1Malaysia:1Care:1Scary:1Brutal...

While Malaysia's healthcare system has earned praise for being affordable, the government is taking another shot at revamping the system in anticipation of rising costs and patient demands.

Those who have watched Sicko - a Michael Moore documentary on the flaws of the billion dollar US healthcare industry - would, however, be wary of such a move.

"It is the most disastrous system in the world where at least 14 to 15 million people are not insured, and when you are not insured, it means you will be pauperised in the event you are sick.

"You will have to get into a charity based hospital which will also ration out healthcare to you as much as they can," said Dr T Jayabalan, the spokesperson for Citizens' Healthcare Coalition (CHC).

Jayabalan ( right), who has been a public health consultant and consumer advocate for the past 30 years, observed that such schemes implemented around the globe have drastically affected the lives of those without comprehensive financial protection.

First mooted in the Fourth Malaysia Plan (1981-1985), the health insurance scheme blueprint has been revived and repackaged as "1Care for 1Malaysia" under Prime Minister Najib Abdul Razak in 2009 to trim public hospital funding.

Supposedly modelled after Britain's National Health Service (NHS), the 1Care scheme is to replace the current two-tier healthcare system, with one that integrates both private and government medical institutions, in hopes of "ensuring healthcare is accessible to all Malaysians" across the socioeconomic strata.

The 1Care scheme will be managed by the National Healthcare Financing Authority (NHFA) and includes an insurance-like funding system.
 
Universal coverage for healthcare

It will be compulsory for individuals to contribute about 10 percent of their household incomes to the scheme, although it only offers selected public health services, said Jayabalan, who used to be invited to past consultation processes.

The Health Ministry justifies 1Care, on the grounds that a restructured national health system would be "responsive, provide choice of quality healthcare and ensure universal coverage for healthcare needs of population based on solidarity and equity".

But Jayabalan, recounting experiences with "restructuring" schemes in the past, fears that 1Care will deliberately result in the escalation of costs to the people and the outsourcing of contracts to those with vested interests - financed by public funds.

"The whole move is to create an authority, and you know how these government-linked companies will be. They will be a source of funding and then a whole hierarchy of bureaucracy (will be created) and paid by people like us," said Jayabalan, who is also the occupational safety and health consultant at Universiti Sains Malaysia.

"Out of the 70 percent who access healthcare, 90 percent are from rural areas and they have no definite income. They are the ones who will be affected the most," he said.

Under the present system, patients who do not want or cannot afford private healthcare can opt for medical treatment at government clinics or hospitals, where they only have to pay a nominal fee for basic and specialised healthcare as it is subsidised by the government.

Last week, the Health Ministry assured critics that the 1Care scheme will not burden the public with undue costs, adding that discussion on the financial arrangements and its impact on the government and taxpayers were ongoing.

"Any conjecture regarding the financial impact on the individual taxpayer is premature at this stage, as discussions are being held at to ensure a positive and workable model," director-general of the ministry, Dr Hasan Abdul Rahman had said.

But if the government had wanted to do something good, Jayabalan argued, consumer groups and the public would have been consulted.

"There was minimal consultation...everything was done stealthily. This time around they are pushing for it at all costs," he said.
 

NHS an agent of destruction

The NHS model from which 1Care is fashioned, is also becoming regressive, added Jayabalan, as an internal market has emerged to take a dominant role in the one-time socialised system.

He said when private initiative was introduced into the NHS, costs have escalated, the comprehensiveness of the NHS has been in crisis, and the equity - the rights of the infirmed and the old - have been denied or destroyed.
 
"Introducing a system like that is asking for trouble because it has been proven that the healthcare costs have been escalating in the UK. If the idea is to keep costs down, then how do you resolve the contradiction? he asked.

But is the government really paying too much for healthcare?

Policymakers, he said, tend to view healthcare as a commodity to be sold for profit, he said, hence further subsidies are often regarded as a loss to the country's revenue.

"Like education, health care is a social good," he said, adding that the government should be prepared to provide healthcare for the people.

He said while our system is not the best, it is pragmatic and coping well and not "bursting at the seams" as claimed.

