Malaysian Healthcare: The Shape of Things to Come?
Divining the future of Malaysian healthcare is risky business. Between the
Official Secrets Act, cautious technocrats, and pre-election bluster, any
crystal ball would be rendered close to opacity.
On 13 August 1999, amidst mounting pre-election anxiety over the ongoing
privatisation of healthcare, the Health Minister announced that the policy
of corporatising public hospitals had been scrapped. The less credulous
then proceeded to speculate as to how the substance of the policy might yet
be achieved without too blatant a reversal of the minister's statement.
In the meantime, the action has now shifted to a related and equally
important aspect of healthcare reforms: the financing of healthcare.
In the last three months, a series of announcements have dribbled out,
hinting at the emergence of a patchwork of health (insurance) funds, which
collectively may be the basis of a de facto mosaic of national health
financing.
On 18 December 1999, the Health Minister referred to a "special medical
fund for the poor" without going into further details about this scheme.
A month later, on 17 January 2000, the Employees' Provident Fund (EPF)
announced its joint-venture with the Life Insurers Association of Malaysia
(LIAM) for a risk-rated health insurance scheme for coverage of 13 (or
expanded coverage of 36) critical illnesses or procedures. The premiums
payable were to be charged in accordance with an age-gradient, rising
sharply from RM30 annually (RM10,000 pay-out upon diagnosis, age 35 years
and below) to RM20,034 annually (RM100,000 pay-out upon diagnosis, expanded
coverage, age 65-70 years).
With less fanfare-a soft launch in November 1999 followed by an ongoing,
nationwide roadshow-Cuepacs (the confederation of public service unions)
introduced its own version of health insurance, CuepacsCare, in joint
venture with AMI Insurans Bhd and MediCare Assistance Sdn Bhd. Unlike the
EPF-LIAM scheme, CuepacsCare charges uniform premiums, but excludes a
larger proportion of the elderly from eligibility (see below).
A further difference is that CuepacsCare re-imbursements are based on
specified inpatient services, subject to a ceiling on payments (max.
RM60,000 a year for individual subscribers) and exclusions of congenital
abnormalities, disabilities arising from wars or civil disorders, mental
illness, eyesight deficiencies and visual aids, artificial limbs and
prostheses, sexually transmitted diseases, quarantinable infectious
disease, pregnancy and child delivery services, vaccinations, AIDS and
related complications, as well as other pre-existing chronic conditions
(such as diabetes, high blood pressure, kidney dysfunction, cardiovascular
disease, cancer) in the first year of subscription.
Among the salient points to note in this emerging melange of health
insurance schemes are the following:
** the EPF-LIAM scheme is a risk-rated scheme, more in line with
commercial underwriting rather than social insurance. The most
objectionable consequence is that those who (will) need health care most
would least be able to afford it. Undeniably, healthcare financing for an
increasingly aged population is a major challenge, but a risk-rated scheme
with exorbitant premiums for the elderly and other high-risk groups (in
effect, rationing by the market) is unacceptable as a solution. The
CuepacsCare scheme side-steps this by excluding from coverage a larger
group of the elderly (next point).
** exclusion of the elderly from coverage: the EPF-LIAM scheme is
available only to those aged 70 years of age and below, with the annual
premiums increasing sharply with age; CuepacsCare subscribers pay a uniform
premium regardless of age, but they have to enrol before the age of 60, and
coverage ceases at age 65. Given that the life expectancy of Malaysians is
approaching the mid-70s, added to the high prevalence of chronic ailments
among the elderly, it is clear that healthcare financing for the aged has
become a major issue of social policy.
** the CuepacsCare scheme is a voluntary scheme for civil servants and
public service retirees (i.e. non-mandatory and allows for opting out).
Because the scheme is community-rated with uniform premiums for all
subscribers, there is the possibility of selective opting out by eligible,
low-risk individuals so that the subscriber pool might end up being
disproportionately high-risk, with over-representation of intensive users
of healthcare. It is unclear if the premiums of RM87 for individual plans
and RM225 for family plans would be viable in the long term under such a
scenario.
** most national health insurance schemes rely on joint employer/employee
contributions. The emerging patchwork of health insurance schemes appear
to be solely the responsibility of employees (EPF contributions were
jointly made, but with the clear understanding that these were employee
savings and assets, distinct from employment health benefits).
In view of the continuing, simmering crisis of Malaysian healthcare - by no
means abolished by the scrapping of corporatisation plans for the public
hospitals - the Citizens' Health Initiative (CHI) calls on the Health
Minister and the Economic Planning Unit to clarify whether this patchwork
of health funds is intended as a de facto national health financing scheme,
perhaps supplemented with additional social safety nets (the special
medical fund for the poor, and perhaps a separate one for the aged)?
