Thursday, August 18, 2011

malaysiakini: 1Care health reforms: Can one size fit all?... by Keruah Usit

1Care health reforms: Can one size fit all?
Keruah Usit
Aug 18, 11
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After the delivery of his second child in Limbang, Sarawak, five years ago, proud father Ketua Baru, a farmer from a rural Penan community, was told to wait before he took his baby daughter Robina home.

He says the medical assistant at the counter at Limbang Hospital insisted that Ketua had to first pay the hospital bill. The sum was small - around RM10.

NONEKetua (left) asked for the bill to be waived. He is a subsistence farmer, with a negligible cash income, and every ringgit was precious to him. 

Ketua said the medical assistant insisted there could be no exemption, although a Health Ministry circular stipulates free treatment for Sarawakian families earning under RM700 a month.

"The medical assistant said, 'If you cannot afford to bring up your children, why do you make babies?' 

"I answered him: 'Where do you think I would get a salary of hundreds or thousands (of ringgit) from?' He told me 'you Penan people are always lying.' 

"In his mind, Penan people are really like animals. He walked into his office after that, otherwise I would have said angry words to him, I might even have spat at him," Ketua said.

Ketua is now a volunteer citizen journalist for Malaysiakini. His income remains the same, but thanks to training courses and a basic, AA battery-operated camera supported by Malaysiakini, he is now adept at making videos and conducting interviews.

He has become aware of the importance of taking note of the names of bureaucrats behaving in an uncouth manner. Ketua is creating his own record of the experiences of the Penan, a community facing encroachment by loggers, and trying to come to terms with modernity.

Ketua is also aware that local and international media are showing growing concern for the social and economic deprivation common among Sarawakian natives. .

Attempts to reach the state health director by telephone and email, to seek comments on Ketua's experience, were unsuccessful.

1Care 'nebulous and unclear'

Rural healthcare faces new challenges. 1Care is the latest manifestation of healthcare funding introduced by the government.

Under this reformed system, both private and public sectors will be funded by a national health insurance scheme, managed by government appointees and drawn from contributions from employers and wage-earners.

Briefings on 1Care have gone on throughout the nation. The briefings have been long on expositions on principles, and short of detail. It remains unclear where the funding will come from, who will manage the insurance fund, how healthcare will be rationed and which groups will be exempted, if any.

No minister has spoken on the legitimate concerns of Malaysian citizens with low incomes or without adequate documentation. Suhakam has noted large numbers of Penan citizens without MyKad.

The lack of these essential documents has affected all ethnic groups in the country, particularly among rural minority groups in Sarawak and Sabah. Promises and deadlines issued by the Registration Department to provide MyKad to these disenfranchised citizens have come and gone.

The proposal for a national insurance scheme picked up speed under the recently retired director-general of Health, Dr Ismail Merican. 

However, he was unable to provide concrete reassurance for undocumented Malaysians, or for the poorest segments of society, that they would receive free treatment under a new healthcare financing system.
No declared policy of equitable healthcare

Concerned doctors say Ismail told them that the MyKad issue had to be resolved by the Registration Department, not by the Health Ministry.

Dr David Quek, immediate past president of the Malaysian Medical Association (MMA), has on several occasions, called for concrete details and frank consultations with the public, over the proposed health funding reforms.

"We (in the MMA) lament the fact that up until now, Malaysia still does not have a declared policy of equitable healthcare for all... ideally healthcare should be freely accessible for all, regardless of ability to pay, and should be based entirely on the basis of need.

"Slogans such as 1Care remain nebulous and unclear, and are not convincing enough to encourage acceptance by our citizens, and certainly in the current form, not by the medical profession," Quek wrote last February.

NONEDespite Quek's warning, no public dialogue on proposed 1Care reforms has ensued, and details have remained jealously guarded by the government.

Doctors and citizen groups, Quek asserted, are anxious that leakages, "already legend with many government and government-linked entities", would waste more money and shrink even the meagre benefits present under the current system.

Other healthcare professionals have expressed similar concernsthat the agency overseeing the healthcare fund would have enormous opportunities for largesse and corruption. 

Yet most of the debate over the proposed healthcare funding reforms, held by civil society groping in the dark, continues to centre on the issue of choice.

Urban Malaysians are concerned over their liberty to consult any family doctor. Many are worried general practitioners will be designated for them, in imitation of Britain's National Health Service. 

Others are also worried that they may be deprived of more expensive investigations or treatments, under a rationed 1Care scheme.

But in Limbang, as in many other poorer parts of Malaysia, most members of the public have never enjoyed the luxury of choice.

KERUAH USIT is a human rights activist - 'anak Sarawak, bangsa Malaysia'. This weekly column is an effort to provide a voice for marginalised Malaysians. Keruah Usit can be contacted

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