EVER so often, we come across appeals for donations to pay medical bills. In a typical case, the illness requires immediate treatment and the patient has to go to a private hospital. The trouble is, not everybody can afford healthcare charges based on commercial rates.
Months ago, it was reported that a 10-year-old boy needed over RM100,000 for a bone marrow transplant. Two bone cancer patients sought donations to undergo surgery. A three-month-old baby diagnosed with multiple ventricular septal defects was in dire need of funds.
Another man had nose cancer and needed financial help, and two days ago, a nine-year-old boy asked for more funds for his bone marrow transplant although his parents had already spent RM300,000.
These are heart-wrenching stories – the young and old fighting for their lives and depending on charity for a lifeline. They are the most vulnerable group and even insurance companies are reluctant to give them coverage.
The government hospitals do not turn away patients no matter how poor they are but having to wait for an appointment to see a specialist or to have surgery can be costly.
When the public sector cannot fully satisfy the demand for healthcare services, it is left to the businessmen to fill the gap.
“The Malaysian healthcare has emerged from a government-led and funded public service system to a dual-tiered parallel system with a sizeable share and thriving private sector,” says Malaysian Medical Association (MMA) president-elect Dr David K.L. Quek.
Overstretched
The waiting time is not the only issue with public healthcare. There is also the need to keep up with technological advancements. Is the Government spending enough to give citizens the latest and the best in treatment options?
About 7% of the national budget is allocated for healthcare. Budget 2010 proposed a reduction from RM13.7bil last year to RM13.1bil. In comparison, the US healthcare spending reached US$2.3 trillion, representing 16.2% of the American economy.
In Malaysia, says Quek, about US$400 per patient is spent on healthcare every year but some of our neighbours are spending in excess of US$1,000. Treatment for chronic diseases alone is said to make up 75% of most countries’ healthcare spending.
But it is unfair to say our public system is bad. The doctors and nurses are stretched and they are doing their best. In fact, some of the brightest talents are in the public sector and it is small wonder that the private sector is constantly luring them.
But the workload in the public sector is daunting. The sector has about 50% of the country’s doctors who attend to 80% of the population while the remaining 50% of the doctors in private practice treat 20% of the population. That explains the long queues at public hospitals. But how many of us can afford treatment at private hospitals?
There is, therefore, a disparity and reform is the way forward. “We welcome a change to the current healthcare system as there is a gap and hopefully, the new system will bridge it. Healthcare should be available to all,’’ says Tropicana Medical Centre consultant cardiologist Dr Haizal Haron Kamar.
Healthcare for all

There is a gap in the current system. Hopefully the new system will bridge it… DR HAIZAL HARON KAMAR
The principle is that there should be universal access to healthcare, whether young or old, rich or poor. The Government has been talking about a revamp for nearly two decades.
Recently, Health Minister Datuk Seri Liow Tiong Lai announced the intention to implement the National Health Financing Scheme (NHFS). That is supposed to provide healthcare for all.
The details are still sketchy but the idea is for all Malaysians to have access to primary healthcare at any public or private clinic. Liow was reported to have said that NHFS would also look at secondary healthcare coverage and the illnesses and treatments it might be able to cover.
Globally, the challenges in healthcare are the rising costs, quality issues and the waning consumer trust. The NHFS will need to address these as well.
There are many options but somewhere along the line, wage earners will have to pay via scheduled monthly contributions or other mechanisms. The self-employed, those who have an independent income as well as employers would also have to contribute and all these will be based on wage scales.
It is said that the rich will pay more. The concept is the rich funds the poor, the able helps the disabled, and the young helps the old.
The implementation
Although the details are still being hammered out, those in the private sector are anxious about their part in the NHFS. “We need a blueprint and we need to know the role of private hospitals and clinics,’’ says Haizal.
Liow could not be reached for comments but from previous news reports, it appears that the NHFS will be split into four phases and will take 10 years to implement.
The first stage is to look at the governance and standards of care issues; the second is to grant more autonomy to primary healthcare providers in areas like human resources and management; the third is to integrate all public and private clinics in a common network so that people can access either one; and the fourth is to introduce a national health insurance under the NHFS.
