Dissent grows over rumoured healthcare tax under ‘1 Care’ scheme

By Clara Chooi

February 01, 2012

KUALA LUMPUR, Feb 1 — Public outrage is growing over a proposed “1 Care” scheme to restructure the country’s healthcare system that critics claim would force employees and businesses to contribute 10 per cent of their monthly income to a government-run insurance fund.

Although details of the scheme are still vague and Health Ministry officials have insisted it is still “too early” to sound warning bells, medical practitioners and consumer associations have banded together since last December to kick off the “Tak Nak 1 Care” campaign, hoping to shelve Putrajaya’s plans before they come into force.

Critics claim the scheme would force employees and businesses to contribute 10 per cent of their monthly income to a government-run insurance fund. — Reuters file pic

Calling themselves the “Citizens’ Healthcare Coalition” (CHC), the group have taken their cause online, using social media tools like Facebook, Twitter, blogs and YouTube to spread information about the scheme and gain wider public support.

Among others, the group have started a “#TakNak1Care” Facebook community page, a Twitter account using the handle @taknak1care and uploaded on YouTube, several video clips urging Malaysians to reject the scheme.

Their efforts appear to be gaining traction among netizens and have even caught the attention of Health deputy director-general (Medical) Datuk Dr Noor Hisham Abdullah, who has been personally involved in lengthy discussions with the group via their Facebook page.

The Malaysian Insider understands that “1 Care” is modelled in its entirety after the United Kingdom’s National Healthcare Service (NHS), a publicly-funded healthcare system, and was mooted in the 10th Malaysia Plan for the Health Ministry’s 2011-2015 strategic plan.

It is believed that the five-phase scheme has already entered its third phase, and the full initiative, post engagement with doctors and pharmacists nationwide, is due to be presented to the Cabinet by March.

According to one CHC member, “1 Care” will replace Malaysia’s current two-tier (public and private) healthcare system by integrating both private and government hospitals, in hopes of ensuring more “equitable” healthcare for Malaysians across all socio-economic statuses.

Under the present two-tier system, Malaysians can choose between seeking treatment at private clinics or hospitals and pay out of their own pockets or via health insurance claims, or opt for treatment at government clinics or hospitals and pay only a nominal fee for basic, government-subsidised healthcare.

With “1 Care”, CHC said it would be made compulsory for all wage earners, excluding government servants and pensioners, and businesses to contribute 10 per cent of their monthly incomes to a government-run Social Healthcare Insurance (SHI).

“So those who can pay, will pay, while those exempted from paying, such as the poor and so on, would still qualify for free basic medical benefits offered under the scheme ... Basically, those who can afford it will pay for those who can’t,” the member said, speaking on condition of anonymity.

But, apart from the “fee-before-service” system under “1 Care”, CHC is also griping over the limited healthcare benefits offered under the scheme such as: a patient is assigned to a specific general practitioner (GP); visits are limited to six times per year; visits are limited to one ailment per visit and GPs or primary healthcare providers (PHCPs) are given Key Performance Indicators (KPIs) to meet and would be subjected to penalties.

“Under this system, PHCPs only profit by billing the SHI for their services. Like all insurance, the SHI won’t approve too many claims to minimise cost. PHCPs may be penalised for giving too much service ... or referring too many patients to hospitals or specialists.

“1 Care” is believed to be modelled after the UK’s National Healthcare Service (NHS). — Reuters file pic

“Doctors may have to provide less healthcare to avoid penalty... but you don’t stop paying or pay any less to SHI,” the group claimed in one YouTube video.

The CHC member explained to The Malaysian Insider that “1 Care” budgets a maximum claim of RM360 per patient for each GP from the SHI, which amounts to only six consultations in a year at RM60 each.

“And with the KPI quotas to meet, GPs would try to delay referring too many patients to hospital. Those who need to seek treatment urgently would then have to go to the hospital on their own and pay out of their own pockets,” the member complained.

When attempting to allay fears over “1 Care” recently, Dr Noor Hisham explained that it was merely at “conceptual stage” and that reconstruction of the country’s healthcare system was badly needed.

“Now in the public sector we spend RM16 billion and only recoup two per cent. On the other hand, we wouldn’t want to burden the rakyat so we are currently looking into various options and models.

“At this point of time nothing has been agreed upon. Until everything has been agreed to by the public and such, we need to study the cost analysis. However, there are already lots of assumptions and speculation and bad branding of the system like this TAK NAK.

“I wonder where they pluck the figures from without substantive data to support,” he wrote in one response.

But the CHC claims a new “1 Care Act” is due to be tabled in Parliament imminently, possible as early as the next sitting in March.

The CHC will brief reporters on the issue tomorrow in the build-up to the Selangor/Kuala Lumpur Healthcare Public Forum on February 12. The Malaysian Insider understands the forum will be opened by Selangor Mentri Besar Tan Sri Khalid Ibrahim and attended by Health Ministry officials.