. Letter to the Editor, STAR. 3rd Dec 2011.I read with great interest the documentary article by the DG of Health in STAR 3rd Dec 2011.It is so true,that the present Healthcare system, though good by all health outcomes standards measured, needssome improvement. Having said that it is fair to say that, the present system is good compared to someof the developed and developing countries around us.See ( Fig 1 ).Fig 1. WHO report 2007 WHO repWhat is even better was that even spending 4.75% of GDP on the Total Healthcare ( Public and Private)in 2009, we are equally good health outcomes. “Syabas” to the government and to all the Healthcareproviders. The DG stated that the government spends only 55% of the total expenditure while 45% isfrom private funding. That means that the government expenditure is only about 3% of GDP. This is farfrom the OECD average of 9.7% of GDP.There is no guarantee that transforming the whole system to an NHS-like system will improve things.Taking care of our people is to take care of our workforce, so that we have a healthy workforce toachieve vision 2020. It is absolutely vital that the government of the day give more emphasis and moremoney to provide good healthcare for a stronger workforce. WHO rep
3.00 2.50 2.00% GDP 1.50 1.00 Public HE as % GDP 0.50 Private HE as % GDP 0.00 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 YearFig 2.PUBLIC &PRIVATE HEALTH EXPENDITURE AS % OF GDP, 1997-2008. MNHA 2009From what I understandfrom the DG’s article, a few points may have been lost in translation. It isimportant to note that all health insurance system work on rationing care. The system provider have tosee which condition to re-imburse and which not to re-imburse. That means that some condition willnot be covered. That is how they cut cost. Besides choice of conditions covered, patients also lose theirchoice of consultants / specialist to take care of them. They are assigned specialist and consultants. Thatto them is cost savings.This cost cutting in turn pays for the management overhead of the insuranceproviders. Healthcare providers get more forms to fill, and the National Health Financing Authority getsmore staff to push more papers. Admin cost will surely go up commensurate with admin paperwork.Admin paperwork usually results in delay in providing care. Whether or not the National HealthFinancing Mechanism have a profit incentive or nor, remains to be seen. Basically, healthcare cost willnot go down. It will at best remain the same, and at worse go up, without improvement in health for thecountry.It is also not pointed out, that with this transformation, more money have to be collected from the“rakyat”. What the DG is saying is that the tax that we are providing now, is insufficient ( although weare only using 2.5% of government revenue on Healthcare), and so they need to collect more money
from the rakyat ( in the form of direct or indirect taxation ), to park the money in a National HealthcareFinancing Mechanism, for use in a transformed healthcare system. For the information of the public,that means to collect more taxes, to raise RM 35-40Billion dollars for the National Healthcare FinancingMechanism. Can you imagine what will happen to the RM 35-40 billion? Are you prepared to put yourmoney into a common pool, having slogged to build up your own savings? Why should one put theirmoney into a common pool and everyone draws out at your expense? This has happened in somewestern countries and the system has failed. If we really need to raise a fund for healthcare ( when theneed arises ), individual Medisave accounts where whatever you earn is yours and if you do not use it,you can leave it to your children or whoever you like, is more practical. It works better. The governmentmust always look after those who cannot afford. That is their social responsibility. They do collect taxesafterall.We, the FPMPAMfeels that the present healthcare system, though good by all outcome measures doeshave deficiencies that need to be improved and corrected. All these can be done if the government ofthe day, will increase healthcare allocation from the current less than 5% of GDP to the WHOrecommended or OECD country average of 8-9%. Better healthcare delivery, at no greater expense tothe “rakyat”, can be achieved. Healthcare is the responsibility of the government and should not beprivatized. It is also an inalienable human right. It is not a privilege.If the table ain’t broken, why fix it?Dr Ng SweeChoonFederation of Private Medical Practitioner’s Association of Malaysia ( FPMPAM ), Medical AffairsCommittee.