1Care: Prioritise, not privatise patient care

Dr Ng Swee Choon | Dec 24, 2011

We refer to the letter from the Director-General, Ministry of Health: ‘Gov’t not abdicating responsibilities thru 1Care’ on Dec 17.

We fully agree with the need to improve the quality and delivery of health services for the rakyat, provide more choice to patients and preserve the strengths in our current health system.

Our pubic healthcare system has been inherited from what the British left behind but it is historically not the NHS of the UK

Over the years, Malaysia has improved its own system and adapted it to cater for our needs.

Our robust one-stop GP clinics are the backbone of our primary care system providing basic medical care for more than 60% of outpatients in the nation.

Unlike in the UK, Malaysian patients can walk in to see their GPs without appointment and be attended to in a reasonably short time.

In the UK, to see a GP requires prior appointment which can be two or three days later even if you are down with fever.

To see a specialist in the UK NHS often requires waiting time of up to two months. This is not so in Malaysia. Thus, the Malaysian healthcare system today and the NHS UK are poles apart.

However, the concept paper of reforming our Malaysian HC system (1-Care) tells us that the proposed system is a mirror image of today’s NHS which is a system that have failed to deliver and also failed to contain cost.

It has resulted in serious accessibility issues at primary and secondary care. Even the British citizens themselves are upset over the inadequacies of their system.

They are travelling to Europe and even as far as South Africa and India for treatment and surgery.

The proposed transformation will greatly affect the patients and the rakyat and we are naturally deeply concerned with its implications.

The current UK NHS itself undergoing more reforms upon previous reforms.

We have asked many times, why are we heading that way?;

•Reforms but at what cost?;

•How much will this whole 1Care for 1 Malaysia cost the rakyat?

•How will it be financed?;

•Will it mean more taxes, direct or indirect ( as in GST / VAT) ?; and,

•Will the government still be responsible for Healthcare or will it be privatized to government linked companies?

These are all important questions that must be openly addressed.

Past experiences at privatization in Malaysia have been not particularly encouraging. Naturally we are very fearful when it involved healthcare.

Representation of Stakeholders

The Federation has indeed been invited to sit in on the Technical Working Group (TWG) meetings. TWG, as the name suggests, does not deal with the big issues but on nitty gritty details.

The terms of reference TWGs involving the doctors are very limited, and deal mainly with clinical governance, how to charge and what to charge and operational issues of clinics and doctors.

The fact is that the proceedings of the TWGs will be part and parcel of the final blueprint of the proposed system which we believe has already been decided, contrary to what we are told.

Moreover, TWG meetings are often called at short ( sometimes one to two days) notice, making it virtually impossible for many to attend.

However it does give the public the impression that we were invited but did not bother to attend

On the other hand, there are also the TWGs deciding on this healthcare transformation on which conflicted stake holders like private hospital chains, pharmaceutical manufacturers, insurance companies and MCOs meet and decide on the “big money issues”.

These meetings are not privy to the patients, doctors, public and the taxpayers.

1-Care will cost more

We expect the cost of proposed reformed healthcare system to push up costs because of the increased administrative cost at the expense of patient care cost.

The 1-Care concept paper has already allocated 5% of the expected total healthcare cost of RM 44.24 billion as administrative cost.

This comes up to a whooping RM2.2 billion each year on administrative costs alone. As doctors we believe that this money should be better spent directly for patient care.

Dr Ng Swee Choon, Medical Affairs Committee Member

Federation of Private Medical Practitioners’ Associations Malaysia.

  1. #1 by Jeffrey on Sunday, 25 December 2011 - 11:44 pm

    If things are Ok don’t tinker and mess it up! We already have had (anecdotal) experience how govt hospitals often provide reasonable service for average people as compared to the higher cost of private hospitals whose benefit is availed more in favour of the well-to-do who could afford. Now you want to privatize. Why: To save cost of funding by the govt and promote economic (read profit) efficiency (for the shareholders & entrepreneurs) crony to those in power? As Dr Ng said,” past experiences at privatization in Malaysia have been not particularly encouraging” (most spectacular is PKFZ). Dr Jomo called it “piratisation” and socialization of losses….The fact is we have a rent seeking/corrupt culture yet to be cured. This affects everything beginning with which company is awarded privatization. It is not open tender.