"(The government) is not really burdened, we have had a very good outcome - our life expectancy has improved, our infant mortality rate reduced - these are good statistics, there are numbers that show that we have a reasonably good system.

Malaysia's total health expenditure for 2009 was approximately RM33.7 billion, a discernible increase from RM31.87 billion in 2008, reports World Health Organisation's (WHO) National Health Accounts.

According to the Economic Intelligence Unit (EIU)'s 2011 report, the private sector is paying more today at 50 percent for the total healthcare expenditure compared with 24 percent in 1985.

Although the report attributed the spike partly to medical tourism, it pointed to the lack of a compulsory national health insurance plan as a contributing factor.

"The public sector accounts for some 45 percent of total healthcare expenditure, and we expect this proportion to remain the same in the forecast period (until 2015)," it stated.
 
1Care is extremely brutal

These numbers indicate that patients are paying for health services from their own pockets, with total out-of-pocket spending for health in Malaysia doubling every five years.

Also, under 1Care, pharmacies will be dispensing medicine, unlike the current practice where patients are able to get their medicines from public clinics and hospitals.

Jayabalan said this was good in a sense, but pharmacies would only be allowed to dispense some medicines while those off the list will require partial payment from patients.

The same restrictions apply for medical care.

"Say....you have appendicitis and need surgery, NHFA will say (the government) will bear this much (but) complications are not covered, a long stay is not covered... that means you are only covered for that particular diagnosed related illness.

"Now what happens if there are complications? Who bears the brunt?" he asked, also foreseeing high administrative costs in the new system.

According to him, the primary healthcare doctor will have to fork out RM10,000 for compulsory accreditation, and comply with requirements such as developing an IT and record-keeping system.

"What will happen is, the doctor's worry will not be you- his worry will be complying with these requirements because they can deregister him and even criminalise, exclude and penalise the doctor," he said.

Jayabalan said the problem with such a scheme is that it makes a fundamental service like healthcare susceptible to the instability of market forces.

"1Care is extremely brutal and morally degrading and the pity is - you're introducing it as a social good. We have accessed it all this years for virtually nothing and suddenly you are introducing market imperatives," he said.-S Pathmawathy

1Care mandatory for all Malaysians

It will be mandatory for all Malaysians to be involved in the proposed “1Care for 1Malaysia” healthcare scheme. However, the government has yet to draw up its execution plan.

“For the healthcare providers it is not compulsory but for the people, it is mandatory,” said the Health Ministry’s Unit for National Health Financing (NHF) deputy director Dr Rozita Halina Hussein (right).

This, said Rozita, is to ensure the pool of contribution is at its maximum and everyone is equally covered.
 
“The government has not made any decision, or taken any move one way or the other... we are looking at various option which are available, we are looking at the best global practices and what is suitable for the country, because you cannot take wholesale,” she said.

She also clarified that the 10 percent contribution were drawn up based on average visits to the hospital and clinics for general and specialised medical care.

 1CARE diwajibkan untuk semua rakyat M'sia

Semua rakyat Malaysia akan diwajibkan menyertai cadangan skim penjagaan kesihatan '1Care for 1Malaysia'. Bagaimanapun, kerajaan masih belum merangka pelan pelaksanaannya.

"Bagi penyedia penjagaan kesihatan, ia tidak wajib tetapi untuk rakyat, ia adalah diwajibkan," kata Timbalan Pengarah Unit Pembiayaan Kesihatan Nasional  (NHF) Kementerian Kesihatan, Dr Rozita Halina Hussein.

Ini, kata dR Rozita, adalah untuk memastikan sumbangan dapat dimaksimumkan dan semua orang mendapat perlindungan yang sama rata.

source:malaysiakini

1 Care penghubung perkhidmatan kesihatan awam dan swasta

Ketua Pengarah Kesihatan Kementerian Kesihatan Malaysia (KKM), Datuk Sri Dr Hasan Abdul Rahman, berkata cadangan pelaksanaan Skim 1 Care yang mencetuskan kontroversi akan membolehkan rakyat Malaysia mendapatkan perkhidmatan kesihatan yang sama tanpa mengira pusat kesihatan kerajaan mahupun swasta.

