Too many govt hands in the healthcare pie

PETALING JAYA: An academic has raised fears of a two-tier healthcare system emerging in Malaysia in which only the rich have access to good healthcare.

Citizens’ Health Initiative’s Chan Chee Khoon said such a system could come about because of the government’s stakes in commercial healthcare through government-linked companies.

Speaking to FMT, Chan said the government was now playing multiple roles in the healthcare system, as a funder, provider, regulator and investor.

Aside from its role in the public healthcare system, he said the government also owned 44 private healthcare facilities in the country through GLCs.

They include 26 owned by KPJ Healthcare Berhad, 14 by Parkway Pantai, and four by Ramsay Sime Darby.

KPJ is owned by Johor Corporation, while Parkway Pantai is a subsidiary of IHH Healthcare Berhad in which Khazanah Nasional owns a 26% stake. Ramsay Sime Darby is owned 50% by Sime Darby, in which the government owns a 66.6% stake through shares held by Permodalan Nasional Berhad, Employees’ Provident Fund and the Pensioners Retirement Fund (KWAP).

“The state is juggling multiple hats as funder and provider of public sector healthcare, as a regulator, and pre-eminent investor in for-profit healthcare,” he said, adding that the situation is rife with conflicts of interest.

“Public sector healthcare is woefully underfunded and plagued by a chronic shortage and continuing outflow of senior experienced staff.”

This, he said, affects the quality of care and its ability to restrain the increase of charges in the private sector where the senior experienced staff flock to.

Chan said Malaysians have been encouraged with income tax rebates to opt for private healthcare if they can afford it so that limited public resources can be conserved for the poor.

“This laudable intention, however, may have the unintended consequence of undermining any remaining stake that the upper middle classes have in public sector healthcare.

“This intuitively seductive but misplaced logic will hasten the arrival of a two-tier healthcare system, deluxe priority care for the rich, and a rump, underfunded public sector for the rest,” he said.

The health policy analyst says the government could introduce a more progressive tax regime to fund universal access to quality care based on need.

Galen Centre for Health and Social Policy CEO Azrul Mohd Khalib said private healthcare players were now directly competing with the public healthcare system.

“The government needs to realise this, as a large part of the double-digit medical inflation occurring in Malaysia stems from high charges imposed by private hospitals owned by GLCs.

“Ironically, the dominance of GLC players essentially imply that the government is competing with itself.”

But he said the private sector should not be seen as the enemy and be engaged as partners to ensure healthcare remains accessible and affordable to all.

For this to work, Azrul said healthcare funding needs to be reformed to widen the funding base providing affordable healthcare.

“We need to migrate to a national health insurance scheme where most of the population makes a monthly contribution to a national pool of funds similar to what you already have under Socso and EPF.

This, he said, would apply to all workers and be based on a sliding scale linked to monthly income and age.

When contacted, Deputy Health Minister Dr Lee Boon Chye said he agreed with the provision of quality universal healthcare based on “needs” as a basic principle, but noted that quality healthcare is subjective and the cost of care can be limitless.

“Furthermore there is always discrepancy on the perception of ‘needs’ between providers and patients so dissatisfaction among patients will still happen even if quality care is given.

“The provider, in this case the government, can set a standard of care but there will always be a demand for more.”

Lee said private healthcare can play a role for patients who could afford it and needed more than the standard care.

On GLCs in private healthcare, Lee said the investment decisions of GLCs was not under the ministry’s jurisdiction.

“The health ministry does not own private hospitals. We regulate all private healthcare facilities under the Private Healthcare Facilities and Services Act irrespective of whether these facilities are GLC-owned or not.”