Sunday, January 17, 2010

Datuk Seri Dr T Devaraj: HEALTHCARE: Let GPs handle the needs of urban poor

HEALTHCARE: Let GPs handle the needs of urban poor

T. DEVARAJ, Penang

I AM writing in response to the letter on 1Malaysia clinics ("Urban poor need shot in the arm" -- NST, Jan 1) in which Health director-general Tan Sri Dr Mohd Ismail Merican provided the rationale for the setting up of such clinics. 
Anything that sets out to address the healthcare needs of the urban poor is to be welcomed. However, can the healthcare needs of the urban poor be alleviated by these 50 1Malaysia clinics?

For instance, how many clinics will be needed in Kuala Lumpur? Would not getting general practitioners currently numbering about 10,000, to do this be a better alternative? Besides, they are already covering urban areas.

I would like to address some of the issues that the D-G mentioned.

One is that the ministry has "proposed that the government introduce an integrated primary healthcare system so the rakyat can seek treatment from doctors in both public and private sectors".

This has been ongoing for decades though without functional integration between the two sectors. For that, financing must be in place. Is there a health financing scheme in the offing?

If so, when will stakeholders, such as the people and healthcare providers, be consulted?

Malaysia's dichotomous healthcare system (public and private) is far removed from being truly primary care-led.

In industrialised countries, healthcare is primary care-led. This is supported by evidence that more than 80 per cent of complaints in which an individual seeks a doctor can be managed by a family doctor (who, in turn, has access to a specialist when needed). The family doctor also has the role of providing follow-up care.

So, why not have a healthcare system which is primary care-led, with functional integration of the public and private sectors and which is financially sustained by a healthcare financing scheme based on taxes and social insurance?

All Malaysians will then be assured access to quality healthcare both as outpatients (through the family doctor in urban areas and primary care system in rural areas) and hospitals. Now, hospitals (public and private) are providing primary care and in-patient care, which is an inefficient way of using health resources.

There is an urgent need to recognise that health resources are best used by having levels of care -- primary, secondary and tertiary care -- apart from self-care.

What we don't have at present is domiciliary care, which is part of healthcare in developed countries.

However, we have non-governmental organisations which have taken hospice care to the homes of patients, addressing in particular the problems of patients with advanced diseases.

Any new healthcare system needs to acknowledge and provide for the community.

From a welfare model of healthcare (with objectives of public and individual good) that was instituted by the government in the 1960s, we have moved through the 1980s to a market model initiated by the government and also sustained by the providers and the public.

Over the years, it is indeed ironic that public and private healthcare systems have continued to develop separately -- a colonial hangover. To achieve equitable healthcare for Malaysians, all stakeholders need to recognise that healthcare is a moral endeavour. It is the responsibility of all stakeholders to advocate a system of healthcare that reflects this ideal, thus reflecting a truly caring society.

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