Who lives and who dies?
The corporatisation and privatisation policies of Malaysia's health care system are deciding who lives and who dies in this country.
A recent case, for example, illustrates how the corporatisation of government hospitals contributed to the death of a man in the prime of his life.
According to a report in the Sun on 21 Jan 2010, hotel worker Ahmad Nazri Ibrahim, 48, died because of bureaucratic delays and non-acceptance of the letter of guarantee from the Employee's Provident Fund (EPF) stating that he and his wife had sufficient savings to pay for life-saving cardiac surgery costing RM 19,000 at the Penang Hospital.
The family of Ahmad Nazri highlighted the bureaucratic runaround they were subjected to so he and his wife could withdraw money from their retirement funds for surgery to clear cardiac blockages.
Ahmad's case raises far more serious and fundamental issues with the country's health policies besides mere bureaucratic delays.
As health is a fundamental human right, the health care system must ensure access to health for all. In 1978, Malaysia signed the WHO Alma Ata Declaration Health for All By 2000. However, since Tun Dr Mahathir (Malaysia's prime minister for 22 years) introduced privatisation of the health care delivery system in the 1980s, health care is no longer a social service.
Health care has been commercialized and is now both a commodity and an industry; a competitive business with entrepreneurialism replacing professionalism in medicine. In the case of the late Ahmad Nazri, the EPF said that it even visited the supplier of stents (required to address the blockages). So was the EPF shopping for stents instead of immediately releasing the contributor's money to save his life?
The health care delivery system today is dominated by a chain of private foreign-owned hospitals, corporatised government hospitals, clinics, diagnostic laboratories, insurance companies, managed care organizations (MCOS), drug manufacturers, investors, and medical practitioners who have become businessmen.
What has spawned the rapid transformation of a once people-oriented health care system into a sometimes callous health care industry whose primary motive is profit, not people? Malaysia is heading the way of the United States, where 40 million Americans do not have access to health care and it is not unknown to see Americans begging in the streets for money to pay for treatment for cancer and other life-threatening illnesses.
President Obama's health reforms are on shaky grounds as the powerful health insurance lobby has influenced not just politicians, but also some voters to reject his ambitious plans allowing more Americans access to medical treatment.
In the Malaysian media, appeals for donations for medical treatment top the list for philanthropic requests. Almost on a daily basis, parents are appealing for donations for treatment to save the lives of their children.
Backdoor privatisation of health care is transforming the universal health care we once enjoyed into a 'user pays' system. There is no transparency and accountability in the development of the plans and policies that impact on the nation's health delivery system.
The Malaysian public has very little information on the many plans and reviews related to a very critical concern, the health care system. Since the 1980s, the government has commissioned numerous studies on health financing and privatisation, but the reports from these studies have not been made publicly available. The consumer movement has repeatedly requested for the government commissioned consultants' reports on privatisation of the health delivery system, only to be told they are “Sulit” (confidential).
The lack of transparency in informing Malaysians about government plans and policies of the major changes in the provision of health care has resulted in the lack of public debate or inputs from all affected by the creeping transformation, resulting in an unpleasant situation for those who cannot afford to pay for their treatment.
A former Director-General of Health in Malaysia, Tan Sri Khalid Sahan, had warned that if health care delivery was left to market forces, the Malaysian health system would get out of control and would be similar to the US system.
Among the consequences would be patient dumping or turning away people requiring emergency care because they do not have the money to pay for doctor's fees, medicine, and hospital services.
Twenty-first century Malaysia is beginning to see the ill effects of health care corporatisation and privatisation - effects such as abandonment of treatment and dumping of patients. Was the late Ahmad Nazir Ibrahim turned away because he was unable to pay for the surgery that could have saved his life?
We should be outraged by the patient dumping practices emerging in what was once a socially just and equitable health care system. Are there more incidents of patient dumping by Malaysian hospitals?
Why are workers who should have employer-based health insurance being forced to withdraw from their retirement savings to pay for treatment at hospitals? It is unconscionable that a health care system is taking away retirement savings from low income workers; yet this is what happens when we allow market forces to dominate the health care delivery system.
Privatising health is burdening the poor - a number of studies have shown that privatisation and market involvement raised the costs of medical treatment. Further, health insurance schemes have shown that the rich may claim tax incentives from the government for their policies and the poor will be burdened. How will low income Malaysians pay?
There are families ending up in dire straits when members fall ill due to escalating costs of medical treatment. Families have sold properties - including rice fields, gold, and even their cows in rural areas - to pay for the treatment of their loved ones.
Malaysia once won international praise for its socially just health care services. Public financing of the health sector ensured equity and universal accessibility. But today, government privatisation policies for health care shrouded in secrecy are risky remedies for the poor.
JOSIE M FERNANDEZ is currently an Asian Public Intellectual Fellow, director of Philanthropy Asia, researcher and engages with Transparency International Malaysia in anti-corruption measures.
An educationist, Josie moved on to citizen's advocacy as founder president of ERA Consumers and regional director (Asia Pacific) for Consumers International.
She holds a masters degree in development
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