malaysiakini: Health: Is government abandoning justice? - by Josie Fernandez

Health: Is gov't abandoning justice?
Josie M Fernandez
malaysiakini, Jul 29, 10
11:20am

A quarter century of privatisation in Malaysia may result in the government abandoning justice and equity in healthcare in pursuit of profits that benefit the connected and the political elite, not the people.

Recently, Health Minister Liow Tiong Lai announced that the government plans to implement the National Health Financing Scheme (NHFS) in stages over a ten year period. The funds would be managed, according to the minister, by the National Health Financing Authority, a statutory body under the Health Ministry. The minister said this body will manage the funds from fees paid by all Malaysians.

But very little information on the fund is available to us, ordinary Malaysians.

No access to studies

Despite the many studies and millions of ringgit spent on consultants and experts in the last 25 years on privatisation of the public health sector, we have no access to these studies and the recommendations of the experts. Many questions on the NHFS have been raised by activists, academics and the opposition parties.

For example, will funds from this proposed scheme replace the government health budget? Will employers stop providing health insurance coverage to employees and instead contribute to the NHFS? Do individual employees make additional contributions? Is it compulsory for every Malaysian to contribute to this scheme? Are the 1-Care Clinics a hint of what is in store for the future of healthcare in the country?

Has there been a stakeholders consultation before the health minister announced the tentative scheme? If so, what was the process? Who were the stakeholders invited to the consultation? I understand the Health Ministry has made presentations to the cabinet on a NHFS for Malaysia. These presentations should be made public to encourage wider public debate on government plans to replace the current equitable healthcare system.

Who will manage the NHFS as a statutory body? Will we see cronyism which has blighted other privatisation ventures of social goods like public utilities? Studies on privatisation of public enterprises by Jomo KS and Terence Gomez have concluded that privatisation has benefitted those who have connections to the political elite.

More recently, Barry Wain in his book 'Malaysian Maverick: Mahathir Mohamad in Turbulent Times' states those who receive lucrative privatisation contracts are actually proxies acting for powerful politicians.

As long as money politics dominates the political landscape in the country, privatisation is likely to be used as a source for political funding.


'Rising healthcare costs' argument

The justification to reduce government involvement in the health sector has been the claims by the government that public sector health costs are rising.

But the statistics tell a different story. The “rising healthcare costs” argument has been used in the last 25 years to move ahead with corporatisation and privatisation of various facilities.

However, an examination of health financing costs borne by the government and the impact of 25 years of privatisation clearly shows that a just healthcare system, once praised by the World Health Organisation, is being taken over by profits and politics.

When Mahathir became prime minister, he was smitten by Margaret Thatcher's drive for privatisation of public services. So a central plank of the fourth Malaysia Plan (1981-1985) was the privatisation of the healthcare system. In the Seventh Malaysia Plan (1996), the government introduced plans to corporatise and privatise public hospitals and medical services.

The figures speak for themselves. Government annual expenditure on health care has decreased. Malaysia spends only 4.4 % of Gross Domestic Product while Argentina spends 10% and Chile (6.2%).

'Unintended' consequences

In his recent paper on 'A Strange Thing Happened on the Way to the Market: A Quarter Century of Privatisation in Malaysia and its Effects on the Healthcare System', Dr Kai-Lit Phua of Monash University underscores some of the “unintended” consequences of the privatisation drive:

• Astronomical increase in drug prices for the Health Ministry (MOH) after the privatisation of the Government Medical Store. A private company - Pharmaniaga - is currently the main supplier of drugs and medical products to the MOH

• The emergence of a two-class healthcare system - A public sector system that lack specialists and an expensive private sector staffed by specialists who will treat even minor ailments. 

• The promotion of medical tourism will worsen the situation of healthcare in the country when experienced specialists leave public sector hospitals for the lucrative private sector.

• Quality of services will be affected in public hospitals.

• Proliferation of private medical schools in Malaysia. In 2009, there were about 10 public and 13 private medical schools. But are there sufficiently qualified professors in these schools?

The healthcare situation in the country is worrying. Withdrawals of pension funds like the EPF for medical treatment was raised in Parliament this week. Seventy-one percent of the applications for the EPF withdrawals for medical treatment come from those earning less than RM 2,500. Withdrawing funds from the EPF for medical treatment is a risky remedy as it will increase the rate of poverty among pensioners in the future.

The government must not abandon a just healthcare system which has guaranteed access to health for all.

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. She holds a master's degree in development management from the Asian Institute of Management, Philippines. Josie has been an active participant in citizens advocacy, leading national and international organisations. 

-----------------ooooo00000ooooo----------------------

COMMENTS (DQ)

Good and important questions asked by a social activist. Health care certainly is too important to relegate its entire system and future to the 'wisdom' of the government of the day! Legitimate questions and issues need to be debated with greater transparency to all stakeholders including the public, to buy in or to reject. There are too many unknown variables with too many possibilities for wastage and careless implementation to simply foist onto the unknowing public! 