  2. #2 by Jeffrey on Sunday, 25 December 2011 - 11:45 pm

    Then one needs an independent regulator. (In telecommunications its Multimedia Commission perceived doing govt bidding than independent). So who want regulate pricing accessibility of health care services etc independently when political cronies are awarded privatized health care services? Don’t forget the 1 Care systems requires corporatisation of public hospitals – that corporatized as usual will likely be in favour of friends of politicians who have money and support the BN! They tend to become “hybrid” ie sufficiently administratively autonomous to charge us a fee for profit and yet with enough govt interference by way of licensing to an extent sufficient to restrict competition from new entrants that will threaten the monopolistic control of the health market by political cronies!

  3. #3 by Jeffrey on Sunday, 25 December 2011 - 11:45 pm

    We get ripped off in the name high sounding name like “privatization” that just put in more tiers to cause wastage and to milk by the favoured. It’s a joke first world ideas like privatization is pushed for amid third prevailing world rent seeking/patronage culture without the underlying transparent and independent institutional/legislative controls could be installed or could operate to check and balance against profiteering and abuse by capitalists (tied up with political power) ostensibly under pretext of privatization especially in an important area like health care which is just about the only area that we rakyat can benefit a bit from the nation’s vast oil & gas revenue.

  4. #4 by Loh on Monday, 26 December 2011 - 1:17 am

    ///•Will the government still be responsible for Healthcare or will it be privatized to government linked companies?///–Dr Ng

    That is what makes 1Care. Unless health services are piratized, how else can the government enrich the cronies of the powers-that-be in the name of providing health services? The people might still be able to visit doctors and pay no charges, but the hospitals and piratized clinics would be able to claim exorbitant health service charges from government.

    The five percent administrative costs would be to support the people who are now employed by the Health Ministry. Surely there are medical graduates styled as doctors who would be better for the patients and for themselves to stay as administrators.

  5. #5 by Jeffrey on Monday, 26 December 2011 - 2:40 am

    ///Unless health services are piratized, how else can the government enrich the cronies of the powers-that-be in the name of providing health services?///-Loh The public have every reason to be wary of Privatisation. Its record has not been good. It is an expedient cloak for corruption. Firstly, it has a good packaging. It is always carried out in name of reform and public interest – supposedly enhancing economic efficiency on the assumption that private commercial interests will always meet rigorous accounting and budgetary standards than state enterprises run by bureaucrats. This a mere assumption. Because when one transfers and shifts state assets to private individuals it is so easy to shift/transfer them to private interests linked to politicians for round tripping, especially when there is difficulty in determining the market value of state assets – here’s there’s a margin to arbitrage- and they are transferred without competitive bidding (bids are generally confidential and protected by Official Secrets Act). They are also not necessarily, in beginning stages, (until they eventually become public listed companies subject to Security Commission valuation and Bursa’s listing rules) subject to rigorous corporate governance .

  6. #6 by Jeffrey on Monday, 26 December 2011 - 2:41 am

    There is no independent watchdog of the privatized entity from stakeholders. As always, its government’s institution (like the case of telecommunications, its MMC) that monitor. The power to make the final decision usually still lies in the hands of an individual minister in charge of that area! The avowed object of meeting market standards is contradicted by licensing requirements that keep out politically unconnected competitors. The private favoured interests may eventually become public, when they want to exit by inviting public subscriptions but that’s later on. Privatisation then is only as good as the political economic environment in which it exists. If the political culture were feudal, patronage based and corrupt then there will not be independent infrastructure and bodies to check and balance and privatization becomes the best excuse/pretext for the powerful and connected to enrich out of public monies, whether from transfer of assets, pricing, or bailouts.

  7. #7 by monsterball on Monday, 26 December 2011 - 5:59 am

    When you have a government for decades governing the country with double standards…nothing is equal to all Malaysians to them.
    Under Mahathir….he showed UMNO b king pins how to twist and turn….programming all Muslims…how much they will loose this and that… fooling his own race….divert attentions and steal RM100 billion.
    Now vast majority Malays know they have been conned by Mahathir…..but the show must go on.
    Do not expect any sincerity from these cunning crooks.

