Skim kesihatan 1 Care, lagi taktik Najib bebankan rakyat...

Kemarahan umum meningkat terhadap cadangan "1 Care" skim penstrukturan semula sistem penjagaan kesihatan, pengkritik mendakwa ia memaksa  pekerja dan perniagaan untuk memberikan 10 peratus pendapatan bulanan mereka kepada agensi menguruskan dana kesihatan kerajaan.

Walaupun maklumat terperinci skim masih samar-samar dan pegawai-pegawai Kementerian Kesihatan menyifatkan masih "terlalu awal" untuk mengkritik, pengamal perubatan dan persatuan pengguna memboikot cadangan itu sejak Disember lalu bermula kempen "Tak Nak 1 Care", berharap Putrajaya mengkaji semula sebelum dikuatkuasa.

Menggelar diri mereka "Gabungan Membantah Penswastaan Perkhidmatan Kesihatan", kumpulan ini telah menggunakan media alternatif dengan menggunakan laman sosial Facebook, Twitter, blogs dan Youtube untuk menyebarkan maklumat tentang skim seterusbya mendapat sokongan orang ramai. 

Kumpulan ini antara lain telah membuka laman komuniti di Facebook yang dinamakan "#TakNak1Care", Twitter menggunakan akaun @taknak1care dan memuatnaik beberapa video klip di Youtube, menggesa rakyat menolak skim itu.

Usaha itu mendapat perhatian dengan cepat di Internet malah menarik perhatian Timbalan Ketua Pengarah Kesihatan (Perubatan) Datuk Dr Noor Hisham Abdullah, yang terlibat secara peribadi dalam perbincangan dengan kumpulan itu di laman Facebook.

The Malaysian Insider difahamkan skim "1 Care" dimodelkan selepas Perkhidmatan Kesihatan Kebangsaan United Kingdom (NHS), satu sistem pembiayaan penjagaan kesihatan dan telah ditekankan dalam Rancangan Malaysia ke-10 untuk Pelan Strategik Kementerian Kesihatan 2011 - 2015.

Difahamkan skim mempunyai lima fasa dan kini sudah memasuki fasa ketiga dan inisiatif penuh, perbincangan dengan doktor dan farmasi seluruh negara, akan dibentangkan kepada Kabinet pada Mac

Menurut anggota CHC, "1 Care" akan menggantikan sistem dua peringkat (awam dan swasta) penjagaan kesihatan dengan memiliki maklumat sulit hospital awan dan swasta, dengan harapan dapat memastikan ia lebih "saksama" kepada rakyat merentasi sosioekonomi.

Di bawa sistem dua peringkat, rakyat Malaysia boleh memilih rawatan di klinik swasta atau hospital dn pembayaran ditanggung sendiri atau melalui tuntutan insurans atau mendapatkan rawatan di klinik kerajaan atau hospital dan pembayaran di bawah kos minima, di bawah subsidi penjagaan kesihatan.

Melalui "1 Care", CHC berkata ia akan mewajibkan semua individu yang berpendapatan termasuk kakitangan kerajaan dan pesara, perniagaan dan menyumbang 10 peratus pendapatan mereka kepada agensi kerajaan, Skim Insurans Kesihatan Sosial (SHI) .

"Jadi sesiapa yang mampu bayar akan bayar, mana yang dikecualikan membayar seperti orang miskin dan sebagainya akan tetap mendapat faedah perubatan asas percuma yang ditawarkan di bawah skim itu. Pada asasnya mereka yang mampu akan bayar bagi mereka yang tidak boleh," kata anggota CHC.

Tetapi, selain sistem "perkhidmatan-sebelum-bayar" di bawah "1 Care", CHC juga mempersoalkan faedah penjagaan kesihatan yang terhad di bawah skim itu seperti jika seorang pesakit dirujuk kepada doktor pakar (GP); rawatan hanya enam kali sehari; rawatan hanya seorang pesakit setiap kali memberi perkhidmatan dan pembekal penjagaan kesihatan (PHCPs) dinilai di bawah Petunjuk Prestasi Utama (KPI) diberikan penalti.

