— David KL Quek
The Malaysian Insider
Feb 11, 2012

FEB 11 — Why the need for Health Reform now?

This is the question that has been posed by many people. What indeed are the key reasons for the government to embark on such a radical transformation of our health system? There is no easy answer. But I would venture some socio-economic and health economic possibilities.1

Although one cannot discount or exclude political reasons or even patronage-linked considerations, I would not wish to embark on this line of speculation, because essentially this would only detract from the real issues at hand. Also, it would be hard to prove what are at best, innuendoes and almost surely shaped by partisan motives and beliefs. But it would also certainly be impossible to allay public fears and anxieties that these sorts of political interjections might play a role in any government policy makeovers. So perhaps, these possibilities should at least be highlighted so that they might be forewarned and prevented from hijacking such a monumental policy shift for personal or partisan reasons.

Major reasons for this proposed health reform are: widening public-private disparity in healthcare delivery; attempt to slow down rising healthcare costs; government policy shift to reduce health care subsidy; implementing W.H.O. mandate to provide so-called universal coverage for health; social health insurance to tap into another copayment mechanism for healthcare payment; and forming an autonomous national health authority. Read the rest of this entry »

— David KL Quek
The Malaysian Insider
Feb 10, 2012

FEB 10 — Out-of-Pocket and Catastrophic Payments

So what is so terrible about out-of-pocket (OOP) payments for healthcare? Why are health economists and policymakers so enamoured with this unsavoury OOP payment that this healthcare financing mechanism has been universally targeted to be eradicated, or at least reduced?

Many health authorities from the WHO and World Bank have analysed this in great detail, taking into account especially poor countries around the world, including those in Asia, Africa, Central and South America. Malaysia too has been included in many multi-country analyses to ascertain if common themes and determinants are shared within the disparate health systems in the regions.

When one looks at poverty levels and unequal economic systems, the health determinant as a function of economic underdevelopment and social aberration unfortunately looms large in some really poor nations. While poverty per se cannot all be attributed to just ill health or the lack of access to proper health care, impoverishment as a result of quests for healthcare has been a classic example of what poor countries are doing wrong. Read the rest of this entry »

— David Quek
The Malaysian Insider
Feb 09, 2012

FEB 9 — Ability-to-pay model in healthcare financing

Ability-to-pay encompasses the concept that people or households would choose an economic activity or service according to their capacity to afford such an activity based on their perceived hierarchy of needs, and also what goods or services to give up or sacrifice.

If healthcare or medical services are priced too high and are perceived as too unaffordable, health care considerations might be placed under such a low hierarchy of needs that it could be sacrificed for more urgent day-to-day needs and essentials.

That is why most countries around the world, if not all, offer a basic basket of health services (safe clean water supply and sanitation, childhood vaccinations, preventive child-maternal health services, etc), which are not taxed and are freely accessible to all, without the need to consider affordability or ability-to-pay. Thus, there is no question of having to consider these basic health services as an economic sacrifice for all income groups. The question arises as to how big or wide a basket of such health services, any country can afford to provide, without the need to impose co-payment mechanisms or additional taxes. Read the rest of this entry »

— The Black Cactus
The Malaysian Insider
Feb 08, 2012

FEB 8 — In the last few weeks, there has been immense debate on the proposed national health scheme dubbed 1 Care in both the internet and the mainstream media. A collective conclusion shared by both the public and the very professionals alike (who play a major role in the system) is the uncanny ability to fully comprehend the confusing entity which remains an uncertainty till today.

This commentary was written to achieve the following objectives

1. To help the public understand why this system was proposed and what led to the genesis of this scheme;

2. If possible, to pressure the government to be more transparent in providing information on the 1 Care scheme to allay fears among the general public; and

3. To help the layperson understand the unaddressed policy issues but highly crucial perspectives surrounding the 1 Care scheme Read the rest of this entry »

— Dr David KL Quek
The Malaysian Insider
Feb 08, 2012

FEB 8 — 1 Care health reform phases

In the 1 Care Health Reform plan, there are four proposed phases of transformation that could take anything from 10 to 15 years (according to officials), depending on the uptake of the various phases and programmes, as well as its implementation progress.