Is this the shape of things to come? If so, it increasingly resembles the
crisis-ridden system of healthcare financing in the United States (private
insurance-based, increasing reliance on for-profit managed care, plus
Medicare and Medicaid) but worse, with employees largely shouldering the
burden. Left in limbo for the moment is the issue of healthcare access for
the rural communities, for migrant workers, and for the low-income
self-employed.
CHI re-iterates its stand, in concert with the Malaysian Medical
Association, the Malayan Nurses' Union and other healthcare professionals,
that a far better alternative to ensure equitable, universal and
cost-efficient coverage of all Malaysian residents is a National Health
(Insurance) Fund - a payroll-based scheme (employer/employee contributions)
with supplementary contributions from progressive taxation to extend its
benefits to ALL citizens and residents. It would be operated as a
non-profit statutory institution with effective and credible citizen
participation.
We consider this option, a single-payer publicly operated healthcare fund,
as a realistic, immediate-term goal which would be compatible with a
continuing mix of public-private healthcare providers, and with the broad
interests of consumers, salaried/unionised workers, and the elderly.
Dr Chan Chee Khoon
Co-ordinator
Citizens' Health Initiative
http://www.malaysia.net/aliran/
11 March 2000
http://www.malaysia.net/lists/sangkancil/2000-03/msg00497.html
Saturday, July 19, 2008
privatization of malaysian healthcare
THe focus question is should or should not Malaysia privatize its healthcare?? at first , i kinda agree that maybe we should privatized it because then maybe it can address all the ills of our current system..
but then , while looking through reports , studies , thesis papers ; i found that it would distratous to engage in a massive overhaul such privatization. It seems that it would be imprudent to rush into privatization because it might jeorpardize our current system. The present ills of our healthcare could simply be addressed with minor reforms and more commitment from those buggers who run the Ministry of Health and the Ministry of education(blame the Moe for poor quality of doctors).
First of all , our present public healthcare system is lauded as one of the best in the world and here is the catch , It is also one of the cheapest in the world when compared to other countries in the world. Ok , the best indicator is to measure the proportionate spending on healthcare against the GDP of the country. Based on the world health report , malaysia's proportionate spending is currently 3.8% of our GDP( 2003).it is one of the lowest in the world. Countries like India spent spent 4.9% of their GDP on healthcare , china 5.5% , Mexico 6% , USA 14% of their GDP and UK 7%. This below the level recommend by WHO which is 5% of the GDP and below world average of 7.9%!
Furthermore , government share on healthcare expenditure is 58% with the rest by private sector. Therefore , government spending on healthcare is around 2.21% ( 2003) of the total GDP.
Therefore , it can be concluded that our healthcare is seriously underfunded. But the fact remains that our healthcare is one of the best in the world . Like 90% of the population is within 3km of nearest health facility and our high mortality rate suggest that healthcare deserved all the credit it get. so , a simple solution to address all the current woes and ills our healthcare would simply increase its allocation!!!
Based on all of the above , u people must be wondering how the idea of healthcare privatization managed to surfaced... Ok it was first highlighted in the 7th Malaysian Plan ( 1996 -2000 )
“the Government will gradually reduce its role in the provision of health services and increase its regulatory and enforcement functions. A health financial scheme to meet health care costs will also be implemented. However, for the low income group, access to health services will be assured through assistance from the government” .
The government then cited reason such as exodus of government doctor to private sector and reduce government's burden of financing the public healthcare. Would like explain the latter , the government will introduce National Health Fund as part of the privatization whereby it would like extra tax but solely marked for health purpose ( contribution by all employee would be compulsory like our current EPF)and it would be single payee for all health service. The mechanism of the fund and coverage of the fund have still not being decided yet. But , this alleviate the burden of financing the healthcare from the government. OK , would like to add that USA's healthcare is also privatized , but it consumed 14% of the GDP and on top of it it deprived 500 million of access to healthcare.
The exodus of doctor to private sector could be prevented by offering better pay to doctors , specialists and nurse. Increase allocation to MOH and doctor get paid more...so simple. Instead government choose to spent billions to fund our affirmative action policy( like allocation to MARA , scholarships such as JPA , MARA ). Would like to highlight the millions gone in sending scholars to do medic in country like UK , Ireland( at cost of 1.1 million per person) who never bother to even pay back the whole sum ( or even half of it) and let alone come back to serve malaysians.
