WHAT'S UP at 1Care? Another system in shambles!

It is hard not to mention president Barack Obama when it comes to politics and healthcare. Having retained the West Wing for the second term, one of his landmark legislative achievements is the 2010 health law reform that aims to expand health coverage and contain the cost.

Malaysia is at the crossroads, aiming to be a developed nation by 2020 with a population expected of 34 million, but not helped by uncertainties in economic performance. Its biggest challenge is to expand healthcare coverage, in terms of quality and capacity, and at the same time inhibit the cost from going exorbitant.

Our current health care system presents a unique challenge to public health physicians, economists and policy makers alike. With too much political interference, heavy subsidies, poor coordination of primary care and hospitals; and between public service and private practice, the '1Care' has been proposed.

So far the public has been kept at bay when it comes to what actually 1Care is? Public forums have not been fruitful either. With orchestrated presentations and Q&A sessions, panellists keep on beating around the bush, not to mention the so-called 'academician' moderators who sought to be too reassuring rather than inspiring real debate.

As prime minister Najib Razak is seeking to renew the mandate for the longest serving political entity in modern democracy, there has been too much rebranding of government services to include the word ‘one’. It is nowadays hard to get through a single day without coming across the word ‘one’. Yet the truth is that substance matters most. Najib can rebrand all he wants but what the people really want is sincere top-down reform by Barisan Nasional.

It entails an end to use of government machinery for their political survival and mileage. Examples galore. Klinik 1Malaysia is a big mess. Primary care system in Malaysia is already intricate, in public sector there are already 2854 government health and rural clinics and 6589 private clinics.

And then, because Najib wants them, we have 115 Klinik 1Malaysia's which are not community clinics and not even health clinics. Klinik 1Malaysia is targeted in urban areas with high population density, whereas health clinics are already doing extra hours and most people can actually afford to go to plenty of private practices available.

Primary care and hospital care at the moment are alien to each other, like two different planets apart with a moon, the university hospitals. There is a lack of communication with no effective sharing of healthcare information. They do not know what the other does and each think it is more important than the other. Bureaucracy is a must and in abundance; the barrier is like the Berlin wall before 1989. The victim is the patient.

All these redundancies go on to show that Najib is just interested with the number '1'. So far, Klinik 1Malaysia has not been cost effective. Efforts were made to promote the clinic. Mainstream media have without fail tried to highlight services offered at Klinik 1Malaysia. The increased workload only strains more resources from established healthcare facilities.

Health clinic doctors are now required to go to Klinik 1Malaysia leaving their own clinics unmanned. Their staffs are being rotated at Klinik 1Malaysia. There was no risk-benefit studies done to show the need for Klinik 1Malaysia other than for the next general election.

Even the budget to set up Klinik 1Malaysia is channelled through BN party branches rather than directly from the Ministry of Health. Top government officials in MOH, especially the one in Pullman Putrajaya, will testify to this!

Hence, political sentiments put aside, what we really need now is a health care system reform that is honest in the sense that it must not aim to gain popularity for the governing party, but it is a structured and well organized health care system that is proactive, responsive, inclusive and prudent in addressing current as well as future needs.

Primary health care should be at the forefront. It is the foundation for health care system that should place strong emphasis on preventive medicine, early intervention and special focus on promoting wellness.

There is a real need to get government primary care service providers and private practice to a roundtable in order to strengthen integrated personalised care approach.

Most private practices are essentially not trained general practitioners or family medicine specialists, so they have to be regulated regularly in order to ensure adherence to clinical guidelines. They have to be made legally answerable, responsible and accountable of patient management through proper record-keeping, strict recruitment of staff and locum doctors.

With the increasing awareness in health issues, various supplements and alternative therapies have entered the market. There is a need for a law to govern and protect medical practitioners from conflicting clinical and business interests.

Primary care and hospital care at the moment are alien to each other, like two different planets apart with a moon, the university hospitals. There is a lack of communication with no effective sharing of healthcare information. They do not know what the other does and each think it is more important than the other. Bureaucracy is a must and in abundance; the barrier is like the Berlin wall before 1989. The victim is the patient.

There is no proper continuation of care, what more holistic multi-disciplinary individualised care. Alas, when a patient misses an appointment, he or she will be lost in a disintegrated system.

The health care system needs to learn the art of doing simple things, doing away with unnecessary boundaries and encourage effective communication to culminate responsive and inclusive healthcare system.

The biggest challenge of all is to be judicious in spending. With RM40 million already gone to Sabah UMNO, it is hard to spend wisely these days. Needless to mention, healthcare service is costly, the staff, their development, medical equipment, logistic and advancement, all entail prudent spending and planning.

One of BN’s instruments to keep bribing Malaysians is subsidies. 55 years after independence, this government has miserably failed to cultivate the citize

Heavy reliance on subsidies is hindering progress. A patient takes medical care for granted because consultation and medication are free or merely RM1 for registration fee. Subsequently, after a while, the patient ends up in and out of the hospital because of end organ failure since angiogram, dialysis, home oxygen therapy, surgical intervention or transplantation is limited, if not expensive. To protect BN supremacy, the government of today has failed to educate the citizens to be responsible for their health.

As reality takes its course, the government could not subsidise medical care forever. In 2012, 4.96% of GDP is spent on health, to achieve developed country standard, the benchmark being 7%. Logically, 1Care has mooted the idea of sharing the burden with the taxpayers via obligatory contribution towards a scheme to finance the healthcare system. Consequently, the ministry had to do damage control by denouncing it as premature. Up until now, the financial aspect of 1Care is a taboo.

Thus, with election looming, it remains to be seen whether the governing party has the guts to tell the harsh truth. Malaysians need a viable, proactive, responsive, inclusive and prudent masterplan to achieve the aim of expanding healthcare yet maintaining the cost. People should judge BN performance after all these years, so are they up for it?

With leakages everywhere, millions of illicit outflows and flourishing corruption, it is almost impossible to expect sincere transformation from BN.

Civil servants should give them a wakeup call. BN has tarnished their professionalism and integrity to the fullest, beyond repair. Facts and evidence do not matter anymore, as long as it is being done in line with effort to uphold BN longevity. Let’s put an end to that.

- Harakahdaily