Make public details of proposed health insurance scheme, urges PSM

PSM’s Dr Jeyakumar Devaraj.

KUALA LUMPUR: Parti Socialis Malaysia (PSM) wants the government to share details of the proposed health insurance scheme so that the public can discuss it and not spring a surprise by announcing it in Budget 2019.

Dr Jeyakumar Devaraj, its former MP for Sungai Siput, fears, based on news filtering through the grapevine, that the scheme being proposed by the health ministry will exacerbate some of the problems that the government healthcare system is facing.

He reminded Health Minister Dzulkefly Ahmad that his first duty was to follow the precept: “First, do no harm.”

Urging the health ministry to offer details of the scheme, Jeyakumar suggested that the government increase the federal health budget by 15% every year till it reaches 4% of gross domestic product (GDP).

It is currently only 2.1% of GDP or RM26 billion out of a GDP of RM1,273 billion.

He also suggested that the government:

* Declare a moratorium on the expansion of private hospitals. “Allow the private hospitals that exist to continue, but do not allow them to expand their bed capacity or to set up new branches. Do not approve new private hospitals for now. That will partially staunch the haemorrhaging of specialists from the government sector.”

* Create a separate Service Commission for government healthcare workers and adopt the pay scale that the National Heart Institue (IJN) is using so that the government service is more attractive for health personnel. “Also, consider the provision of three-month sabbaticals for specialists every five years of service in the government so that they can go abroad and pick up new skills.”

* Do a forensic audit on how medicines, other goods and also services are being purchased through third-party intermediates. “Many of us feel that a significant portion of the health budget is being siphoned off to private pockets through oversized contracts.”

Health insurance for B40?

Jeyakumar said information filtering through the grapevine suggested the government was thinking of taking out insurance policies for B40 families that would entitle these families to treatment worth RM10,000 per year at private hospitals.

“There are three million B40 families. Assuming a fourth of these families use this insurance in a year, the total payout would be RM7.5 billion for a year. Such a policy would be quite popular, initially at least.

“The B40 families would be happy to have the option of getting some treatment in the private hospitals without having to make an initial contribution to the scheme.

“The private hospitals would be more than delighted. They would get their marketing teams to advertise treatment plans to encourage the B40 families to use their insurance for screening, investigations and treatment that these families might not really need.

“And the insurance companies would be ecstatic if they too could get a bite at the cherry. So if everyone is going to be happy, why are people like me unhappy with this proposal?”

It was because, he said, they saw parallels to what had happened in the late 1980s.

“At that time, Tun Dr Mahathir Mohamad liberalised the healthcare system by allowing for-profit private hospitals to be set up. Prior to that, only non-profit private hospitals were allowed in Malaysia.

“The argument that Dr Mahathir used then was that the richer people should be encouraged to pay for treatment at private hospitals so that government expenditure on healthcare could be focused on the poorer half of society. Dr Mahathir cited the case of rich businessmen coming to government hospitals in their Mercedes to get highly-subsidised treatment.

“At that time, Dr Mahathir’s arguments seemed reasonable to many Malaysians. Only now can we appreciate how much that policy has damaged our public healthcare system.

“At this point in time, only 10% of the specialist doctors with more than 10 years’ experience post-specialisation remain in government service. About 90% of the experienced specialists are in the private sector, which caters for 25% of the in-patients in the country.

“This leaves 10% of the nation’s experienced specialists to handle the 75% of in-patients admitted to government hospitals. Is it any surprise then that there are delays in getting specialist treatment in government hospitals, or that mistakes occur because there are not enough specialists to adequately supervise the younger doctors?”

He said a two-tiered system of medical care had evolved in Malaysia, where the 25% who can pay, received prompt state-of-the-art treatment in private hospitals while the 75% who depended on government hospitals encountered delays, long waiting lists, difficulty in accessing senior specialists in government service and the risk of serious complications because of sub-optimal care.

“This is the direct result of the policy change introduced by Dr Mahathir. The scheme being proposed by the health minister and his deputy will exacerbate some of the problems that the government healthcare system is facing.

“The boost in demand for private healthcare by RM7.5 billion a year will accelerate the out-migration of specialist doctors from the government sector.

“This, in turn, will cause the quality of services in the government hospitals to deteriorate even further, exacerbating the crisis of confidence in government hospitals, which in turn will force even the B40 to top up the insurance that the government has initiated for them.

“This is because the RM10,000 they are to be given will not be enough to cover all the health needs of a family if a serious illness strikes.”

Over time, Jeyakumar said, the public healthcare system would get even more run down and the Malaysian public would be saddled with high health insurance payments.

“In the medium term – 10 to 15 years – the proposed insurance scheme will seriously burden the very people (the B40) who are to be the recipients of this populist handout.

“The problem with this insurance proposal, like the liberalisation policy introduced by Dr Mahathir 30 years ago, is that it does not consider the health sector holistically. Both proposals fail to appreciate that changes in the private sector will impinge on the public health sector in several ways.

“We have to seek out the potential impact of such changes and avoid making decisions that might undermine the public healthcare system of our country.”