TAWAU: A proposed medical insurance scheme by the government has raised concern among private practioners here and

across the peninsular. Suspicion has risen over the 1Care scheme which many believe will only benefit a few private companies at the expense of patients and doctors. The doctors fear that healthcare expenses will increase as 1Care will become a monopoly through a giant managed-care organisation (MCO). Although the government is yet to reveal the full details of the 1Care scheme, initial disclosures have raised concerns. According to doctors here, in theory the scheme appears to save money for the consumers but in reality it is otherwise. It should save consumers from having to pay out of their pockets for their primary healthcare and thus protect them from excessive healthcare expenses, but in reality 1Care will come under a new company and thus a middleman.The middle man will profit from patients and their caregivers. This will result in healthcare costs going up, the standard of treatment may drop and the public will be burdened with a new healthcare tax, said a private doctor who requested anonymity. The doctor said most fraternity members are worried that their ability as medical practioners to provide quality medical care will be compromised by the scheme which will collect fixed funds from all working adults and their employers. They are also preparing to face criticism from the establishment who may see their opposition to the plan as trying to protect their income first. Scheme may lead to undertreatment Meanwhile in a letter obtained by FMT, a group of doctors from the peninsular have also listed their concerns and are urging the government to engage all parties, including patients and the public before deciding to introduce the scheme. They said it is important that dialogues be intiated and stakeholders respond to valid questions on the scheme. Spelling out their concerns and worries, former Penang Medical Practitioners Society (PMS) presidents Dr Ong Hean Teik and Dr Haniffah Abdul Gafoor along with ex-Penang branch leader of the Malaysian Medical Association Dr SP Palaniappan, said the scheme is being promoted as having an immediate impact on improving the countrys healthcare system while also addressing the poor government medical facilities in Sabah and Sarawak. The experience worldwide is that a fixed capitation fee per patient will lead to inadequate and undertreatment since physicians tend to conserve resources to prevent financial loss. Although patients do not directly pay for their treatment, they are still indirectly paying since a portion of their income will automatically be deducted and given to the insurance company running this programme. Instead of spending only for their healthcare, patients are actually contributing to finance the operation of a private insurance corporation, the doctors noted in their letter. The doctors believe that to qualify for the scheme, they may have to buy computers and software from a designated supplier and also pay for certification. This appears to be a business model guaranteeing profit for the computer programme seller and the body providing education/certification of doctors. Patients dont pay for drugs, which will be prescribed by doctors only from a standard list, and can also be dispensed at participating designated pharmacies. Clinics and pharmacies will then collect payment from the insurance corporation. Patient treatment will be limited to only these approved drugs, and any other drugs used will be paid fully by the patient out-of-pocket, the letter noted. Patients may pay more The doctors said that while patients need not pay, quality of treatment will drop since the range of drugs will be limited. There is a monopoly in deciding which drugs get onto the approved list and profit will be guaranteed for the company supplying and manufacturing these drugs. Patients will be registered with a particular doctor and treatment must be only from this doctor. If a patient chooses to see another primary care doctor or if specialist treatment or hospitalisation is needed, patients will again pay out-of-pocket. The doctors said patients will no longer be able to seek a different primary care doctor, even if they travel to another town or if the initial treatment is ineffective.

Since the scheme does not cover specialist and hospital costs which are far higher than primary care charges, patients may actually end up paying large out-of-pocket fees despite contributing to the new insuring company.

KUALA LUMPUR: Local doctors have slammed a proposed government medical insurance plan which sought to profit from the sick. According to them since the government derived its revenue from all tax-payers it must not seek to profit from its activities. The government must develop a system to protect the health of all, especially those unable to pay for their own needs, they said. According to them hospitalisation cost accounts for the bulk of a countrys medical expenditure. Noting this, former Penang Medical Practitioners Society (PMS) presidents Dr Ong Hean Teik and Dr Haniffah Abdul Gafoor said that in 2008, the government was responsible for 78% of total hospital beds in the country and accounted for 74% of total admissions. But the government spends only 44% of the total healthcare expenditure in the country. The private hospitals which see only 26% of total admissions however use up 56% of total healthcare spending, they said in a letter obtained by FMT. Noting these details in the letter, which was jointly signed by their colleague, former president of the Malaysian Medical Association (Penang branch), the doctors said under-funding and excessive work has led to unsatisfactory patient service in government hospitals, forcing patients to seek attention from private healthcare. If efficiency and service in the government hospitals improve, patients will not have to seek treatment from the expensive private sector. The government must improve service in their hospitals. If government hospitals can cater effectively to patient needs, the private hospitals will be forced to lower prices to compete and attract patients, as has happened in Singapore, they said. Escalating cost of private care They argued that a national healthcare financing scheme that increased investment in public hospitals will thus automatically lead to a lowering of fees in the private hospitals thus greatly reducing total healthcare spending for the whole country. To seriously reduce national healthcare spending, the government must develop a financing scheme to increase public hospital investment and improve its service, they said. How can the setting up of a private corporation to act as an insurance company cum MCO (Managed Care Organisation) reduce overall health spending? Have not hospital bills in the private sector escalated with increasing health insurance and middle-man MCOs? In no other country in the world has the government started a financing scheme for outpatient clinics before dealing with the more expensive and more important problem of hospitalisation cost, they added. They said workers would take home a smaller income since an increasing portion of their salary would be deducted, while business costs would rise since employers would be forced to contribute to the operation of the private insuring company. The poor must not end up the big loser as we saw recently when the Private Healthcare Act was used to close down charity dialysis centres. It is our duty as responsible citizens to try to look after the sick irrespective of income level. Since the government derives its revenue from all tax-payers, it must not seek to profit from its activities, but develop a system to protect the health of all, especially those unable to pay for their own needs, they said. It is understood that the Health Ministry has been quietly consulting those in the industry, including the Malaysian Medical Association on the scheme. 1 Care for 1 Malaysia sounds like a very good slogan but behind this impressive slogan and all the controversies, rhetoric, claims and counter claims lies a very big and fundamental question of where is the funding of such a massive overhaul of our healthcare system going to come from?

