Saturday,
January 28, 2012
TAK NAK
1CARE!
Eyes Wide Open
Healthcare
"reforms" called 1Care for 1Malaysia are upon us and it's a truly
frightening prospect.
The BN government has been
selling 1Care in the MSM throughout 2011, describing it it glowing terms
without giving away any details at all. A concerned citizens group called #taknak1care managed to get hold of some
insider information and started a Tak Nak 1Care facebook campaign that's
picking up steam.
The revelations on their
Tak Nak 1Care Facebook page worried the authorities enough that the Deputy
Director General of the Ministry of Health, Datuk Dr Hisham Abdullah joined in
the discussions on the page to try and do some damage control. However, he has
so far been unable to answer or categorically refute any of the information
revealed on the page and has been reduced to repeating the mantra of
"nothing has been decided yet, but whatever it is will benefit the
rakyat".
But interestingly, the Dep
DG has acknowledged is that Malaysia is currently about halfway through the
1Care implementation process. This blogger wonders how you can be halfway
implementing something that doesn't exist yet?!
As I understand it, 2012
is when the implementation is supposed to be stepped up. Already we see various
articles in the mainstream media about the drawbacks of our current healthcare
system. This is done so that the rakyat will be conditioned to accept the need
for healthcare reform. The laws authorising the 1Care reforms may even be
passed this year. So we don't have much time to stop this train wreck from
happening.
I won't be discussing the
structure of 1Care in this article. For that, please “Like” the #taknak1care facebook page.
There is a wealth of information about 1Care there, several intelligent
discussions including long discussions with the Dep DG of MOH himself, and new
information is posted often. You can also search Youtube
for the Tak Nak 1Care videos.
For now, I would just like
to explore the problems and questions that arise from 1Care
"reforms".
Firstly, I believe 1Care
is based on some fundamentally flawed assumptions.
Assumption 1:
The Malaysian government
cannot afford public healthcare anymore.
Although the BN government
spends significantly less on healthcare (only about 2% of GDP) compared to
similarly developed countries, Malaysia is internationally
acknowledged for our relatively high level of healthcare. This
low cost and high effectiveness shows that Malaysia already has an
internationally praised, reasonably efficient healthcare system already in
place now. (This is a very important point to remember as you read the rest of
this post.)
But despite the low, low
government expenditure, the BN government is saying that it can no longer
finance even the 2% of GDP for healthcare. It plans to force all rakyat to pay
up to about 10% of their monthly income into a Social Health Insurance (SHI) to
share the cost. This is ridiculous! Isn't the government's healthcare
expenditure funded from taxpayers hard earned money? Why are we being asked to
pay again?
The BN government should
first solve the problems of leakages, wastages, corruption and runaway
outsourcing costs instead of forcing the rakyat to finance their irresponsible
ways.
Instead, we see the BN
government spending taxpayers on more "important" projects such as
the:
- RM 1 billion Mega Tower,
- RM 12 billion PKFZ
fiasco,
- RM 3 billion submarines
that don't work,
- RM 50 billion MRT
project that only covers a few km, etc.
And let's not forget
- the RM 1 trillion in
illicit capital outflow from the country.
If the government
recovered even a fraction of all these wasted resources, our country would be
able to easily finance even expand our public healthcare system for generations
to come! But as it is, we can see that the BN government has no intention of
halting its wasteful and corrupt practices. They clearly do not have the
rakyat's interest as its priorities.
Assumption 2:
The healthcare system
needs a complete overhaul
Malaysia currently has a
somewhat efficient dual system. There seems to be an unwritten rule among the
rakyat that those who can afford it, go to private healthcare providers. Those
who can't, go to public providers. The wealthier taxpayers (only 10% of the
population) take care of themselves and willingly pay taxes to provide free
healthcare for the poorer 90%.
This dual system has
worked well for decades (and internationally acknowledged, remember) although
it has some problems. But most of these problems can be traced back to
government policies and lack of regulation / standards enforcement. These can
easily be solved by conscientious government intervention.
The most urgent healthcare
problems now are runaway profits and irresponsible public financial management.
Solving these two problems should be the first step to any reform. However, it
would seem that the govt has little intention to go in that direction. Instead
it wants to implement a SHI to wash its hands of its already low healthcare
expenditure.
But for the sake of
argument, let's assume that the Malaysian healthcare system is really so bad it
needs a complete restructuring. There are many other countries whose models
have worked very well with little financial burden to the rakyat. But our govt
seems to have not explored any other model for the last two decades except
privatisation and creating an SHI to pay for it.
