have appendicitis and need surgery, NHFA will say (the government) will bear this much (but) complication is not covered, long stay not covered... that means you are only covered for that particular diagnosed related illness.
"Now what happens if there are complications? Who bears the burnt?" he asked, foreseeing also high administrative costs in the new system.
According to him, the primary healthcare doctor will have to fork out RM10,000 for compulsory accreditation, and comply with requirements such as developing an IT and record-keeping system.
"What will happen is, the doctor's worry will not be you- his worry will be complying with these requirements because they can deregister him and even criminalise, exclude and penalise the doctor," he said.
Fundamentally, said Jayabalan, the problem with such a scheme is that it makes a fundamental service like healthcare susceptible to the instability of market forces.
"1Care is extremely brutal and morally degrading and the pity is - you're introducing it in a social good. We have accessed it all this years for virtually nothing and suddenly you are introducing market imperatives," he said.
But is the government really paying too much for healthcare?
Policymakers, he said, tend to view healthcare as a commodity to be sold for profit, he said, hence further subsidies are often regarded as a loss to the country's revenue.
"Like education, health care is a social good," he said, adding that the government should be prepared to provide healthcare for the people.
He said while our system is not the best, it is pragmatic and coping well and not "bursting at the seams" as claimed.
"(The government) is not really burdened, we have had a very good outcome - our life expectancy has improved, our infant mortality rate reduced - these are good statistics, there are numbers that show that we have a reasonably good system.
Malaysia's total health expenditure for 2009 was approximately RM33.7 billion, a discernible increase from RM31.87 billion in 2008, reports World Health Organisation's (WHO) National Health Accounts.
According to the Economist Intelligence Unit (EIU)'s 2011 report, the private sector is paying more today at 50 percent for the total healthcare expenditure compared with 24 percent in 1985.
Although the report attributed the spike partly to medical tourism, it pointed to the lack of a compulsory national health insurance plan as a contributing factor.
"The public sector accounts for some 45 percent of total healthcare expenditure, and we expect this proportion to remain the same in the forecast period (until 2015)," it stated.
1Care is extremely brutal
These numbers indicate that patients are paying for health services from their own pockets, with total out-of-pocket spending for health in Malaysia doubling every five years.
Also, under 1Care, pharmacies will be dispensing medicine, unlike the current practice where patients are able to get their medicines from public clinics and hospitals.
This is "in a sense good", said Jayabalan, but pharmacies will only be allowed to dispense some medicines while those off the list will require partial payment from patients.
The same restrictions apply for medical care.
"Say....you have appendicitis and need surgery, NHFA will say (the government) will bear this much (but) complication is not covered, long stay not covered... that means you are only covered for that particular diagnosed related illness.
"Now what happens if there are complications? Who bears the burnt?" he asked, foreseeing also high administrative costs in the new system.
According to him, the primary healthcare doctor will have to fork out RM10,000 for compulsory accreditation, and comply with requirements such as developing an IT and record-keeping system.
"What will happen is, the doctor's worry will not be you- his worry will be complying with these requirements because they can deregister him and even criminalise, exclude and penalise the doctor," he said.
Fundamentally, said Jayabalan, the problem with such a scheme is that it makes a fundamental service like healthcare susceptible to the instability of market forces.
"1Care is extremely brutal and morally degrading and the pity is - you're introducing it in a social good. We have accessed it all this years for virtually nothing and suddenly you are introducing market imperatives," he said.
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