More private wings not a panacea for ills of health system

 

A cancer patient at a public hospital recently had to wait for more than four hours to be seen by a specialist. His appointment, made a month ago, was supposed to be at 11.30am, but he was seen only at 4pm.

When he spoke to others waiting there, the patient realised that they were all in a similar predicament. A doctor he approached told him in confidence that they are overwhelmed by the number of patients to be seen every day.

Apparently, it’s the same at many government hospitals and clinics. The long wait is a common complaint from most Malaysians who visit public hospitals. And with Malaysia’s population getting older, the problem can only get worse.

The longest waiting list is for diagnostic procedures, such as scans and scopes, and for surgeries. Medical equipment and operating theatres are very much lacking at almost all hospitals.

It’s tough for the majority of Malaysians who are not insured and depend on government facilities. According to surveys, only about 33% of Malaysians possess medical cards, either personally or provided by employers.

Can this basic problem be resolved by a recent proposal to expand private wings in hospitals, a proposal mainly aimed at raising revenue for the underfunded national health service.

On paper, perhaps so. Moving patients in the middle-income M40 group to the full-paying services (FPP) will reduce the number of patients in the normal wings by 20% to 30%.

This could well ease the waiting time for non-paying patients who make up the bulk of those seeking treatment in public hospitals, or at least it appears so.

The upside to the proposal is that treatment will still cost about 20% to 40% cheaper compared to private hospitals, an estimate given to me by some specialists.

Currently, FPP services are available at 10 government hospitals, offering patients an option to choose their specialist doctors, access to first class or executive wards, and services at more competitive rates than private hospitals.

It was reported that the FPP generated about RM22 million in revenue in 2018.

But wait a minute. Does this not involve the same facilities, equipment and medical staff? Yes, they do use the existing infrastructure. One specialist said they are allowed to do two or three sessions a week but, again, it depends on the hospitals’ policies.

They are allowed to choose the times; it can be in the morning, afternoon or evening sessions, during which they will be away from the mainstream wards. As admitted by a specialist in a major hospital, this will stop them from having clinics for the whole of the five and a half days they are open for non-paying patients.

As a result, the waiting period for non-paying patients may be affected. Even hospitals that do not have private wings are seeing a massive surge in patients seeking specialist treatment, at a time when the nation faces a severe shortage of specialists.

There have been claims of a few specialists 

manoeuvring

 patients towards their clinics in the private wing. This is a conflict-of-interest situation that will affect patients to an extent. Though this has not been reported, a specialist claimed that there were a 

few rotten apples

 who had reportedly done this.

Health minister Dzulkefly Ahmad may have a valid argument in pushing for the FPP option, but not with the current infrastructure which is bursting at the seams.

This move will inevitably create three classes of patients in the country – the T20 upper-income group and those who can afford medical insurance and go to private hospitals; the M40 middle-income group who opt for the FPP for faster treatment; and the B40, who have no choice but to wait. They will be given the lowest priority of course.

The government and its specialists will make more money – but at the expense of the poorer segment of Malaysians, who always happen to get the raw end of most policies.

Across the world, governments are trying their best to ensure equal access to health services for all classes of citizens. What’s happening in Malaysia is the exact opposite.

For over three decades, a proposal has been bandied about for a national health financing scheme, which can effectively bring about an equitable health service.

It’s one of the best ways to bring about fairer health benefits to all irrespective of their social standing or earning capacity. There should not be any form of discrimination in healthcare.

However, nothing concrete has resulted, aside from the normal announcements by leaders that the government was looking into the proposal.

The priority for Dzulkefly and the health ministry should be to spend their energy on this matter instead of expanding the FPP. - FMT

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