Privatising Health Insurance Is Anti-Poor Say Activists

PENANG, Jul 20 (IPS) - A senior health ministry official has sought to allay fears that Malaysia's proposed national health insurance scheme could be privatised - but civil society activists are still worried.
The government plans to set up a National Healthcare Financing Authority next year to manage an estimated 3.38 billion US dollars in healthcare financing.
When asked whether aspects of the scheme such as management of funds would be privatised, Lee Kah Choon, the Health Ministry's parliamentary secretary, told IPS, ''The core understanding is that the scheme will not be privatised.''
But few details have been revealed to the public so far, raising concerns that private interests could benefit from the scheme and that the poor would struggle to pay insurance premiums.
''Yes, I am worried,'' says political economist Andrew Aeria. ''It amounts to the privatisation of an essential public service which is currently paid for through taxes.'' He worries that the poor could end up having only limited access to the health service or receiving less than quality service as they can, at best, afford only minimum health insurance.
''It will be a two-stage affair,'' explained Lee about the implementation. The Health Ministry, he said, was working with an ''international organisation'' to prepare the project document, which would contain the terms of reference for the project. ''The consultants have to come out and say whether it (the scheme)can be done without privatisation,'' said Lee.
Once the project document has been finalised, the next stage would see the appointment of consultants to work out the details of the scheme proper. This stage, Lee said, would determine who is to be covered - whether everybody would be covered at one go or whether it would be implemented in stages for targeted groups.
But the fact that the identity of the consultants has not yet been disclosed worries activists of the Coalition Against Healthcare Privatisation,made up of over 80 civil society organisations.
''It all depends on which consultants you hire,'' one of the coalition's steering committee members, Jeyakumar Devaraj, a respiratory specialist-turned-grassroots activist, told IPS.
Consultants, noted Jeyakumar, come with an ideological bent and are hardly independent. ''You can choose a consultant to tell you what you want to hear and make it sound like it is objective advice.''
''At the very least you must tell us who the consultant is and allow civil society to dialogue with the consultant,'' he said. ''And once the consultant's report is done it should be made public for public debate and not treated as an oracle from God.''
Lee said the consultant's identity would soon be revealed.
This is not the first time that consultancy work has been carried out. The Health Insurance Commission (HIC) Consultancy of Australia had undertaken a project in 2002 aimed at providing consultancy advice on the proposed establishment of a National Health Financing Authority in Malaysia. HIC is an Australian government statutory authority whose objective is ''to assist in improving health outcomes in Australia.''
Its project on Malaysia ''involved the preparation of a submission, covering the key issues that had prompted the reform of the national health financing system,'' an HIC Consultancy spokeswoman in Australia told IPS via e-mail. ''It also discussed the underlying principles and institutional and organisational requirements necessary for the establishment of a new health financing and payment system.''
HIC Consultancy, however, did not disclose to IPS who had commissioned the project nor its recommendations. The firm's website states that its usual project funders are multilateral organisations such as the World Bank, the Asian Development Bank (AsDB), the International Labour Organisation (ILO), AusAID, the World Health Organisation (WHO) and, sometimes, commissioning governments.
Despite inadequate funding, overstretched government hospitals in Malaysia have performed impressively. In fact, Malaysia's infant mortality rate of seven out of every thousand live births in 2003 is on par with developed nations û a tribute to the viability of the existing public health care system.
The government now claims it cannot cope with rising health care costs, prompting activists to point out that privatisation of sectors within the public health care system in the 1990s was responsible for a huge chunk of the higher costs.
Critics point out that health care expenditure in Malaysia has aditionally hovered around 3 to 4 percent of GDP (with the public sector accounting for only about 2 percent) - well short of World Health Organisation minimum recommendations of 5 to 6 percent.
''The argument the government is currently making - that the public sector cannot afford to continue providing quality health care for free - is a red herring especially when the government is spending billions on unnecessary arms purchases like modern fighter jets and submarines,'' says Aeria.
If the official scheme is pushed through, activists want it to provide a comprehensive basic insurance package for all û instead of specialised packages at higher premium rates for those who can afford better service as already hinted at in media reports.
For his part, Lee said the government is mindful of the choice of consultants. The consultants preparing the project document are from a ''very respectable international organisation'' that would be acceptable to all parties.
''The appointment of the consultants (for the scheme proper) will be discussed with stakeholders including the Malaysian government, international organisations and workers.'' Civil society, he added, would be involved in the consultations as well.
Activists like Jeyakumar aren't taking official assurances at face value. They want primary health care û especially among rural and marginalised communities û to be the cornerstone of the country's health service.
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