Rationing healthcare the karipap way

The price of everything has gone up. Everyone knows that. Just imagine, even a piece of “karipap” costs anything between RM0.60 to RM0.80 today.

This is for your basic karipap, leaving alone the different high-end varieties with fillings containing chicken, pieces of an egg or sometimes even mutton curry.

Consider this. It used to cost RM0.40 less than five years ago, and you could get 3 karipaps for RM1!

When you walk up to a stall where you see the wonderful rows of karipaps laid out in front of you, you are often spoilt for choice.

Which one do you choose?

Well, that’s really up to you, depending on what you want in your karipap and how much of money you’re willing to spend for it. It’s important to note though, that the choice is yours. No one can force you to pick a particular karipap.

Unfortunately in Malaysia, getting healthcare is not as simple as buying karipap. And we do not realise it.

For those who are fortunate enough to be able to purchase some sort of private medical insurance or have employer medical insurance coverage, you are free to walk into any hospital of your choice.

In fact in the private hospital, you are even free to choose the doctor of your choice to treat you.

At the risk of oversimplification, picture this as you having a wallet full of money and thus the ability to buy as many types of karipaps you want in the stall mentioned earlier, with no limitation on even how many karipaps.

But many Malaysians do not have this choice. Their option is the public healthcare sector.

With a few exceptions like the Full Paying Patient schemes, one is rarely able to choose the doctor or the hospital. It’s just like the stall that only has one type of karipap being sold: the typical one with the potato curry filling.

Only that is a bit more complex now. There are only 10 karipaps, with 100 buyers wanting to buy them.

The stall owner is now left with several choices:
1. Sell 10 karipaps to a single buyer,
2. Sell 5 karipaps to two buyers, or
3. Cut each karipap into 10 pieces.

Perhaps this strategy to ensure how many people get karipap is simplistic. But the problem brings to mind the issues in healthcare access in Malaysia.

The health ministry is trying to ensure healthcare for everyone, but the resources are limited. In other words, only a limited amount of karipaps will ever be available.

People will continuously fall ill. This means there will almost never be enough healthcare resources.

The solution is to ration healthcare. There should be constraints and limitations on how a person can use healthcare services.

The government is continuously having to figure out how to divide the limited amount of resources.

You cannot just walk in to see a top cardiologist in a public hospital. You will be seen by medical officers and by the level of severity of your condition, you gain access to a cardiologist.

Is this rationing? Let me give an example.

You could go into a private hospital, see a cardiologist, get examined and discover that your chest pain was actually just mild indigestion. But the highly qualified cardiologist has examined and diagnosed you, an effort which generates a human resource cost. That has a high ringgit and sen value attached to it.

In the government’s healthcare system, you would probably be seen by a medical officer in a primary care setting first; or if you had an acute chest pain episode, the emergency department. They would triage you there and subsequently if they discovered you did have a heart problem, the cardiology team would be brought in to manage you.

This also has a ringgit and sen value attached to it, though arguably much cheaper than the first option.

Take note that the discussion here is not one of quality of care between public or private care, but rather just a breakdown of average costs of care provision.

No government wants to do anything but the best for its citizens. Unfortunately, financial realities make this impossible. As such, services have to be rationed.

Rationing healthcare is about making choices. During the Covid-19 pandemic, for example, we saw how the government chose to ration all other healthcare services and focus on pouring in resources into the Covid-19 response. That was the government’s choice.

Did such rationing have other effects? Yes, it did. People had delays in procedures, treatments or even appointments. But there was no choice. The rationing was needed, arguably even necessary, to ensure that there was enough resources to settle the emergency at hand.

As we slowly slide out of the Covid-19 pandemic at this time, it’s time for our healthcare sector to retask themselves to deal with both the conditions neglected during the time of Covid-19 as well as to prepare just in case Covid-19 comes back.

Hard choices need to be made as we relook at new healthcare rationing measures to deal with this new normal. - FMT