1Care Info Pack

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All you need to know about 1Care!

This has the most important info about what 1Care is really about. If you want to know more, the footnotes at the bottom of each page has links to the original documents.

- Why the government wants 1Care
- Who benefits the most from 1Care
- How 1Care really works
- What it will really affect you

Almost all info has been taken from government sources.

Published in: Health & Medicine, Business
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1Care Info Pack

  1. 1. 1CARE – FAQsQ: What is 1Care for 1Malaysia? A: 1Care will merge private Q: Do I still have to buy medical insurance? A: 1Care hasand public sectors into one system. Everyone pays private very limited coverage, so you need insurance or lots of cash.sector prices. There will be no more government healthcare forthe 75% of the rakyat who cant afford the private sector. It will Q: Can I get my money back when I retire or if I never usebe a fully privatised, SHI-based system. the system? A: You will never get your money back.Q: What is 1Cares Social Health Insurance (SHI)? Q:What if I am poor? A: If you are a family of four earningA: An insurance scheme that every working adult must buy. below RM500, the government pays the SHI for you.This SHI pays for your healthcare. But international studiesshow that SHI systems INCREASE costs and do NOTHING to Q: When will this scheme start? A: It already has. 1Care isimprove healthcare! currently in Phase 1 & 2 of a 4 phase implementation process. This is confirmed by the Health Ministrys Deputy Director-Q: How much do I have to pay? A: The government General, Datuk Dr Noor Hisham Abdullah. The process isestimates they need 9.5% of your income to maintain 1Care. expected to be completed within the next 2 to 5 years.They are also exploring sliding scale deductions, where thepoorer pay less and the richer pay more. So you could be Q: Why do we need this 1Care reform?paying much more than the 9.5%! A: The government claims it cant afford to pay for healthcare. The Health Ministrys 2011-2015 Plan proposes cost-cuttingQ: Do employers still provide healthcare benefits? measures to make government hospitals "abandon acuteA: The 9.5% is supposed to be shared between employer, care" and "more strictly limit services" to the rakyat. Butemployee and government. But its actually ALL paid by you: they willingly give out BILLION-RINGGIT contracts for services that dont improve healthcare!(1) Your portion is deducted from your salary.(2) Governments portion is paid with your tax money(3) Employers will eventually pass the cost back to you THE RAKYAT DEMANDS OUR RIGHTS!Q: What healthcare do I get in return? A: According to the The UN Universal Declaration of Human Rights states:1Care Concept Paper, your 10% will pay for about 6 clinicvisits or 1 specialist visit a year, or 1 hospital stay in 11 years. "everyone has the right to a standard of livingAnd you will STILL need to pay when you see the doctor! adequate for the health and well-being of oneself and ones family, including medical care."Q: What is a Primary Healthcare Providers (PHCP)?A: PHCPs are 1Care-certified GPs. Everyone must register As a signatory to this declaration, the Malaysianwith a 1Care PHCP. If you dont like your PHCP, you can pay government must uphold its dignity and not impose anyextra to see another one. policy that restricts the rights of the people to affordable and quailty healthcare – either in public ot private sector.Q:Why do I need to register with a PHCP? It is the governments responsibility provide enoughA: 1Care tracks your health records through the PHCP. If you quality and affordable healthcare for all the health needsuse “too much” of 1Cares healthcare budget, you may get of everyone in Malaysia, without any discrimination.only limited or even no healthcare until a new budget isapproved. Unless you pay extra to get your own doctor. A moral and caring government will not force people to choose between disease or financial ruin.Q: What is Gatekeeping? A: You cant go to any hospital orspecialist without your PHCPs referral. If you dont like the A moral and caring government would not treat itsspecialist or hospital he refers you to, 1Care gives you the citizens health as a commodity to be traded, manipulated“choice” to pay extra to see your own. and negotiated for profit. The rakyat elects governments to protect our interests!Q: How is the PHCP paid? A: 1Care pays PHCPs a flat rate Taxes must be used for the rakyats benefit, including tofor every patient. Theres no reward for better care, so doctors provide quality healthcare and other essential services.have no incentive to improve. They also have a fixed budget. If Therefore, the rakyat states clearly:they see too many patients, they wont get paid. So your PHCPmay not see you if hes out of budget. Youll have to pay extrato see another doctor.Q: Can I change my doctor? A: Yes, You can apply to the TAK NAK 1CARE!authorities, submit the paperwork, wait for approval, etc. If you Instead, the rakyat demands:dont want the hassle or long waits, you can pay extra to seeyour own doctor. 