Government bureaucrats must wake up to the current reality that its paternalistic approach is passe and over--that simplistic arrogated statements that it 'knows best' and that the authorities will decide best for the 'national' good, just won't be good enough to persuade an increasingly skeptical public wary of its venal excesses, corruption and cronyistic tendencies!

Malaysiakini-Baradan Kuppusamy: Creation of commercial hospital wings a mistake - critics

Creation of commercial hospital wings a mistake - critics

Baradan Kuppusamy
Mar 17, 10
12:03pm

 

A Malaysian government scheme to create commercial 'private wings' in major government hospitals has come under fire from critics, who say it will add to the burden of people who need public healthcare the most.

Already, campaigners have been opposing the privatisation of health care services in this South-east Asian country, a trend that involves the introduction of more 'efficient' market forces in a sector that has traditionally seen a larger public and state role.

The government is determined to fully implement the Full Paying Patients (FPP) programme in all major general hospitals within the year, saying that the pilot phase it carried out in two big hospitals over the past six months has been successful.

Privatisation under another name

But "it is a clever way of privatising health care," said Nasir Hashim (below), leader of a protest movement against the scheme and president of the Socialist Party of Malaysia. "The poor who already suffer from high cost of health care and rising food and living costs will suffer even further."

"Not only will desperate patients further excluded but they will be forced to rely on precious savings to fund their healthcare needs," he said in an interview. "This is a form of backdoor privatisation."

"Such a scheme is fundamentally flawed and will only serve to deprive the low-income (groups) and poor of their right to specialist care," added S M Idris, president of the Consumers' Association of Penang. "Their basic human right is being taken away."

They also fear that the creation of the private wings will move the focus of government hospitals and specialists will shifts to paying customers instead of needy patients.

"Private healthcare in principle is to complement public healthcare and not assume the role of the public healthcare sector as the principle guardian of the people's health," opposition lawmaker Charles Santiago said.

Right now, major general hospitals have sections that are open to all patients who enjoy equal access to bed, medicine and specialists' care. But the new scheme would mean that specialists' care, operating theatres and other facilities would be open only to full-paying patients after 5 p.m. every day.

Major drive

The government of Prime Minister Najib Razak, who came to power in April 2009, is on a major drive to remove subsidies in order to accelerate free- market measures and make the country more attractive for foreign investors.

He is eager to cut back on deficit financing that has plagued the country since the 1997 Asian financial crisis, undertaking measures such as removing subsidies on oil and other petroleum products and introducing a new goods and service tax.

Making the egalitarian health care system, which is heavily subsidised, a self-paying one, is one of his goals.

Social activists, lawyers and opposition lawmakers, including the Socialist Party of Malaysia, organised numerous protests against the FPP scheme this month.

Nasir, who led a large protest in several big hospitals and submitted memoranda listing the flaws of the FPP scheme, say that the despite Malaysia's wealth, nearly 60 percent of the country's 28 million people are considered to be in the lower-income groups.

Another four million foreign migrant workers – documented and undocumented - also depend on the same stretched and outdated health system and would feel the impact of the FPP scheme.

"The FPP scheme ignores quality foster care and treatment of patients who depend on regular public hospitals for their needs," Nasir said. "We want the scheme cancelled."

Santiago (left) argued, "This abrogation of duty of the government to citizens is seen in the corporatisation privatisation schemes under the Najib administration. The scheme is the first step in the eventual privatisation of the public healthcare sector."

Poor might have to pay

Critics fear that poor patients might end up paying services and charges that are now provided free in government hospitals, such as medicines, board and lodging, surgical procedures, nursing, use of equipment and administrative costs.

"All these charges when added are exorbitant and beyond the means of many Malaysians," Santiago said.

In a country already suffering from perennial shortages of medical personnel, the FPP scheme could well be an additional push factor that encourages doctors, nurses and specialists to move to the private sector.

There are 6,400 medical vacancies in the public sector, with a 2008 doctor- patient ratio of one to 1,105 patients.

Overworked doctors

As a result, medical officers in the public sector are heavily overworked and doctors often see up to 150 patients a day, Idris says. "With FPP, doctors will come under additional pressure."

S Arulchelvam, secretary general of the Socialist Party, says that the FPP would result in discrimination in treating paying and non-paying patients. "The public-private mix would lend itself to corrupt practices as in the case in some countries where health care is a mix between public and private care," he added. "The net benefit for the poor will be less access and a further erosion of equity."

"Those who cannot afford to pay full rates should be given discounts or, in the poorest cases, free treatment. Patients in the second-class and those in first-class should pay a large percentage of the costs of treatment," Arulchelvam said.

"This way, the primary role of public hospitals to offer equitable and accessible healthcare to all citizens is maintained. There will be a conflict of interest if the already overburdened public healthcare resources are further diluted to cater for private wings," Idris explained.

- IPS