According to the Minister, the National Health Financing Authority, a statutory body under the Ministry, will manage the funds. New legislation may have to be passed and existing ones amended to pave the way for this scheme. Regardless of how much one contributes, everyone will enjoy the same standard of care.
Whatever the shape of the new scheme, it should not burden consumers. The patients’ waiting time should be reduced and the rakyat should get access to healthcare.
Separating the pharmacies from the system may be a good move, but there should be a proper control of medicines so that there is no profiteering.
Also being considered are training and the need to embrace developments in technology. Identifying general practitioners who will be the patients’ first touchpoints is critical as well. Linking the private and public sectors is another big hurdle.
To Liow, the scheme will control escalating costs better; let consumers choose between going public or private; offer better quality care; and be more effective, efficient, viable and sustainable.
The Ministry is still looking at the best mechanism for collection; rates and conditions of contribution; how to pay to the clinic or hospital; the illnesses to be covered; the ratio of co-payment; and the financial implications to the Government.
What doctors, insurers say
Quek, whose association represents some doctors but not all, hopes for dialogues and discussions with the Ministry so that the doctors can give feedback. Their concern is understandable, as there is a thriving private healthcare industry that needs to know where it will fit in the whole scheme of things.
He says: “We understand that the country needs some form of universal coverage for Malaysian residents but feedback from all is necessary. The consultants can give their views but the views of the various stakeholders – the private hospitals and clinics and the citizens – are critical in determining the robustness of the plan.
“We want a system that the public will benefit from at reasonable costs. And the public buy-in is needed because the cost of healthcare is expensive.’’
Haizal, who has worked as a doctor in Britain for six years and is therefore familiar with the National Health Scheme (NHS), says in Britain, the private hospitals are not part of the NHS.
Equally anxious are the insurers. Today, people with insurance policies can walk into any private hospital to get treatment. Will that be the case when the NHFS comes into play?
To them, the scheme is a “good start for better and more accessible healthcare services in the country’’ and if properly managed, it can be like similar schemes in Britain and Australia. But there are potential pitfalls, of course.
Life Insurance Association of Malaysia (LIAM) president Md Adnan Md Zain says abuse and fraud are the main challenges facing insurers in offering such coverage, adding that being prudent and offering selective types of coverage will help manage the loss ratio effectively.
According to the association, there is a tendency for doctors to charge higher when billing patients covered by health insurance.
What the consumers want
What the consumers want is not to have to worry about crippling healthcare bills. Yes, there is a price to healthcare but it should be manageable. One thing that everyone fears is illness or disease in old age. It is difficult to get insurance for the very old as coverage usually stops at 70. Many people have to dip into their Employees Provident Fund (EPF) accounts, which is supposed to be for their retirement years.
Observers says the usage of EPF funds for medical treatment is “unacceptable” as the EPF savings should not be depleted. It is meant for old age, not illnesses.
With the NHFS comes the potential of taxes going up so as to enable the Government to fund it. If healthcare is to improve, the money has to come from somewhere.
Federation of Malaysian Consumers Association (Fomca) secretary-general Muhammad Sha’ani Abdullah says the scheme is essential as the current insurance-based model does not provide affordable coverage for those in need of healthcare protection.
The Government needs to get more funding if it wants to implement NHFS but it should not overburden the consumers. And for those who want something better than a standard room, for example, they have to pay for the extras. This is to ensure that no one abuses the healthcare system.
It will be tough to streamline the healthcare system but being a late starter, we can learn from those who have done it. We know the British model is not perfect and that the Australians are looking to improve its current system. In the United States, the new healthcare bill has just been passed after much debate.
What we want is a holistic approach to healthcare. Therefore, engaging with the relevant stakeholders is crucial so as to cover all angles and make it a success.
Staying on course to make sure it become a reality this time around will be a huge challenge. But there is no denying that the citizens need the NHFS. The cost of healthcare will triple in two decades and the man in the street may not be able to afford to fall sick then.
Source: The Star Online
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