Then again , as for now government has privatized to branch of our public healthcare system such as the Hospital Support Service ( cleaners , maintanance ) and also the Government Medical Store( the one that supply drugs to hospital ) .
The privatization Government Medical Store to Remedi Pharmaseuticals ( now run 75% of distribution of drugs) for example ; shows an increase 0f 3.3 FOLD( compared to pre-privatization) in prices of drugs without any proper justification (such as inflation , increase of cost of production). this backed by a study by USM and University Sedaya. The study even question the reason of privatizing the GMS in the 1st place. since government still subsidize the system , we do nt really see the impact of this(yet). and who is paying for this,...the rakyat tax moneylah!!! also interesthing to point out that Remedi do enjoy some form of personal connection with the rulling party( cronisym again !!)
http://gajanayagam.blogspot.com/2008/04/privatization-of-malaysian-healthcare.html
but then , while looking through reports , studies , thesis papers ; i found that it would distratous to engage in a massive overhaul such privatization. It seems that it would be imprudent to rush into privatization because it might jeorpardize our current system. The present ills of our healthcare could simply be addressed with minor reforms and more commitment from those buggers who run the Ministry of Health and the Ministry of education(blame the Moe for poor quality of doctors).
First of all , our present public healthcare system is lauded as one of the best in the world and here is the catch , It is also one of the cheapest in the world when compared to other countries in the world. Ok , the best indicator is to measure the proportionate spending on healthcare against the GDP of the country. Based on the world health report , malaysia's proportionate spending is currently 3.8% of our GDP( 2003).it is one of the lowest in the world. Countries like India spent spent 4.9% of their GDP on healthcare , china 5.5% , Mexico 6% , USA 14% of their GDP and UK 7%. This below the level recommend by WHO which is 5% of the GDP and below world average of 7.9%!
Furthermore , government share on healthcare expenditure is 58% with the rest by private sector. Therefore , government spending on healthcare is around 2.21% ( 2003) of the total GDP.
Therefore , it can be concluded that our healthcare is seriously underfunded. But the fact remains that our healthcare is one of the best in the world . Like 90% of the population is within 3km of nearest health facility and our high mortality rate suggest that healthcare deserved all the credit it get. so , a simple solution to address all the current woes and ills our healthcare would simply increase its allocation!!!
Based on all of the above , u people must be wondering how the idea of healthcare privatization managed to surfaced... Ok it was first highlighted in the 7th Malaysian Plan ( 1996 -2000 )
“the Government will gradually reduce its role in the provision of health services and increase its regulatory and enforcement functions. A health financial scheme to meet health care costs will also be implemented. However, for the low income group, access to health services will be assured through assistance from the government” .
The government then cited reason such as exodus of government doctor to private sector and reduce government's burden of financing the public healthcare. Would like explain the latter , the government will introduce National Health Fund as part of the privatization whereby it would like extra tax but solely marked for health purpose ( contribution by all employee would be compulsory like our current EPF)and it would be single payee for all health service. The mechanism of the fund and coverage of the fund have still not being decided yet. But , this alleviate the burden of financing the healthcare from the government. OK , would like to add that USA's healthcare is also privatized , but it consumed 14% of the GDP and on top of it it deprived 500 million of access to healthcare.
The exodus of doctor to private sector could be prevented by offering better pay to doctors , specialists and nurse. Increase allocation to MOH and doctor get paid more...so simple. Instead government choose to spent billions to fund our affirmative action policy( like allocation to MARA , scholarships such as JPA , MARA ). Would like to highlight the millions gone in sending scholars to do medic in country like UK , Ireland( at cost of 1.1 million per person) who never bother to even pay back the whole sum ( or even half of it) and let alone come back to serve malaysians.
Then again , as for now government has privatized to branch of our public healthcare system such as the Hospital Support Service ( cleaners , maintanance ) and also the Government Medical Store( the one that supply drugs to hospital ) .
The privatization Government Medical Store to Remedi Pharmaseuticals ( now run 75% of distribution of drugs) for example ; shows an increase 0f 3.3 FOLD( compared to pre-privatization) in prices of drugs without any proper justification (such as inflation , increase of cost of production). this backed by a study by USM and University Sedaya. The study even question the reason of privatizing the GMS in the 1st place. since government still subsidize the system , we do nt really see the impact of this(yet). and who is paying for this,...the rakyat tax moneylah!!! also interesthing to point out that Remedi do enjoy some form of personal connection with the rulling party( cronisym again !!)
http://gajanayagam.blogspot.com/2008/04/privatization-of-malaysian-healthcare.html
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