1Care: What ails Malaysia’s health care system?

Aliran: Aliran joins hands with fellow Malaysians in their collective concern with regard to the proposed ’1Care’ scheme to restructure Malaysia’s health care system – a move that would definitely exact a heavy toll on their physical as well as financial health.
Supposedly based on the UK National Healthcare Service (NHS), the 1Care scheme is said to be aimed at financing the supposedly increasing costs of public health care while making it still affordable to the lower-income group.
But we fear that, like most other “restructuring” schemes in the past, 1Care will deliberately result in the escalation of costs to ordinary Malaysians and the outsourcing of contracts to corporate interests – financed by public funds. The direct beneficiaries – private hospitals, health management organisations, pharmaceutical firms and those administering the national health financing fund – are likely to profit handsomely from this scheme at the expense of the public.
We recall how the costs of pharmaceuticals soared after the Government Medical Store was privatised in 1994. A similar rise was seen in the costs of general hospital support services after they were privatised.
The so-called mantra of cost-effectiveness that is often promised with such restructuring or de facto privatisation schemes is highly questionable. Critics of the 1Care scheme justifiably claim that the quality of health care treatment will plunge. The new health care financing authority may impose limits on the number of hospital visits by a patient or introduce financial incentives for GPs to limit their number of referrals to specialists in the effort to trim costs and improve profit margins. The welfare of the weak and the poor will be sacrificed without any qualms on the altar of greed and profit.
In effect, 1Care will provide massive public subsidies for private hospitals. An analogy would be the use of public funds given out as PTPTN study loans, which effectively acts as a huge government subsidy to private colleges, which have mushroomed. The cost is borne by indebted ordinary students, who have to make long-term study loan repayments. In the same way, payments out of the national health care authority’s funds (raised from the public via taxes and monthly public contributions) will serve as large subsidies to boost admissions, the occupancy and the bottom line of private hospitals and GLC-owned ‘private’ hospitals. Even government hospitals could end up behaving like private hospitals.
Malaysians will probably have to pay 6-10 per cent of their monthly income in contributions to the fund. A significant chunk of this money will go towards the administration costs of the health care financing fund. The pockets of ordinary Malaysians could be hit even further if they opt for a GP of their choice. What about those who are unemployed or unable to afford health insurance contributions? How would they be able to get medical treatment under this new scheme?
There is basically not much that is wrong with the existing public health care system that cannot be fixed with a greater allocation of government funding and more effective management of personnel and resources. At present, the government spends just over 2 per cent of GDP on public health care – a pathetic amount well short of the internationally recommended 5-6 per cent. Why not allocate more funds to our general hospitals, which already provides universal coverage to anyone who needs treatment, instead of squandering public funds on useless projects or allowing massive corruption to persist?
We call upon the government to reconsider its plan to implement this massive scheme. Spare the ordinary rakyat – already suffering from the effects of inflation – this additional heavy financial burden. Just allocate more funding to our general hospitals and ensure that it leads to a distinct improvement in the quality and efficiency of our general hospitals.
A government of the people has the responsibility and moral obligation to protect the interests of the rakyat – and this includes their health care.

Dr Mustafa K Anuar
Honorary Secretary
3 February 2012