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. 

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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: Xavier Jayakumar says 70% stand to lose with proposed health scheme

70% stand to lose with proposed health scheme

Joseph Sipalan

malaysiakini, Jul 13, 2010, 5:22pm

 
Around 70 percent of Malaysians will stand to lose if the federal government goes ahead to implement its National Health Financing Scheme (NHFS), said the Selangor government.

Selangor state executive councillor Xavier Jayakumar (left) said the scheme will unduly burden the people, as it merely allows the federal government to pass on the responsibility of healthcare costs to the public.

He said that 70 percent of the nation uses public hospitals, while there is no slowdown in the rate of migration of doctors from the public to the private sector.

“Under the present system, you can just walk in (to a public hospital) and pay RM2, you see a doctor and get free medication,” Jayakumar said at a press conference at the state assembly today.

“Under the new scheme, if you are not insured you will have to pay at the market rate. Seventy percent of the population earns below RM3,000 and go to public hospitals... they cannot afford this.”

Two days ago, Health Minister Liow Tiong Lai announced that the NHFS will work on a flat contribution rate and will not leave out the poor, giving an assurance that the government will cover the full costs of primary healthcare treatment for those who cannot afford it.

Underspending on healthcare

Jayakumar queried Liow's reasons for making the announcement, saying that neither the people nor the federal government itself is ready for the scheme.

“We have been talking about this (NHFS) for a long time, but why make this announcement out of the blue?

“The health minister himself said that it will take another 10 years before they can fully implement the scheme... which should not be put in place unless it has been thoroughly looked into,” he said.

Jayakumar blasted the federal government for prioritising reduced national healthcare expenditure, claiming that Malaysia's less prosperous neighbours can still afford to provide a bigger healthcare budget to their citizens.

He chided the federal government for comparing its 2009 healthcare budget of RM13.7 billion to revenue collected from the industry, which stands at below five percent of its annual expenditure.

Jayakumar pointed out that the World Health Organisation (WHO) recommended that for developing countries between six to seven percent of their Gross Domestic Product (GDP) should be set aside for healthcare.

“Based on our GDP of RM500 billion, Malaysia is only spending around two percent of its GDP on Malaysian healthcare.

“Thailand spends nearly eight percent of its GDP on healthcare, and they have a very good scheme for their citizens. If they can do it, why can't it work for us?,” he said.