We know that the basic principle of part-government and part-public funding underlies this concept and the reason behind this shift of funding policy is the ever-escalating health costs which the government cannot continue to provide funding for indefinitely. Let me quote two very important facts. 1) According to the 2012 Budget that was announced by our prime minister, the allocation for health totals RM1.8 billion, which is equivalent to 3.7 per cent of the total budget. There were other ministries that have higher budget, notable ones being the Ministry of Defence. The World Health Organisation recommends that at least five to six per cent of a total budget be allocated to health. Many other countries allocate up to seven to eight per cent. Malaysia is way below that mark. 2) A recent quote by the Minister in the Prime Ministers Department, Datuk Seri Idris Jala, as published in The Star on February 19 is as follows I am of the view that we must introduce the GST. We have 28 million people but only one million are paying tax. My questions to the ruling government are as follows. 1) Since Malaysias health allocation is still way below the WHO recommendations and that many other countries have much higher contributions, is it justifiable at this point to claim that we cannot continue to fund our healthcare system when many other countries are funding theirs at a much higher rate? 2) Even if this inability to fund the healthcare system is inevitable, wouldnt it be prudent to cut costs first by running the system more efficiently, multitasking staff rather than having one staff for each and every task, preventing leakages and unnecessary wastage of medicine, resources etc and only finally if all this is done, then sources of other funding such as from the public are considered as any basic financial course will have taught us. 3) If only one million Malaysians are paying tax, how is it mathematically possible for the one million to support the healthcare bill of 28 million? How can the other 27 million contribute to the fund, when they are not even eligible to pay tax? Even if they are supposed to contribute to the fund, how much as total percentage will come from the 27 million? Inevitably, the governments bill will still be substantially higher than what it is today considering that a big portion of this general fund will obviously go to the third party who will be tasked with running this massive system. These are fundamental questions that need to be answered before such a scheme can even be considered in finer detail. PETALING JAYA: Former premier, Dr Mahathir Mohamads, defence of the proposed 1Care healthcare system as a means to counter the rising cost of healthcare has come as no surprise to the Citizens Healthcare Coalition (CHC). Mahathir had said that the government could no longer support the countrys current healthcare costs alone and that the need for contribution towards healthcare could be valid. But CHC representative, Dr T Jayabalan, said that Mahathirs comments were to be expected as he was the architect of healthcare reforms in 1983. By 1994 the pharmaceutical services were privatised, but with the government being a stakeholder, he said in a statement. With the privatisation came a 15-year monopoly for pharmaceutical supplies to the government health facilities by Pharmaniaga. It was a closed tender and this disallowed competition. An online news report had earlier noted that 1Care aims to place private medicine under government control, a step further than Dr Mahathir Mohamads sweeping health privatisation upheavals in the 1980s that delivered a hefty windfall to Umnos partners, including Dr Mahathirs son Mokhzani. Jayabalan stated that privatisation had caused the prices of generics to sky-rocket, subsequently denying the underprivileged and the less fortunate access to medicines. He added that the privatisation process had also involved co-payment by the patient wherein the patient had to purchase essential drugs and devices that were expensive and not in the inventory. A study by researchers from Universiti Sains Malaysia (USM) in 2008 on pre and post privatisation prices of drugs showed a price increase of 10.42% from 1995-1996 compared to the pre-privatisation price, Jayabalan quoted. There was also a massive price increase of 64.04% in the prices of drugs from 2001-2003. The study also indicated that drug prices dont match the inflation rate or the Consumer Price Index (CPI). Poor cant afford IJN Jayabalan used the National Heart Institute (IJN) as an example, saying that its corporatisation made it the costliest specialists centres in the country where the poor wait for about two years for treatment while the rich are allowed to schedule overnight surgeries. This is what privatisation does and we can credit Mahathir for this dismal state of affairs, he said.

It is a warped argument to suggest that rising costs of pharmaceuticals has made healthcare unsustainable since the government only spent 2% of its annual gross domestic product (GDP) on healthcare over the last 13 years. Jayabalan called the privatisation of healthcare a great disservice to the people as up to 70% of Malaysians are dependent on public facilities. Healthcare is a public good and should not be made to fit into a market system, he asserted. 1Care has sparked outrage from industry practitioners and consumer associations who claim that wageearners would be forced to contribute 10% of their income to a government-run insurance scheme. The new scheme however is said to provide limited benefits and force the public to fork out more money for basic healthcare. To my mind, just the administrative costs of 1Care alone (projected to be perhaps as much as 20% of the estimated 40 billion ringgit healthcare fund) will inflate healthcare expenditure. One wonders what the CEO salary of the administrative body will be! If you have separation of dispensing and consultation, the cost of GP visits will go up. If you mandate the use of specific software and hardware for use by 1Care practitioners, then the additional expenditure (plus perhaps any compulsory CME, certification etc.) will be passed on to the tax and SHI paying consumer. So will 1Care curb healthcare expenses? I sincerely doubt it. Like any other privatisation exercise in the healthcare sector implemented by the current administration so far, e.g. Fomema and Pharmaniaga, we have only seen increased costs, not cost saving.