"Dalam sistem ini, keuntungan PHCPs dengan mengiklan perkhidmatan SHI. Seperti semua insurans, SHI tidak meluluskan semua tuntutan. PHCPs mungkin dikenakan tindakan kerana memberi terlalu banyak perkhidmatan atau merujuk terlalu ramai pesakit ke hospital atau pakar.

"Doktor mungkin perlu kurangkan khidmat penjagaan kesihatan bagi mengelak penalti...tetapi anda tidak berhenti membayar atau bayar kurang ke SHI," dakwa kumpulan itu dalam video di Youtube.

Menjelaskan perkara ini, anggota CHC memberitahu The Malaysian Insider, "1 Care" memperuntukkan tuntutan maksimum RM360 setiap pesakit untuk GP dari SHI, dengan RM60 setiap kali rawatan.

"Dan dengan kuota-kuota KPI, GP akan cuba melengah-lengahkan dari merujuk terlalu ramai pesakit ke hospital. Sesiapa yang memerlukan rawatan segera, yang perlu ke hospital sendiri dan membayar sendiri," adu anggota itu.

 

Semasa cuba mengurangkan kebimbangan ke atas "1 Care" baru-baru ini, Dr Noor Hisham menjelaskan ia hanya "peringkat konsep" dan penstrukturan semula sistem penjagaan kesihatan negara amat diperlukan.

"Sekarang sektor awam akan membelanjakan RM16 bilion dan mendapatkan semula dua peratus. Sebaliknya kami tidak mahu membebankan rakyat tetapi melihat pelbagai pilihan dan model.

"Pada ketika ini tiada apa yang telah dipersetujui sehingga semuanya mendapat persetujuan orang ramai dan kami perlu mengkaji kos analisis. Bagaimanapun ada banyak andaian dan spekulasi dan imej buruk seperti kempen TAK NAK.

"Saya hairan dari mana mereka mendapatkan angka-angka itu tanpa disokong data substantif," katanya dalam satu respons.

Namun dakwaan CHC, ia dipercayai undang-undang baru "Akta 1 Care" dijadualkan untuk dibentangkan di Parlimen tidak lama lagi, kemungkinan pada awal Mac. CHC akan menemui pemberita untuk memberitahu mengenai perkara itu esok, disusuli Forum Awam Kesihatan Selangor-Kuala Lumpur pada 12 Februari.

The Malaysian Insider difahamkan forum itu akan dirasmikan Menteri Besar Selangor Tan Sri Khalid Ibrahim dan pegawai Kementerian Kesihatan. - Clara Chooi - malaysian insider

Desas desus cadangan Skim Penjagaan Kesihatan Nasional 1 Care yang bakal dilaksanakan kerajaan akan menyebabkan rakyat menanggung beban lebih parah, kata Naib Presiden KEADILAN, Datuk Seri Chua Jui Meng.

Ini kerana katanya, rakyat akan diminta menyumbang 10 peratus melalui potongan pendapatan mereka kepada agensi pengurus dana kesihatan yang dilantik oleh kerajaan, sekiranya skim itu menjadi kenyataan.

“Melalui skim 1Care kerajaan akan melantik satu badan yang akan menguruskan skim ini yang mempunyai kuasa pemutus menentukan kehendak rakyat,” katanya dihubungi Keadilandaily.com hari ini.

“Jangankan 10 peratus, satu peratus pun sudah cukup tinggi untuk rakyat dan ini tidak termasuk cukai GST yang bakal dikenakan pertengahan tahun ini.

“Rakyat di bawah pentadbiran Najib terus berdepan bebanan kos hidup yang tinggi kerana perlu membayar tol, minyak, bil elektrik dan air yang terus diswastakan,” tegasnya.

Berbanding dasar kesihatan sedia ada, katanya, rakyat bebas memilih samada hendak mendapatkan khidmat kesihatan dari klinik swasta atau hospital kerajaan.


