Friday, March 12, 2010

What's Wrong with Our Health Care System?



The most frequent complaint of public hospitals is the long waiting list. Do you know that the Ministry of Health (MOH) has introduced the Full Paying Patient (FPP) scheme in 4 public hospitals in Malaysia. They are the Hospital Sultan Bahiyah in Alor Setar, Hospital Serdang and Hospital Sg. Buloh in Selangor and Hospital Sultan Ismail in Johor. This will be expanded to more hospitals soon. The FPP scheme allows doctors in government service to charge full fees to those patients who can afford it. Where do the lower income group, the Government servants and retirees go to get subsidized specialist treatment? Will they be pushed behind the line of the FPP queue? What will this do to the already long waiting list to see a government specialist?

Are you paying up to RM3000 in medical insurance every year and still have the nagging fear that this may not be enough cover when you need it most? The MOH has approved 43 new health tourism licenses to private hospitals. Medical centres are buying and trying to outdo each other in buying expensive high tech equipment. Private hospitals are adding more and more frills to their services. There is a lack of control by the authorities in the hospital charges. Will private health care be out of the reach of most locals and only affordable to the rich medical tourists?
What do you know about the 1Malaysia Clinic and its impact to you? The MOH has announced that 50 1Malaysia Clinics will be set up in some urban areas. These will be manned by hospitals assistants and nurses. What is the scope and depth of diagnosis at these clinics? Will you visit these clinics if you are running a fever or some other ailment? Are these 1Malaysia Clinics another one of those 1Malaysia Whatever that keeps coming up every other month?

Not everyone is using public health care. But at the rate private health care costs are escalating, the day of affordable private health care may be out of reach of many people very soon. Come to this forum and find out what’s ailing our health care system.

HEALTH FOR ALL ( WHO declaration)

In 1977, the World Health Assembly decided that the major social goal of governments and WHO should be the attainment by all people of the world by the year 2000 of a level of health that would permit them to lead a socially and economically productive life.

In 1981, the Assembly unanimously adopted the Global Strategy for Health for All by the Year 2000. This was the birth of the “Health for All” movement.

“Health for All” does not mean an end to disease and disability, or that doctors and nurses will care for everyone. It means that resources for health are evenly distributed and that essential healthcare is accessible to everyone.

It also means that health begins at home, in schools, as well as the workplace, and that people use better approaches for preventing means that people recognise that ill health is not inevitable and that they can shape their own lives and those of their families from the avoidable burden of disease. 

By Masterwordsmith

In the past, Malaysia had a health care system that we were proud of but today, it is altogether a different story because our health care system has transformed into a buoyant dual-tiered parallel system, with a sizable and thriving private sector. To date, there is no system whereby every citizen has universal access to a unified system of health care. Ideally, the public sector caters to the bulk of the population (about 65%), but the sad truth is that only 45% of all registered doctors, and 25-30% of specialists serve in the public sector.

From the economic viewpoint, health care is a merit good that an individual or society should have on the basis of some concept of need, rather than ability and willingness to pay. However, current trends show that one day, there could be an eventual corporatization of the public sector facilities and services should be allowed to unfold, there could come a time when market forces dictate the price, extent and quality of the services offered.

 Photo : Recent protests against "Full-Fee Paying  Patients" scheme at Government hospitals. (photos from Parti Sosialis Malaysia website)
The tax-funded public health care sector caters for the bulk of the population (~65%), but is served by just about 45% of all registered doctors, and even fewer specialists (25-30%). The cost of these services is almost entirely borne by budget allocations from the central treasury, with patients paying paltry nominal sums for access both to outpatient clinics or admissions to hospitals.

Currently, budget allocations subsidize the public sector so patients paying only nominal fees for outpatient treatment and hospitalisation. The private sector on the other hand, has grown tremendously over the past 25 years. However, this two-tiered system with quite different goals may be unsustainable in the longer term. It is unlikely that there can be full integration of private-public health care sectors. We can hope for better partnership and collaboration of services to harness the best of each system for the health care betterment of our citizens. We should aim for a more cost-effective system. A single or easily portable system of reimbursement should also be considered. No matter what, our government must take care of the welfare of its citizens.

There are many health-care issues in our country including:
  • Long waiting list at public hospitals
  • Lack of control of charges in private hospitals
  • Lack of control of high tech medical equipment.
  • Lack of action on preventive health care
  • Level of competence of the doctors, nurses and paramedicals
If you want to know more about health care issues,  Sembang-sembang Forum is organizing a talk. Please come for the talk. You can be assured that it will be an enriching time for you.

Recommended for further reading:

Provision of Health Care to the Population: The Changing Landscape by Dr. Jeyakumar Devaraj (MP Sg. Siput)

Private wings will cripple public healthcare
by Consumers Association Penang.

The Malaysian Health Care System: A Review
by Dr. David K. L. Quek

Health For All  by World Health Organisation

Declaration on Occupational Health For All 
World Health Organization 1994


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