1. DE-PRIVATISE PUBLIC HEALTHCARE 2. STOP CORRUPTION, WASTAGES, LEAKAGESQ: Do I have to pay for hospitalisation or surgery? 3. INCREASE FUNDING FOR PUBLIC HEALTHCAREA: 1Care will never fully reveal what they provide. But the1Care Concept paper shows that if you get serious diseases 4. REGULATE PRIVATE HEALTHCARE CHARGESlike cancer, heart or kidney disease – you pay your own. Other 5. MAINTAIN THE PRESENT 2-TIER SYSTEMneeds are subject to 1Cares budget limitations.
  2. 2. 1CARE – WHAT ITS REALLY ABOUTAccording the the Ministry of Health: Clearly, the objectives of 1Care “reforms” are already being met by the healthcare system we have now. And many of the problems in our healthcare system can be easily solved without a total revamp. So why is government so very keen to implement 1Care “reforms”? PRIVATISATION AND PROFITS These slides are from a January 2009 presentation by the Ministry of Health entitled: “FUTURE OF HEALTH CARE FINANCING IN MALAYSIA” by Dr Abd Rahim Mohamad, MOH Planning & Development Division. In the first 20 slides, Dr Abd Rahim lists the problems with Malaysias healthcare system. Then he presents two reform options – introduce a NHI [2] and more privatisation, or improve the current system:Slide 27 from presentation: “MALAYSIAN HEALTHCARE SYSTEMTOWARDS ACHIEVING BETTER HEALTHCARE FOR MALAYSIA” by Dr.Abd. Rahim bin Mohamad, MOH Planning and Development Division.Briefing given in Putrajaya, 28 September 2010BIG WORDS DISGUISE THE REAL INTENTIONSThe government uses nice-sounding words to give people apositive impression of 1Care, but the meaning of the wordscould be very different from what most people think.Here are the real meanings of some words we need toremember when discussing 1Care:INTEGRATE:1Care will merge private and public healthcare sectors tocreate a single system. All government facilities will functionlike independent “private entities” [1] and charge private sector Slide 22: “FUTURE OF HEALTHCARE FINANCING IN MALAYSIA”rates. 1Care will completely privatise healthcare. - Dr Abd Rahim bin Mohamad, 18 January 2009UNIVERSAL COVERAGE:The concept of EVERYBODY being able to get ALL the A right-thinking person would have chosen the second option.healthcare they need. Malaysia already has universal It is more efficient and costs less for the rakyat. But in the nextcoverage. The government uses taxes to provide all levels of slide, Dr Abd Rahim proposes the FIRST option:healthcare and has clinics and hospitals everywhere. Malaysiaalso has a thriving private healthcare sector for people whodont want to use government services.SOLIDARITY AND EQUITY:The concept where the richer pays to support the poorer to getequal quality of healthcare. Malaysia already has equitybecause 10% of the population pays taxes to make publichealthcare available for the other 90% who are too poor to paytaxes. Most richer citizens also use private healthcare so thatthe poorer can use public healthcare.CHOICE OF QUALITY:Malaysians already have choice – people can choose themore expensive private sector with shorter waiting times andbetter environment, or the cheaper public sector with betterexpertise and facilities. Slide 23: “FUTURE OF HEALTHCARE FINANCING IN MALAYSIA” - Dr Abd Rahim bin Mohamad, 18 January 2009[1] A Malaysian Pharmaceutical Society (MPS) report quotes a “Dr Nordin” from the MOH as saying “the current Govt Hospitals and HealthClinics will be given autonomy and will operate like private entities”. This was during a briefing about 1Care to MPS by senior MOH officialsheld on 15th Jan 2012. View the report here: http://on.fb.me/wD0utH[2] NHI: National Health Insurance, another name for Social Healthcare Insurance (SHI), a compulsory nationwide medical insurance scheme