“Sepatutnya kerajaan mengekalkan sistem sedia ada di mana rakyat miskin mendapat khidmat penjagaan kesihatan murah melalui hospital kerajaan manakala mereka yang memiliki sedikit kemampuan boleh ke klinik swasta sesuai dengan pendapatan mereka,” kata bekas Menteri Kesihatan ini.


Portal The Malaysian Insider hari ini melaporkan cadangan skim berkenaan, di mana rakyat yang memiliki peringkat pendapatan tertentu akan diwajibkan memberikan 10 peratus pendapatan bulanan mereka kepada agensi mengurus dana kesihatan negara.


Dilaporkan, pengamal perubatan dan persatuan pengguna memboikot cadangan itu sejak Disember tahun lalu, bermula dengan kempen ‘Tak Nak 1 Care’ dan menggesa kerajaan mengkaji semula cadangan berkenaan.


Pada 28 Mei 2010, Menteri Kesihatan, Datuk Seri Liow Tiong Lai, dilapor berkata, perdana menteri sangat teruja dengan cadangan itu, selepas beliau dimaklumkan mengenainya.


Mengulas lanjut, Jui Meng mendesak pentadbiran Najib menjelaskan skim berkenaan dengan memberikan butiran terperinci.


“Kita juga mendesak kerajaan mempelawa NGO, aktivis rakyat dan mereka yang pakar dalam bidang ini untuk berbincang sebelum apa-apa keputusan dibuat mengenainya,” tegas beliau. Keadilandaily

1Care marked by 'indecent haste'

A senior PKR leader has characterised as “indecent haste” the government’s healthcare proposal that is said to be set for promulgation amid criticism and anxiety from concerned professionals.
Dr Tan Kee Kwong, head of the party’s disciplinary panel and likely candidate for the Wangsa Maju parliamentary seat in the Federal Territory, said:

“For a measure this huge and in a sector (healthcare) this important, the government’s approach is characterised by indecent haste and a lack of public consultation.

“Good healthcare is a citizen’s right which makes any measure impacting that right the concern of everyone. This would make the lack of consultation and transparency concerning the government’s contemplated measure a source of grave concern to the people.”

Tan said details about the government’s healthcare proposal, called 1Care, requiring
individuals to pay 10 percent of their annual income towards the scheme make the costs “onerous” especially when the payee is restricted to six visits a year to the doctor.

“Ten percent is not a small amount for an individual to fork out and when you are restricted to only six visits a year that makes things lopsided because no normal person wants to visit the doctor unless he or she is really sick.

“A person who is ill may be required to see the doctor several times a year. The restriction at six visits is arbitrary and may turn out to be gravely limiting.”

Tan, who was a deputy minister in the BN government as an elected MP for the Gerakan component of the ruling coalition, said that he had, intermittently, been part of the long drawn and discursive process in which a national healthcare proposal has germinated in the bowels of government.

Part of government study groups

He said he had been part of government study groups that have gone to many countries in the world to study various healthcare systems.

“The one that is now about to emanate from the government is said to involve a combination of the public and private sectors but the costs to the citizen and the proposed limitations on frequency of medical attention for the payee suggest the project is weighted in favour of the provider than the recipient.

“This would deprecate the right of citizens to healthcare and would tilt the emphasis in favour of profit to the provider,” commented Tan.

He envisaged that in its approach to healthcare, a Pakatan government would weigh the balance in favour of the recipient of healthcare rather than the provider.


“Details proposed by the ruling government that a certain percentage of the gross annual payment by individuals would go to a middleman managing the system are a recipe for bureaucratic bloat and profiteering,” said Tan.


He said the government should submit its proposals to broad consultation with the public and with healthcare professionals.


