IJN should be inclusive to all

 

From Ashraf Abdullah

I don’t know him from Adam. But a piece written by one S Balagurunathan of Ampang about the plight of government pensioners who can no longer seek follow-up treatment at the National Heart Institute (IJN) somewhat moved me.

It rekindled an issue which became quite a hot topic earlier this year.

Balagurunathan said he felt compelled to write about this when his friend, a former Tokoh Guru award recipient, was suddenly told he could no longer seek follow-up treatment for his heart ailment at IJN and was referred to a general hospital. This is despite the fact that he served the nation diligently as a teacher all his adult life.

I am not certain where and when Balagurunathan’s article first appeared, but it has been making its rounds in WhatsApp groups since Monday.

When the matter was first raised by disgruntled retirees in February, the health ministry responded by saying that patients are only discharged from IJN when their conditions are stable with a monitoring period of six months to a year, and one to two years for children.

It added that the approach allowed some 4,000 new patients to seek treatment at IJN annually, maximising cost effectiveness. The statement made no mention that the patients will no longer be prescribed the same medications that they received at IJN.

Former international trade and industry minister Rafidah Aziz also took exception to the new policy, saying that retired civil servants should continue to be given access to IJN’s top-class treatment.

This cost-saving policy, which disrupts the continuity of care for these retirees and forces them to transition to unfamiliar environments and new medications, is not only inhumane but also lacks any rational justification.

It is a move that not only disrespects the contributions of these former public servants but also undermines the fundamental principles of equity and compassion that should guide public health policy.

Retirees are taxpayers and stakeholders

One of the most glaring issues with this decision is the fact that these retirees are taxpayers who have contributed to the very existence and operation of IJN, which is fully owned by the finance ministry.

Granted, some of them may not fall under the personal income tax paying bracket, but they certainly pay all other taxes that the previous governments and the Madani government have imposed.

IJN, a beacon of excellence in cardiovascular care, was established and is maintained through public funds – money collected from the hard work and dedication of millions of Malaysians, including these retirees.

By denying them access to IJN, the government is effectively alienating them from a resource they have rightfully earned.

The argument that redirecting retirees to other government hospitals is necessary for resource optimisation is flawed and dismissive of the fact that these individuals have already invested in the healthcare system.

IJN was not established as a luxury but as a critical healthcare facility meant to serve the needs of the people, including those who have served the nation. To deprive them of this service now when they are old and need it most is to betray the trust they placed in the system throughout their working lives.

The importance of continuity in healthcare

Continuity of care is a cornerstone of effective medical treatment, particularly for chronic conditions like cardiovascular disease. Many retirees have been receiving treatment at IJN for years, building relationships with their healthcare providers who are intimately familiar with their medical histories, needs, and responses to treatment.

This writer spoke to a few pensioners, including a retired headmaster who relayed how he had to recount his entire medical history to the doctor at the new facility he was referred to, unable to recollect some dates and procedures that he had gone through at IJN.

It also points to one thing – that patients’ full records at IJN are not shared with the other hospital. Only a handwritten note from the IJN cardiologist as a referral.

Continuity is vital, as it ensures that care is tailored to the individual, and that any changes in their health are promptly and accurately addressed.

By forcing these retirees to transition to other government hospitals, the health ministry is disrupting this continuity of care. The new hospitals, while in no doubt competent, may not have the same level of specialisation or familiarity with the patients’ histories as IJN.

This disruption can lead to mismanagement of treatment, delays in care, and a decline in the overall quality of healthcare that these retirees have been receiving. For individuals with serious heart conditions, even minor lapses in care can have life-threatening consequences.

This is especially so as the other hospitals also have to deal with patients with illnesses other than those heart-related. Administrative and other bureaucratic processes may delay early medical response.

The psychological impact of displacement

Beyond the medical implications, there is also a significant psychological toll that comes with this sudden and forced displacement. The relationship between a patient and their healthcare provider is built on trust – a trust that is developed over time and through consistent, compassionate care.

Retirees who have been treated at IJN have grown to trust not only the expertise of the doctors but also the environment of the Institute itself. They are familiar with the processes, the people and the overall atmosphere, all of which contribute to a sense of security and well-being.

The psychological comfort provided by IJN, therefore, is not a trivial matter, it is a critical component of their overall treatment plan. The health ministry’s decision to disregard this aspect of care is not only insensitive but also medically unsound.

Generic medicines

I am neither a medical expert nor a pharmacist, but it is common knowledge that generic drugs are often used as a cost-saving measure and are not always equivalent to their branded counterparts.

Patients who have been on a stable medication regime for many years may find the new medications incompatible. Adapting to new medications is particularly difficult among the elderly.

The cost of these complications – both in human terms and in healthcare costs – would far outweigh any savings achieved by switching to generics. Moreover, the decision to prioritise cost over care quality sends a disturbing message about the government’s commitment to the health and well-being of its retirees.

It suggests that their lives and health are secondary to budgetary concerns, a stance that is both morally and ethically indefensible.

Misplaced priorities

The health ministry’s decision reflects a broader issue of misplaced priorities. While the need for cost management and resource allocation in healthcare is undeniable, these considerations should never come at the expense of the most vulnerable members of society, especially those who have dedicated their lives to public service.

The retirees affected by this decision are not just numbers on a balance sheet; they are individuals who have earned the right to be treated with dignity and respect.

When these retirees entered public service, they did so with the understanding that their dedication and hard work would be recognised and valued, both during their careers and in their retirement.

By denying them access to IJN when their services are no longer needed, the government has failed to uphold its end of the contract. - FMT

Ashraf Abdullah is a former group managing editor of television networks at Media Prima Bhd.

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.