Assumption 3:
Privatisation and SHI are
the best reform option
In highly privatised
places like America, reforms in the shape of an SHI could be a welcome relief.
In a privatised system, healthcare is a product, and pricing strategies
maximise profits. But healthcare is not normal product – you can choose not to
buy a car, but you cannot choose not to have a heart attack. You can return a
blouse for a refund, but you cannot return a surgery. These conditions
guarantee that healthcare providers will forever enjoy a seller's market!
In such a context, SHI
promises affordable universal healthcare in time of need, as long as people put
up with a little less spending money every month after the deductions. It's a
viable alternative to costly GP visits / prescriptions, long-term care like
diabetes, or sudden catastrophic healthcare spending in cases like cancer or accidents.
A well implemented SHI
could also function as a disciplinary tool for healthcare providers. SHIs can
demand quality and accountability from healthcare by limiting payments for bad
healthcare practices and irresponsible finances. Of course, it has its
drawbacks, but it's still better than private healthcare being priced out of
many people's affordability.
But Malaysia does NOT have
a completely privatised healthcare system that an SHI initiative could improve.
So in order to justify this fundamental policy shift, the BN government is now
CREATING the necessary conditions for it by essentially privatising the entire
healthcare system through 1Care!! It's like banging your head with a hammer so
that you have an excuse to buy Panadol!
Ridiculous!
Of course, now they won't
dare to use the “P” word as the rakyat had put up with so much hardship due to
past privatisation policies. The popular euphemism now is “AUTONOMY” which
allows indivdual govt units to decide policies independently without govt interference
– like pricing policies, for example.
If that's the case, what's
to stop government healthcare facilities from acting like for-profit
organisations?
Assumption 4:
There will be enough high
income earners to significantly contribute to the SHI.
Using GDP growth and macro
economic data as an indication of citizens' financial fitness for implementing
SHI is flawed. We must take into consideration grassroots conditions such as
income disparity, inflation and cost of living as well. Right now, the income
disparity is widening, cost of living is skyrocketing and official inflation
rates do not reflect the realities on the ground. But looking at macro economic
indicators may give the impression that there is a large middle class that can
afford a compulsory SHI.
Plus, the government's
economic indicators are highly suspect. The official poverty level is
determined as RM800/mth household income. But in Budget 2012, the PM
acknowledges that households earning less than RM3000/mth have trouble making
ends meet. Official figures show inflation at about 3%, but independent studies
show that urban inflation is probably at a rate of 10%. This difference is
because the government measures inflation rate with prices of goods that are
not typical purchases of most Malaysians.
Implementing a univeral
SHI based on such vague and confusing financial data could prove disastrous to
the rakyat who are already burdened by high costs of living!
The BN government's rush
to implement 1Care based on flawed financial assumptions without a proper study
of the rakyat's situation only demonstrates their insensitivity and misplaced
priorities. Clearly, the rakyat's interest are the furthest from their minds.
Besides the problems these
flawed assumptions create, 1Care throws up several issues of concern as well.
Issue 1:
Double taxation, zero
additional benefit
The SHI concept itself is
ridiculous within the Malaysian context. As explained earlier, we are
internationally acknowledged as having achieved a reasonably efficient healthcare
system at very low expenditure.
With the introduction of
1Care, Malaysians will now be paying taxes, AND the SHI, AND their private
insurance premiums. If the SHI rates were reasonable and the benefits package
good, many people would probably have no problem with that. The only people
unhappy would be the private insurers as they will lose business to the SHI.
But as insiders have
revealed, insurance companies are included in the MOH's 1Care Technical Working
Groups to hammer out the details of 1Care implementation. And since we do not
hear any complaints from them even when 1Care implementation is halfway
through, we can safely assume that their business has not been threatened.
Insiders also reveal that
all our monthly payments to 1Care's SHI only gets us Primary Healthcare
(General Practioners / Clinics). Even then, the rakyat STILL has to share the
cost (co-pay) for medicines and medical accessories. And tertiary care
(hospital / specialists) is NOT COVERED AT ALL by the SHI. So the rakyat will
still have to pay out of pocket or depend on private insurance, like we do now
(no wonder private healthcare insurers' are not complaining - their market
remains undisturbed by 1Care, right)!
How is this supposed to be
an improvement over our present system?! Does the BN government really expect
the rakyat to roll over and accept being forced to pay twice for a “reformed”
system that burdens them with higher healthcare costs but delivers zero extra
benefit?
