1Care or just “I don’t care”

by Dr Hsu

Malaysian Healthcare system, despite some inadequacies, has been functioning well in comparison to countries of similar living standards. In fact, the facilities of some of our hospitals rival that of the advanced nations.

In certain aspects, our system is even better than many of the advanced nations. Malaysians can have immediate access to medical care and  treatment whenever they feel unwell, unlike in some of the developed countries, where it may take a few days or even weeks to seek an appointment to see a doctor.

Government healthcare cost has been on the rise. Part of this I blame it onpiratetisation privatisation as well as leakages and wastage in funding hardwares as well as softwares. Billions have been spent on building new hospitals and medical equipment as well as the software system for the opeartion of such hospitals. But as in other aspects of Malaysian life, leakages and wastage could have amounted to 20-30% of overall spending.

Because of the increasing cost of the healthcare system, government is considering instituting a Health financing system, formerly call the National Health Financing scheme ( i have written a paper on this topic in 2006 – search under the masthead of this blog or see the link at the end of this post). This has now been conveniently renamed 1Care.

Very little is known about this 1Care. As in the Malaysian tradition with regards to policy matters, there is hardly any (or shall we say absolutely no) consultation with the end-users ,  the Rakyat and the consumer groups. Although the ministry is said to be working with the Malaysian Medical Association (MMA), even doctors know very little about this scheme.

What little info that is available hints at a system that will drastically alter our lifestyle. Unlike now, we cannot  no longer choose our own doctors. Apparently under this 1Care system, each individual will be assigned to a doctor, presumably someone who is operating nearby. How this allocation will be done and what criteria will be used are unknown as yet.

Patients assigned to that particular doctor will have a limit as to how many times he or she can consult that particular doctor in a year. Those with chronic diseases like asthma, hypertension and diabetes will not be able to see their doctor  as often as now, compromising their health.

All doctors will have to be in this scheme, and would be allocated patients. Doctors are not allowed to dispense medicine. As a compensation, their consultation fee is set to go up , as high as RM60 per visit. This contrasts with the present system where for a fees of around RM30 – 40, you can consult a doctor and be treated with medications for common ailments.

So who is to fund for this incredible scheme? The end users of course since there is no such thing as a free lunch in this world. From what is known, everyone will have to be in this scheme, and each house hold is supposed to fork out 9 to 10% of their income to a National Health Financial Agency.

For those who are young, hale and hearty, they have to fork out the same amount, which will probably be deducted from their pay as in EPF scheme.  Like all other insurance scheme, this actually works on the  concept of the more healthy subsidising the less.

But for the less healthy, dont be too happy yet. Apart from the limit on the number of times they can visit their assigned doctors,  they also have to spend extra time and transport cost to get their medical supply from a pharmacy after seeing their doctors.  There will also be certain diseases which will be excluded from this scheme, and out of pocket payments (OOP) will have to be made for these dieseases.

Because the doctors are now being paid a higher consultation fees and because extra costs are incurred for medicines to be dispensed by pahramcy, the total healthare costs will shoot up, as in the experience of many countries which have implemented health financing scheme.

The money eventually comes from the people. When the healthcare cost goes up, the NHFA is going to ask for more money and that will translate to more deduction from the rakyat.

What is ironical is that the present system is efficient and cost effective. Malaysians in fact spend much less on heathcare than their counter parts not only in developed countries but developing nations as well.

The above table ( charted by me using WHO statistics)  shows the percentage of Total Health expenditure of malaysia in 2002 and 2003 compared with many other countries.

Even countries with comparables GDPs in international dollars such as Mexica and Brazil spent much more on health care than Malaysia. Developing countries with lower GDPs such as China and India also spent higher proportion of their GDPs on the health of their citizens.

Malaysia government has a duty to take care of its citizens’  health care. As it is, it is spending much less than the WHO reeommendation of 7% of GDP on health care. Our government spends around 6-7% of government  budget on health,  which is much less than our GDP.

The old saying that “do not try to fix anything that ain’t broken” is apt in this case.

I have written a paper on National Health financial scheme in 2006. In it I have extracted many statistics against implementation of such a shceme and posted them in table forms. This paper was also published  in FOMCA’s publication last year, after obtaining my consent via email. For those who want to know why I oppose such a scheme, and the rationale behind my opposition to such scheme, please read the paper “Malaysian Healthcare- a critical look at National Health Financial Scheme” in this blog:

http://hsudarren.files.wordpress.com/2006/10/malaysian-healthcare-a-critical-look.pdf