  8. #8 by yhsiew on Monday, 26 December 2011 - 7:17 am

    The opposition should scrutinize the government so that it does not turn 1care into no-care!

  9. #9 by k1980 on Monday, 26 December 2011 - 8:25 am

    After 1-Care, jibbi will introduce 1-Liwat

  10. #10 by sotong on Monday, 26 December 2011 - 9:27 am

    As long as few people can make a lot of money….everything OK!

  11. #11 by monsterball on Monday, 26 December 2011 - 9:33 am

    Every Malaysians that cares..do not care two hoots whether Najib cares or don’t care.
    It is good PR leaders are watching every step he makes that he can don’t care .but not go overboard with careless…reckless plans to upset caring and sharing Malaysians peaceful life…over and over again.
    First PM…running away from Christmas celebration…shows how much he cares for the opportunity to see his “1Malaysia” mean anything.
    Najib is the biggest liar and hypocrite compared to all previous PMs.

  12. #12 by undertaker888 on Monday, 26 December 2011 - 9:52 am

    The corrupted tentacles of umno and bn are reaching far and wide. Public healthcare will not be spared. The cost will finally balloon to reach the scale of pkfz magnitude.

    1care? Do you think they care? At the end it will be Icareformypocketsthananythingelse.

  13. #13 by Winston on Monday, 26 December 2011 - 11:27 am

    I understand that the worst part of the NHS system in UK is, not only the
    waiting time, but also the restriction of patients of a particular area to a
    specific doctor!!
    There is absolutely no choice!!
    Even if this doctor happens to be a dumb-dumb!!
    You have to accept him!
    Till death do you part!!!
    On top of that there is the time lapse from the time of making the
    appointment to the actual act of seeing him!!
    The whole thing that has been gnawing at the ruling party is that
    ever since they come to power, they never bother to improve anything for
    the people!
    Just look at how the government hospitals are run!
    Trying to park one’s car in such hospitals is enough to give one a heart attack!!
    And believe me, even so-called teaching hospitals have systems that are completely
    It’s more like a fish market than one that is fit to be such!
    Or as they say in typical Malaysian parlance, “Mana ada sytstem”.
    Or MAS!!!
    That in a nutshell, sums up everything in this country!!!
    Good country, good people but absolutely rotten central government!

  14. #14 by ENDANGERED HORNBILL on Monday, 26 December 2011 - 7:13 pm


    Ha, ha, ha….
    With UMNO it’s always been 1(one) DON’T CARE….
    ………………………………….or I DON’T CARE…………
    What difference does it make?

    Plunder, pillage, pilferage…….

  15. #15 by Loh on Monday, 26 December 2011 - 8:00 pm

    1Malaysia= one person’s Malaysia. That person is like the emperor, quite absolute in the sense that he needs to go through the game of democratic election.

    1Kedai= Kedai in support of the slogan of the citizen number one. That is the first gentleman, who is the husband of first lady.

    1Care= the care is about how to take the money when the people’s poor health becomes an excuse for making money. The system of care is to support the slogan of first gentleman.

    1xyz; xyz can stand for anything so long as it is in support of first gentleman’s efforts to play and win the democratic game.

    Soon it will be 1BN and 1UMNO since UMNO is clearly different from that UMNO formed in 1946, and now that not all 3.4 million Malays, some of whom had no choice but to sign up for memberships to share UNNO’s spoils, would agree to the lion-mouse split and most would not vote for the same. UMNO could face management buy-out.

  16. #16 by raven77 on Tuesday, 27 December 2011 - 12:15 am

    The reason the MCA, BN, MOH and this DG keep getting away literally with murder is ..because our opposition MPs in parliment dont take these things seriously and dont take serious efforts to stop this pilfering especially when it comes to healthcare…

  17. #17 by k1980 on Tuesday, 27 December 2011 - 2:08 am

    1Kedai= Kedai in support of the slogan of the citizen number one

    Remember a few months ago when that particular person needed only pay RM3.00 for a set lunch, while all other people have to pay RM6 for the same lunch. And he went round praising the restaurant for charging only RM3…..

You must be logged in to post a comment.