Insuring health

The Star: A scheme for all

How will the proposed National Health Financing Scheme work?
According to a model proposed by Health Solutions (SE Asia) Sdn Bhd, the scheme will adopt a non-profit, social insurance format.
It should be financed by the Federal Treasury, which will provide a global budget to finance the expenditure, says Dr Kananatu Krishnan, adviser to Health Solutions, a healthcare consulting company that conducts feasibility healthcare studies, manages healthcare services and personnel, as well as provides training for allied health personnel.
Dr Kananatu, who was formerly with the Economic Planning Unit, Ministry of Health, was one of the speakers at the recent International Conference on Health Communication (HealthCom2005), which was organised by the Asian Institute for Development Communication to discuss issues related to health communication strategies and programmes.
The global federal budget will be topped up by community-rated premiums from all the employed and the self-employed, EPF and SOCSO contributions, as well as any third-party payers such as the insurance agencies for group insurance coverage, he adds. (Community-rated means everybody is charged the same premium for a particular plan, irrespective of age, gender and the current or likely future state of their health.)
All these will go into a centralised healthcare fund called the National Health Security Fund.
“Each contributor may establish a Medical Saving Account with the fund. The fund can then function as a dedicated scheme to support all lifelong health needs of an individual and the family,” says Dr Kananatu.
The health fund should be supported by a network of public healthcare services, with the contribution of private sector services.
“Instead of the government putting money into government facilities, they put it into a fund, which provides money to all the hospitals based on the services they provide. This way you break the barrier between private and public (healthcare),” says Tan Sri Datuk Dr Abu Bakar Suleiman, former director-general in the Health Ministry and currently president of International Medical University, speaking at the same conference.
The above-mentioned National Health Financing Authority that oversees the scheme “is proposed to be under the Ministry of Health and not to be privatised,” says Dr Kananatu.
“We want to create a health fund that is government-owned (non-profit). The government needs to be at the centre of decision-making, in terms of allocation and use of resources, to ensure achievement of national health policies,” says Abu Bakar.

How much will you pay?
There seems to be little question that Malaysians are willing to spend money on health services, says Dr Kananatu.
“According to the National Household Health Expenditure Survey, in 1996, people had spent RM2.8bil, out of pocket, on health services. The government spent RM2.2bil on operating expenses for health services.
“People are spending more than the government expenditure. It goes to show that people are prepared to pay for health services,” he remarks.
He also comments on an earlier survey, conducted from 1986 to 1988, which showed that each consumer was roughly spending about RM50 per year for his/her household health expenditure.
“When asked if they would contribute about RM10 a year to use services in the public and private sector, without any co-payments when the services were needed, 95% of consumers said yes, that amount would be adequate and they would be willing to pay it,” he says.
While we may be willing to pay for health services, how much should we pay as part of the premiums for the Fund? How will these be collected?
These are important questions that have yet to be answered. “They are still studying this,” says Dr Kananatu.
Since the idea was mooted in 1983, the National Health Financing Scheme has taken more than 20 years to see the light of day. Will next year be the year it finally moves from paper to practice?
If so, one can only hope that the details will be properly ironed out before the scheme is implemented.