The Consumers Association of Penang (CAP) welcomes the news that the Ministry of Health is not going to rush ahead with any implementation of a healthcare financing scheme.
The right to good health has been recognised as a basic human right that everyone possesses. In 1978, the Alma Ata Declaration was adopted by the world community, to which Malaysia was a party. The Declaration proclaimed that by the year 2000, all peoples of the world should attain “a level of health that will permit them to lead a socially and economically productive life”.
It has been widely acknowledged that Malaysia’s health delivery system has been effective in reaching out to provide healthcare services to the most disadvantaged groups in society.
Peter Heller, a health economist from the International Monetary Fund who studied the Malaysian healthcare system, reports “the Malaysian model of health delivery may constitute an effective instrument for redistributing income in developing countries”. (Heller P.S, Sciences and Medicine, 1982)
In spite of the information that has already been released on a proposed National Health Financing Scheme (NHFS), how exactly this scheme is to be implemented still remains unclear.
CAP has already raised its concerns about some of the proposed provisions of the NHFS, but the Ministry of Health officials either have not been able to provide an answer, or in some cases, will not answer.
Instead of embarking on a new Financing Scheme and other proposed major changes to the public healthcare delivery system, CAP strongly urges that the present system of government medical services be retained in its basic form.
Some modifications can be explored and implemented to ease the strain on the Government. For instance:
- The SOCSO fund can be adjusted to support the financing of healthcare, as opposed to beginning a whole new system. SOCSO’s services can be extended to include medical care in general, and not be restricted to the treatment of industrial accidents and occupational diseases. The annual “profits” of SOCSO (which actually represents a significant subsidy to the State by workers) could thus be transferred to the Health Ministry through hospital payments.
If the existing SOCSO contributions are still insufficient, the rate of SOCSO could be raised marginally. An increase of only RM1 a month by employees plus another RM1 by employers would yield at least an extra RM200 million a year in SOCSO contributions, which could be used to finance medical treatment.
The sectors of society who do not contribute to SOCSO — the farmers, fishermen and the self-employed or the unemployed — can still be allowed to make use of Government clinics and hospitals, paying only nominal rates, with discounts, or receive free treatment based on various criteria in place.
- As for the middle income and high-income earners, they could also use the SOCSO fund to pay their medical bills. Many among them would also avail themselves of private insurance or the insurance purchased on their behalf by their employers. Thus they need not avail themselves of subsidised public medical services if they decide against it.
- Patients themselves can contribute a bit more for the use of the public healthcare system. For instance, Third Class patients should continue to be charged nominal rates for specialist and in-patient treatment. These charges can be raised slightly, where appropriate, to bring in more revenue. Those who cannot afford to pay full rates should be given discounts or, in the poorest cases, free treatment. Patients in the 2nd Class and those in the 1st Class should pay a greater percentage of the costs of treatment.
- The current charge of RM1 for outpatient treatment at Government facilities could be raised. Raising the outpatient rate to RM5 could bring in at least another RM300-400 million. This sum would also go towards financing the present healthcare system.
- Escalating drug prices can put a tremendous strain on the financial resources of the Government and the public. A National Drug Pricing Control System can be introduced which will maintain the prices of drugs in the public and private sector at a level that is reasonable, stable and affordable. The effective use of an Essential Drugs List, and the wide usage of more generic drugs as opposed to patent brands can also be encouraged and supported.
- The fees that are charged for treatment at private hospitals could be better regulated. A larger section of the population will be willing to avail themselves of services at private hospitals if the fees are more reasonable, and this will help shift some of the load from the Government healthcare services.
- The dependence on our current allopathic or modern system of medicine can be reduced by encouraging traditional practices that do not require expensive drugs or sophisticated technology with its accompanying high costs. Some measures in this area have already been implemented and this is promising. The Ministry of Health could revive the role of traditional midwives or bidan that would reduce the need for hospital births and its resultant high costs. The services of qualified tok mudins and bone-setters can also be introduced into the present healthcare system. The services of qualified practitioners in Malay, Chinese and Indian medicine should also be integrated.
- The present healthcare emphasis is more focused on medical treatment. A shift in focus on preventive measures nationwide will further reduce the financial strain on the healthcare system. For instance, accidents constitute one of the major causes of hospitals and deaths in Government hospitals. Placing more emphasis on safety measures that will reduce road accidents, occupational accidents, and improve safety in playgrounds and other areas will contribute tremendously towards alleviating the financial burden on public healthcare services.
- In response to the fact that life expectancies are increasing and it is expected that healthcare costs for the elderly, who tend to develop chronic, expensive and often, incurable diseases, will rise, the Ministry of Health could work more aggressively, together with the people, towards eliminating the root causes of diseases and laying the foundations of good health, especially in the younger generation. There is a need to advocate and implement drastic changes to improve unhealthy lifestyle practices both in the young and old.