Importantly, the Health Ministry increasingly understands that it would require general public acceptance, as well as significant consensus and (if possible) seamless buy-in from as many stakeholders as possible.

There is recognition that if the public fails to accept this in toto or in part, then there might be need to re-tweak or re-design certain aspects of the reform plans. Just how much the bureaucrats or our political masters are willing to change and adapt remains to be seen.

Therefore, it is crucial, indeed essential, that the public and interested stakeholders take an active role in providing enough input to help make this reform the one that they want. We should not simply accept a top-down programme designed by bureaucrats, and selectively enacted by policy makers. Why? Because, it would be disastrous if this reform fails or runs into the usual gaffes, just a few years down the line. Health care is simply too unforgiving and vital to fail or be subject to arbitrary social experimentation, no matter how good the intentions! Read the rest of this entry »

— David KL Quek
The Malaysian Insider
Feb 07, 2012

FEB 7 — Is the Malaysian health system really in trouble that it requires such a drastic revolutionary change? Is 1 Care for 1 Malaysia Health Reform the answer? Will this proposed radical change make our health system more efficient and effective as touted by officials?

Or, is this proposed reform too ambitious and sweeping that it could possibly lead to severe disruptions to our current health system that we are so used to?

More importantly, would this health reform plan become another government-linked corporate entity which, instead of benefiting the public, only enriches a few favoured cronies or insiders? The difference now is that this will be a humongous multibillion-ringgit exercise and the fattest cow to milk to date!

Sadly, at this juncture in time — in the name of social development, modernisation, and economic necessity even — there have been so many government-linked projects being scandalised and mired in corruption accusations and profligate leakages.

Thus, it would be foolhardy to implicitly trust the government to do the right thing despite the economic rationale or correctness, indeed despite even the most honourable intentions! We are dealing with the health choices and rights of the public, which could become severely disrupted and endangered if or when hurried reforms turn out to be another debacle of catastrophic proportions! We cannot afford a failed social experiment of this magnitude! Read the rest of this entry »

By Clara Chooi
The Malaysian Insider
Feb 02, 2012

PETALING JAYA, Feb 2 – The newly-formed Citizens’ Healthcare Coalition (CHC) came out for the first time today to demand the government shelve its proposed “1 Care” insurance scheme, warning that its implementation would spell “disaster” for Malaysia’s healthcare system.

The pact insisted that the present two-tiered model was superior to “1 Care”, which it predicted would only turn healthcare management into a “business”.

“We believe the (current) Malaysian model is superior for the Malaysian environment. We do not want healthcare to be turned into a business.

“We believe there should be both public and private sectors – public as a service-oriented model and private as a corporate model… it is not possible for a service sector model to be corporatised,” Federation of Private Medical Practitioners Associations of Malaysia (FPMPAM) president Dr Steven Chow said during CHC’s maiden media briefing at the Global Business and Convention Centre here this evening.

According to CHC, “1 Care” is a new national healthcare system that will force all households to surrender nearly 10 per cent of their monthly household incomes as contribution to a government-run Social Healthcare Insurance (SHI) scheme.

The group insists that the scheme would not achieve its objective to provide equitable access to healthcare for all segments of society and would only increase costs. Read the rest of this entry »

By DrNGSC

1. The government plans to introduce a new healthcare system called 1-Care. It includes an insurance system to fund for healthcare.
    

2. The National Healthcare Financing Authority will be in charge of 1Care – and it is likely to be turned into a GLC.
    

3. Based on available information, every household will be made to pay up to 9.4% of gross household income for social health insurance. The payers will be the individual, the employer and the government via taxes, exact proportion still being worked out)
    

4. There shall be no choice. Everyone has to pay. There is no opting out. We have to pay upfront. It will no longer be fee-for-service; it is fee-before- service.
    

5. There has been no information on exactly how this payment will have to be made or how the government will collect from self-employed people.
     Read the rest of this entry »

Dr Ng Swee Choon | Dec 24, 2011
Malaysiakini

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. Read the rest of this entry »