Tan remarked that initial details of the government’s proposed scheme have issued in a perversion of the Najib Razak administration’s vaunted slogan of ‘1Malaysia - People First, Performance Now’ into ‘1Care - Formulation First, Consultation Last’.- malaysiakini

Docs reject 1Care scheme, healthcare not a business

Healthcare is not a business to derive profits, medical practitioners and a non-governmental group have warned, and they want the government to review its proposed 1Care for 1Malaysia scheme.
The Citizens’ Healthcare Coalition (CHC), together with the Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM), denounced the health ministry’s initiative to implement this national insurance-based system to fund healthcare.


“1Care does not address existing problems and issues and it will be detrimental to the well-being of consumers.

“In this scheme of things - the outsourcing of services - they want to outsource healthcare as well,” CHC spokesperson Dr T Jayabalan (left) said at a media briefing in Kuala Lumpur yesterday.

“They call it a social insurance scheme but there is nothing ‘social’ about it. If it concerns the people, why weren’t consumer groups invited for discussions on the matter?” Jayabalan asked.

In taking steps for the plan to be scrapped, CHC and FPMPAM are moving fast to inform their members about the 1Care scheme and for them to educate their patients, as well as conduct forums and dialogues in the various states of the country.

“For every attempt they have made, the rakyat and the relevant groups, such as consumer associations, have put the brakes... but this time, things are being done stealthily,” said Jayabalan, a veteran public health consultant.

Speculation is rife that initiatives are being taken to table a bill at the March sitting of parliament, to moot a national healthcare financing authority (NHFA) in the hope of  “ensuring healthcare is accessible to all Malaysians” across all socio-economic status.

CHC has generated an online campaign on Facebook and Twitter, asking Malaysians to reject 1Care, which will not only be expensive as every employed individual will have to contribute as much as 10 percent of his or her monthly income to the NHFA for basic healthcare, but will also be restrictive in the options offered to those requiring healthcare.

However, this is not the view of the government, which first proposed such a scheme under the Fourth Malaysia Plan (1981-1985), before reviving it as 1Care a couple of years ago.

According to a concept paper available on the CHC Facebook page, 1Care was mooted under the 10th Malaysia Plan as the health ministry’s 2011-2015 strategic plan, similar to Britain's National Healthcare Service (NHS).

Healthcare is welfare

Jayabalan said the government has already began rolling out 1Care with a plan to corporatise the Malaysian Medical Council (MMC) when parliament sits in March. He said speculation was rife about the tabling of a Pharmacy Bill, “and this is where the separation starts... the tactic is to divide the people... it is the best way to push things through”.

 It is understood that the four-phase scheme has already been put into place, with the full scheme due to be presented to the cabinet by March, after the authorities engage with doctors and pharmacists nationwide.

“It’s just like every other past restructuring exercise, such as the corporatisation of the National Heart Institute (IJN) a couple of years ago. They promised efficiency, so there is no waiting time in IJN now? Those who can’t pay upfront have to wait for years,” Jayabalan said.       

“If the government is thinking about welfare - what’s welfare? It is not doling out from your pocket. Welfare is social in nature and it is the duty of the government to provide this service.”

FPMPAM president Dr Steven Chow (right) said instead of revamping the entire healthcare structure, the government should just address the weaknesses, such as improving better access to healthcare.Chow said the government should emulate the example of Hong Kong, which encouraged public interaction when it proposed setting up a voluntary medical insurance scheme.

“This country is headed for disaster if it abandons the current system for 1Care,” Jayabalan added. - malaysiakini


 Public forum on govt’s plans next week

Sunday, 12 February 2012 (4.00pm–6.30pm)

Sunflower Room, Global Business & Convention Centre

No.8 Jalan 19/1, Section 19, 46300 Petaling Jaya

Organised by Citizens’ Healthcare Coalition.

Officiated by Selangor MB. Khalid Ibrahim. 

Speakers: Health ministry official, Selangor executive councillor for health Dr Xavier Jayakumar, private practitioner Dr. Ng Swee Choon, Penang consumer and health activist Dr. T Jayabalan. Moderator: lawyer Philip Koh Tong Ngee

cheers.