Issue 2:
Integrating public/private
healthcare sectors will drive costs up
Since 1Care integrates
public and private primary care services and standardises their fees, there
will essentially no longer be any "public" GPs. All GPs will be paid
private rates under 1Care (latest information is RM60 per visit, billed to the
SHI). So we can definitely expect primary healthcare costs to suddenly rise
significantly.
1Care GPs are also
required to be "jaga pintu" (gatekeepers). No one can see any
specialist or be admitted into any hospital without a 1Care GP's say-so. This
leads to the big question – since public GP services and rates have been
rationalised, will public hospital/specialist services also be integrated and
their charges standardised?
This is very likely to
happen as it would not be “fair” for government specialists to be paid less
than their private counterparts in this new integrated system. The Dep DG of
MOH himself hinted at this in one of his comments on the #taknak1care page.
Specifically he commented that:
"For a
specialist or doctor if I see 10 patients a day or I see 100 patients the
salary is the same. If you are efficient you be given more work. This is the
system we have now."
Since 78% of hospital beds
in Malaysia belong to the government who also handles 74% of admissions,
imagine what would happen when all these government facilities start charging
private rates under 1Care. Healthcare costs to shoot through the roof! It would
also be reasonable to assume that a large segment of our uninsured population
would no longer be able to afford the skyrocketing healthcare costs under this
new 1Care scheme.
What's more, this
development will have multiplier effects. One of the effects I foresee is in
the insurance sector. Since 1Care's SHI benefits only cover limited GP
services, private insurers will have to raise their premiums and limit their
payouts to ensure their profitability is not affected by the tsunami of rising
costs in tertiary healthcare.
Clearly, the BN
government's 1Care reforms will dump the rakyat in the wayside in pursuit of a
system that values money more than life.
Issue 3:
Social safety net
disappears
Our public healthcare
system has always been the primary choice for lower income groups. It is their
chance to get good, almost-free healthcare. However, even before 1Care is fully
implemented, government hospital charges are now no longer “negligible”. Rooms
in some government hospitals now cost as much as private hospitals. Other fees
may be much lower than the private sector, but can still run into thousands for
a even simple surgical procedure.As it is now, many poor household find it hard
to pay for public healthcare - and 1Care hasn't even been fully implemented
yet!
In Budget 2012, the PM
acknowledged that households earning less than RM3000/mth have trouble making
ends meet and a RM500 one-off cash aid makes a big difference. With roughly 60%
of Malaysian households earning below this threshold, how can they be expected
to contribute up to 10% of their income into 1Care's SHI? How will they be able
to afford expensive long-term / tertiary care if there is no longer a public
healthcare system? Where do they go - back to the dukun and sinsei in the
villages?
With the floodgates of
privatised rates thrown opened, what's to stop our “reformed” 1Care system from
going the the free-for-all American way, where any service within the
healthcare industry has the potential to be monetised, subdivided and monetised
again? Now that the “autonomy” concept seems to be given free reign, government
owned units can freely make such decisions without interference from the
government and the rakyat won't be able to do anything about it.
Conclusion
These and many other
disturbing issues and concerns are turning up as bit by bit, as the scope and
structure of 1Care are revealed. But so far, the BN government has no answers
for the rakyat.
The information gathered
from documents available online indicates that 1Care will create more problems
than it solves. In fact, the implementation of 1Care's SHI concept will
actually destroy our present efficient system, reverse-engineer for us all the
problems of the American privatised healthcare system AND create ALL-NEW
problems because of its very limited coverage. 1Care could be the most
dangerously ridiculous case of putting the cart before the horse that
Malaysians have ever been subjected to by the BN government!
The BN government should
fix its own fundamental flaws and get its priorites right first before
subjecting the rakyat to such dubious reforms! The BN government should
remember that they owe it to the rakyat to provide healthcare and other
essential services, instead of washing their hands in the privatisation basin
and kicking back to enjoy less work and more money. We've had enough of
privatisation policies that forced rakyat to pay through their nose for
inefficient monopolies controlling phone services, water, electricity,
sewerage, waste disposal, postal service, public transport, and the list goes
on... Now the BN government wants to privatise and monetise another essential
service - healthcare!
The rakyat should not take
this lying down anymore. We must not be held ransom to this "You Money
Or Your Life" 1Care system. We owe it to ourselves and our children to
make sure 1Care is stopped dead in its tracks!
TAK NAK 1CARE! Join the movement,
spread the word.
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