NST: Easing hospital crowds, Clinics to issue referrals under 1Care system

Easing hospital crowds
Clinics to issue referrals under 1Care system

NST, 2011/01/10
By Ling Poh Lean

KUALA LUMPUR: The Health Ministry will integrate all private and government clinics under the 1Care system for better service.

Health Minister Datuk Seri Liow Tiong Lai said it would produce a blueprint of the plan in two years.

He said under the system, patients would go to clinics, which would decide whether to refer them to hospitals.

“The system will make sure everyone receives premium healthcare. Patients can choose whether to go to private or government clinics,” he said after opening the De HomeBiz Gallery outlet at Great Eastern Mall here yesterday.
He said the ministry would carry out the system in six phases.

The first phase involves strengthening the facilities and services in government hospitals and clinics.

The second phase will cover the integration of private and government clinics.
The third phase will see the ministry making sure that all clinics serve as gatekeepers and refer cases to hospitals. This is to reduce the crowds in hospitals.

Liow did not touch on the other phases.

The system is part of the restructuring of the healthcare system under the 10th Malaysia Plan.
“We expect the blueprint to be ready in two years, but I’m not sure how long it will take to complete all phases.

“The prime minister understands that healthcare is a crucial sector and, hence, we need to study this system carefully before we can carry it out. We can’t rush into this.” Liow was commenting on a report in Berita Harian, which said the system was meant to upgrade healthcare services in the country.

It is similar to the National Health Service in the United Kingdom.

He said the ministry would get opinions and suggestions from the Malaysian Medical Association on the system.

There are about 4,000 private clinics and 800 government clinics in the country.

Last year, the government spent RM14 billion on healthcare.

Liow urged people in the high-risk group for influenza A (H1N1), such as pregnant women and elderly folk, to get vaccinated.

He said there were 16,061 H1N1 cases in the country as of Jan 8.

Read more: Easing hospital crowds
Clinics to issue referrals under 1Care system http://www.nst.com.my/nst/articles/2011011000140720110110001407/Article/#ixzz1Actd3sRP

malaysiakini-Susan Loone: Malpractices alleged at 1Malaysia clinics

Malpractices alleged at 1Malaysia clinics

Susan Loone
Mar 22, 10
2:43pm

 

A medical practitioner has criticised newly formed 1Malaysia clinics set up by the Ministry of Health for providing poor quality of medical services to patients, which include wrong prescription of medicines and wrong diagnoses.

Dr T Jayabalan, who represents workers and the Malaysian Trade Union Council, claimed that a recent study he conducted in Kampar, Perak revealed that medical assistants in government clinics have been issuing wrong prescriptions to patients.

He cautioned that the clinics, brainchild of Prime Minister Najib Abdul Razak (right) which aimed to provide access to healthcare for all Malaysians nationwide, may also be affected by these malpractices as all of them are manned by medical assistants and nurses.

"This seems to be common practice among medical assistants. They are giving out prescriptions for the wrong medicines, or prescribing medicines which they are not allowed to prescribe. They have also been found to have wrongfully diagnosed patients," said Jayabalan, who is also health adviser to the Consumers Association of Penang.

Though he called setting up the clinics "laudable", he said that the public now want quality instead of just 'good' access to healthcare.

Jayabalan made these claims at a talk titled 'What is wrong with our health care system?' on Saturday at the Caring Society Complex in Penang.

The event was organised by Sembang-Sembang Forum, a group of Penangites concerned with social and civil issues affecting their daily lives. Former Gerakan assemblyman for Machang Bubok Toh Kin Woon moderated the event.

Jayabalan also said he was appalled that the 44 clinics, launched in January, targeting the urban poor, and charging merely RM1 for its facilities, were not set up in a transparent manner as doctors were caught unawares by the project.

Currently, there are 10 1Malaysia clinics in the Klang Valley, five each in Penang and Johor, four each in Perak, Sabah and Sarawak, two in Kedah, one in Perlis and three each in the rest of the states.

Questionable staffing of clinics
His statement is supported by Malaysian Medical Association president (2009-2011) Dr David KL Quek in January who said that "while the MMA supports better, affordable and more accessible healthcare facilities to the public, the manner in which this has been announced, where they are to be sited, as well as the fact that these clinics were to be manned by medical assistants and nurses, took many doctors by surprise".

Meanwhile, Dr Jeyakumar Devaraj (right), Parti Sosialis Malaysia Sungai Siput parliamentarian, lamented the acute shortage of medical staff, especially specialists, to attend to the needs of rising number of patients.

He said that in April last year, the Ministry of Health has approved licenses to establish 45 new private hospitals in the country.

Health Minister Liow Tiong Lai has disclosed that since the implementation of the Private Healthcare Facilities and Services Act 1998 and its regulations in 2006, the ministry has received 55 applications for the establishment of new private hospitals, of which 45 have been approved.