Namun begitu, beliau tidak memberikan maklumat jelas berkenaan perkara itu, dan tidak menyatakan bahawa kebanyakan rakyat Malaysia mempunyai akses kepada pusat kesihatan swasta di bawah sistem kesihatan dua hala sekarang.

Beliau hanya menjelaskan KKM mempunyai tempoh dua tahun bagi mengemukakan blueprint dan pada masa ini, perbincangan bersama-sama 11 kumpulan teknikal sedang dibuat berkenaan blueprint tersebut, serta menegaskan cadangan berkenaan masih lagi berada di peringkat perbincangan.

Di bawah skim kerajaan-swasta sedia ada, rakyat Malaysia diberikan pilihan untuk mendapatkan rawatan sama ada di pusat kesihatan kerajaan mahupun klinik ataupun hospital swasta.

Kebanyakan syarikat sudah membiayai kos pekerja dan keluarga  mereka, untuk mendapatkan rawatan di pusat-pusat kesihatan swasta.

Dalam sesetengah kes, kerajaan juga turut membiayai kakitangan mereka bagi mendapatkan rawatan di pusat kesihatan swasta.

Namun Dr Hasan (gambar) menjelaskan dalam rancangan “Dialog” di RTM1 malam tadi, “langkah baiknya tanpa mengira perkhidmatan kerajaan mahupun swasta, rakyat mampu mendapatkan penjagaan kesihatan yang lebih baik, akses yang lebih mudah dengan kadar responsif yang tinggi”.

Beliau turut memberikan respon terhadap kritikan-kritikan yan diterima KKM berhubung cadangan pelaksanaan Skim 1 Care yang telah menimbulkan kekecohan daripada pengamal perubatan swasta dan orang ramai setelah butiran lengkap berkenaan skim tersebut disiarkan di media online sejak beberapa minggu lalu.

Pengamal perubatan awam dan swasta tidak bersetuju dengan cadangan tersebut dan mendakwa individu dan golongan peniaga akan dipaksa membayar 10 peratus daripada pendapatan kepada skim berkenaan.

Berdasarkan cadangan itu juga, setiap orang akan hanya diberikan satu doktor di kawasan mereka dan tidak dibenarkan untuk memilih. Individu juga turut akan dihadkan jumlah untuk rawatan dalam sebulan.

Pengarah Kesihatan itu turut berkata Malaysia mempunyai 600 klinik swasta, dan 813 klinik kerajaan, dengan 60 peratus pesakit memilih perkhidmatan klinik kerajaan. Bagi hospital, negara mempunyai 231 hospital swasta, manakala hospital kerajaan berjumlah 141.

Semalam, Menteri Kesihatan Datuk Seri Liow Tiong Lai berkata, cadangan berkenaan kumpulan perniagaan akan dikenakan levi 10 peratus daripada pendapatan mereka untuk dana insuran penjagaan kesihatan 1 Care akan di semak semula.

Kementerian Kesihatan turut mengadakan taklimat bersama ahli farmasi berkenaan pelan tersebut yang dilihat untuk memperbaiki sistem kesihatan sedia ada.- malaysian insider


NMNT -  In Aust, taxpayers paid 1.5% of their salary or 2.5% if they over certain tax brackets providing they don't have private health coverage. No min or max visit to the doctor and or by the way if the expendinture is more than $1500 outlay p/a from the pocket of householder/combined even...u get the money refunded. Now this is what we call real 1CARE. In M'sia i see it only as another 1SCAM. 

Dr David KL Quek - Actually the number of health-uninsured in the USA is around 42 million or around 16% of the population. The ACA or Obamacare health reform is to try and lower this to under 20 million where possible by mandating that everyone or household and/or companies purchase or co-buy some limited insurance to ensure some coverage. Also, the total healthcare spending in USA now accounts for some 16-17% of the GDP, some 2.8 to 3 trillion USD!

Hang Tuah PJ - I have medical insurance. Why should I be subjected to this. And 10% of my salary ???!!! If I earn RM10K, every month I have to pay RM1K whereas I only pay a couple of hundred for my insurance cover currently. What bullshit is this!!!!!

cheers.