Wednesday, February 01, 2012

Cashing In On People's Interest

Another bone of contention has surfaced, this time hitting at every Malaysian because we all get sick at one time or another and at least once in a lifetime we get hospitalized. The painful issue is of course HEALTHCARE and the government now plans to introduce a new scheme called 1Care. Notice how unimaginative the government has become or how boring, every scheme it started in the last 2 years or so have bandwagoned on the 1Malaysia concept. 1 this 1 that. THIS report shows how frustrated and helpless we are becoming in the light of a new plan to increase the cost of healthcare.

Days ago I received the below report. I don't know how accurate it explains the scheme but the main concern is cost and service. The public must have access to public forums to understand the impact this scheme have on them. Healthcare has long being the domain of welfare services by the government but slowly but surely it has become commercialized until it shows that the government really does not care about the well being of the average Malaysian. My questions are: must we have to take this path to buy medical insurance to have our illnesses treated? Must we put a burden on those who are less healthy and therefore require more frequent visits to the doctors especially specialists? Do we need to change the model we are presently using? Isn't there a better way? The government must not rush into legislating this into an Act. The biggest losers will be the poor and average income families as well as those who are prone to get sick. Have a heart.

Salient points – 1Care

1. The government plans to introduce a new healthcare system called 1Care. It includes an insurance system to fund for healthcare.

2. The National Healthcare Financing Authority will be in charge of 1Care – and it is likely to be turned into a GLC.

3. Based on available information, every household will be made to pay up to 9.4% of gross household income for social health insurance. The payers will be the individual, the employer and the government via taxes, exact proportion still being worked out.

4. There shall be no choice. Everyone has to pay. There is no opting out. We have to pay upfront. It will no longer be fee-for-service; it is fee-before-service.

5. There has been no information on exactly how this payment will have to be made or how the government will collect from self-employed people.

6. The government will be expected to contribute to the insurance premiums of government pensioners, civil servants and five dependants.

7. But the problem is: 1Care does not cover all your medical expenses. Only for a prescribed basic list of what “you can have” healthcare items. Anything more than basic you will have to pay your own.

8. Your long-serving independent family doctor will have to join the system or will not be allowed to see you under the 1Care scheme. The robust, cost-effective independent clinics serving the country will be replaced by 1Care clinics.

9. You cannot pick your own doctor. 1Care will allocate a doctor to you.

10. If you want to see a doctor of your choice, you’ll need to pay for that from your own pocket. Your allocated doctor will decide when and which specialist you can see if the need arises (a process called gate-keeping).

11. The NHFA will pay GPs RM60 (present proposal) for each patient as consultation fees. It does not include medicine. Compare this with presently, for cough and cold visit, the GP would charge RM20-RM30 for consultation and medicine. With 1Care: consultation for GP visit is RM60 and this does not include medicine.

12. You cannot see your doctor as and when you feel the need arises. There will be a rationing system in place as well. There will also be rationing for specialist care with the GP as the gate-keeper. Likewise if you wish to see the specialist of your choice or go to a hospital of your choice, unless referred by your allocated doctor, you will also have to pay out of your pocket.

13. Even if you only see the doctor once in a year, you will not get a refund from 1Care. Your medical costs are prepaid in advance irrespective of whether you become sick or not. You are also expected to make an additional co-payment for your visit. This is to discourage you from seeing doctors too often.

14. You will be prescribed only medicines from a standardised list of not-the-original medicines in keeping with WHO List of essential medications. This will save cost for 1Care and maximise profit for the insurance companies. Insurance companies will have major say in the price and the range of this standardized medicine list. It will likely to be the cheapest medicine.

15. The doctor will only give you injections. You’ll need to get all other medicines from a pharmacist, even if it means hauling three sick children with high fever along a hot, dusty busy street looking for the nearest pharmacy.

16. If you do not like what is given to you, you can get alternative care by paying out of your own pocket.

The Big Picture

  • Each year, we all pay a total of RM44.24 billion a year for healthcare – now called National Healthcare Hospitals and clinics (an integration of public hospitals and clinics, private hospitals and private GPs. which in essence is a privatisation of public and nationalisation of private healthcare facilities)
  • All this will now go under 1Care.
  • This means 1Care will get almost RM45 billion a year.
  • The administrative cost is likely to be 10% or about RM 4.5 billion

The Poor

Who will then care for the poor and the marginalised population when the private and public healthcare corporatize and turned into independent commercial entities each competing with the other for business and profits?

  • Public hospitals and clinics are service-driven will become corporatize/privatise and have to be profit-driven
  • So who will serve the people in remote places?
  • Who will serve the very poor people?


What happens when the government introduces 1Care?

The whole system of independent one-stop GPs will be restructured and converted into 1Care clinics like the UK NHS general practitioner system.


Ali has always having skin rashes for many years. He has to see his doctor once a month to get treatment. That would mean he will have to see his doctor 12 times a year just for this illness. What if he has other illnesses?


But now, Ali’s doctor has allocated only a budget equivalent to six visits a year. Regardless of how many time Ali would need for his yearly treatment. What happens then? A rationing system will kick in. If the doctor sees Ali too many time, his “P4P” (Pay for Performance) profile will be poor and he will be paid less.

To start with, Ali will probably cannot just walk in and expect to be treated. He will have to make an appointment. There will be a long waiting list. What if Ali needs to be treated for fever or some painful joints? He will also have to wait for his appointment. If he cannot wait and wants immediate treatment from another doctor he will have to pay on his own. This is what the NHS UK system is offering its patients.

Lim has an appointment to see his doctor over a knee ache. Just before his appointment, he has an ingrown toe nail that has become painful. At the clinic, after his doctor treats him for his knee ache, he asks his doctor if he could look into his ingrown nail. His doctor says “No, the system does not allow me to do that. You must make another appointment. This visit I can only treat and bill for your knee ache. 1Care will accuse me of over-servicing my patients. I have no discretion here, all is by SOPs” This is what the NHS UK system is like today.

Mutu lives in a remote rubber estate. One day he had chest pain and went to the nearby 1Care clinic. He has blood pressure problems since young and has had fits. A hospital assistant saw him. Because of a change of his medications to the cheapest not-the-original medications, his blood pressure went out of control and his seizures returned. He developed a fatal stroke and died This is already what is happening when essential original medications are replaced with the cheapest .The cheapest medications is not necessarily the best for the patient and certainly not the safest.

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