Jeyakumar brought up concerns that for each private hospital set up, about 10 senior medical experts would be 'pinched' from public hospitals.

"This will severely affect the standard of service provided at the government hospitals especially at a time when there is already a severe shortage of doctors to serve in the public sector," he added.

malaysiakini-Azly Rahman: Class divisions in access to healthcare

Class divisions in access to healthcare

Azly Rahman
malaysiakini, Mar 22, 10
1:56pm

'Why can't all Americans have the same access to healthcare to those enjoyed by members of Congress?' is a popular question on the ObamaCare debate.

At the time of writing I am following the debate over universal healthcare for all Americans. If the US$1 trillion Bill passes, it will help insure 32 million Americans that do not have access to healthcare.

This is another controversial issue in the tradition of Democrats and Republicans. This is a good case study of one of the enduring issues of an advanced capitalist state.

I know friends who do not have health insurance and who question the human rights dimension of it - right to life, liberty, and the pursuit of happiness, endowed by the Creator who insist that 'all men are created equal' and cautioned by the Enlightenment thinker Jean Jacques Rousseau that “… everything is good in the hands of the Author of Things and everything degenerates in the hands of Man”.


From the point of view of the Democrats, the health insurance system is broken and in deep crisis. Millions cannot get proper medical health. The insurance system is predatory. Expanding health coverage and lowering prescription drug prices, and giving rebates to insurance companies are the main features of this proposal.


From the Republicans' point of view, Americans need health reform but not to the point of bankrupting the country. A Bill which covers the cost of abortion is the controversial part of it; that Americans must not pay for those who do not have the respect for life. The Bill is said to be a wrong approach that will make winners and losers in the system. Essentially it will open up other complications in virtually all aspects of the system.


Whatever the outcome of it, Americans will still be divided ideologically on this issue. The argument is emblematic of the American political philosophy: what is the role of the government vis-a-viz the social contract between the 'ruler and the ruled'?


It is a classic Jeffersonian-Franklinian debate. America has evolved into a country envisioned by Benjamin Franklin - America which is more of the big business and less on the man on the street.


Americans are taught to not trust governments; its history is that of a revolt against British colonialism famed by the slogan 'taxation without representation' and therefore 'give me liberty … or give me death', as the revolutionary leader Patrick Henry said.


Americans went to war and bankrupted the nation. It was a Republican war. That drained trillions of dollars, perhaps contribution to the near-collapse of the American Empire, as many a Complexity theorist would propose. The Butterfly that flapped its wings in Baghdad, near Saddam Hussein's mansion has contributed to the turmoil in the Obama Office.

Rights of all Malaysians


But what is the situation in Malaysia, as we have evolved as a modern state enculturalised by happenings in other advanced countries such as the US?


How do we care for the sick? Essentially is there also a class system in our healthcare system? Do the poor get the same treatment as the wealthy members of parliament or those in the list of billionaires?


With the proliferation of private hospitals, are we creating the foundations of a class system that will inherit the problems the Americans are trying to resolve?

Or is this merely a natural progression of an economic system that is also predatory in culture - that the rich will be richer and the poor growing in numbers?


With the urge for Malaysian private hospitals to venture into 'medical tourism', will our good doctors abandon their Hippocratic Oath in favour of professional hypocrisy?


Marx would say that we are defined by the economic condition we are in - we are homo economicus. I suppose how we live and how we die and how we are taken care of in-between this period of 'borrowed time', depends on how the state defines what human rights mean vis-a-viz our ability to pay for healthcare and how we lived our lives as a economic beings.


We must consider that each human being is a cog in the wheel of Capital. Those who own the machines of production oftentimes influence policies through political-economic arrangements.


A wealthy country such as Malaysia that prides itself on tall buildings and a growing number of billionaires ought to start reflecting on the need to ensure that each citizen will have affordable healthcare.


One wonders what the limit of wealth creation is and where the moral dimension is in capitalism, when the rich control the lives of the poor.


By shaping ideology and creating installations to change the social relations of production - and by doing this through the control of mind, media, machinery, and materials - we expect that wealth is to be shared. Socialism for the rich must be replaced with capitalism for the poor.


It's 11pm here in New York. The historic Bill has just been passed, 219 to 212 in the House. God bless the life of 32 million more Americans. Let Malaysia learn from this victory!

DR AZLY RAHMAN, who was born in Singapore and grew up in Johor Bahru, holds a Columbia University (New York) doctoral degree in International Education Development and Masters degrees in the fields of Education, International Affairs, Peace Studies, and Communication. He has taught more than 40 courses in six different departments and have written more than 300 analyses on Malaysia. His teaching experience spans both in Malaysia and in the United States and in a wide range of teaching context; from elementary to graduate education. He currently resides in the United States.

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