  3. 3. 1CARE – PRIVATISATION IN DISGUISEBehind all the big words and macro economic mumbo-jumbo, WHO BENEFITS MOST FROM 1CARE?1Care is really just about money – a lot of money. The Economic Transformation Programme (ETP) report [4] enthusiastically promotes "health as an economicThe government has been trying to privatise healthcare ever commodity". The report declares Malaysia should make:since Dr Mahathirs time. In 1991, the Privatisation Master “ healthcare as an engine ofPlan officially listed healthcare to be privatised. In 1996,the 7th Malaysia Plan stated “privatisation of health facilitiesand services will also be an important aspect”. Since then,many segments of public healthcare have been privatised. economic growth ”Just a few examples of government privatisation:1992: Institut Jantung Negara corporatised (due to be privatised with impending Sime Darby buy over)1994: The Government Medical Store is privatised. Now, Pharmaniaga monopolises manufacturing, purchasing, storage and distribution of all drugs and medical products. Prices went up 3.3 times.1996: Hospital support services privatised to three UMNO- linked companies. Costs rose from RM143 mil in 1996 to over RM1 bil in 20092011: Radiology services in public hospitals privatisedFINISHING THE JOB1Care will be the final piece in the process to completelyprivatise Malaysias public healthcare system. According to aMOH briefing to the Malaysian Pharmaceutical Society, “GovtHospitals and Health Clinics will be given autonomy andwill operate like private entities” and “1 Care transformation The ETP report calls for the government to “use itsproposals are now in the final stages.” [3] infrastructure capabilities, domestic consumption base and diverse population to create an economic growth agenda for healthcare.” (In other words, the government should use its facilities to make money from the rakyat.) The ETP report also identifies medical tourism as an “attractive sector” and explains that “with 1.9 beds per thousand and 0.8 doctors per thousand as of 2008, Malaysia has a solid foundation to build on.” (pg 557) These numbers include both private and government doctors / hospitals! So with 1Care, the government is positioning themselves to reap huge profits from the health tourism boom, together with the private sector. Meanwhile, the rakyat is forced to subsidise the governments business through a compulsory SHI [5]! As if this is not bad enough, the ETP further proposes thatSlide 48: “MALAYSIAN HEALTHCARE SYSTEM TOWARDS ACHIEVING Malaysia should be internationally promoted as a “R&D andBETTER HEALTHCARE FOR MALAYSIA” - Dr Abd Rahim bin Mohamad clinical trial destination for the pharmaceutical and med tech industries” as our country has a “high incidence ofAs this slide shows, the government wants to liberalise, lifestyle diseases”.then capitalise on the lucrative healthcare industry. 1Care“reforms” will make this possible. Merging the public and The government is not only forcing the rakyat to subsidise theirprivate sectors lets the government charge private sector fees. healthcare business, they will also offer the rakyat up to be1Care also guarantees the government a captive market of the worlds lab rats!full-paying patients, because the entire population must beregistered under 1Care.[3] MPS report on MOH Seminar on 1Care Health Transformation held on 15th Jan 2012, http://on.fb.me/wD0utH[4] You can view the ETP Healthcare Report (Chapter 16) from here: http://scr.bi/w2deN2 (the ETP has removed it from its own website)[5] SHI: Social Health Insurance. 1Care forces everyone by law to pay up to 9.5% of their monthly income for a compulsory insurance
  4. 4. 1CARE – HOW DOES IT WORK?1. INTEGRATION:1Care will merge the private and public healthcare sectors.There will be no more government subsidised system. Allhealthcare services will charge private sector prices. Thiswill leave the 75% of the rakyat who depend on publichealthcare with inadequate healthcare. Slide 33: “MALAYSIAN HEALTHCARE SYSTEM TOWARDS ACHIEVING BETTER HEALTHCARE FOR MALAYSIA” - Dr. Abd. Rahim bin Mohamad 2. PHCPs – DOCTOR JAGA PINTU All GPs will have to register as 1Care Primary Healthcare Providers (PHCP). But their Medical Degrees wont be good enough. They must go for additional 1Care training. PHCPsSlide 19 from presentation entitled “TOWARDS PUBLIC PRIVATE will also not be allowed to dispense medicines. You will have toINTEGRATION: ASPIRATION FOR 1CARE” by Dr. Azilina Abu Bakar, MOH get it from a pharmacy after you see your doctor.National Health Financing Planning and Development Division Some other important issues about PHCPs are:To disguise the high costs of 1Cares privatised system, thegovernment will force everyone to buy a compulsory Social REGISTERING PATIENTS:Health Insurance (SHI). The government says that you dont Everybody must register with a 1Care PHCP. If you dont likeneed to pay to see a doctor if you have this 1Care SHI. this doctor, you can pay extra to see another one. If you want a second opinion, you also pay extra. But your SHI premiumsThis is a big lie because the rakyat are forced to pay up to will not be reduced or refunded.9.5% of their income every month for this SHI. And as thisMOH slide proves, 1Cares SHI only covers some services. Registration also lets 1Care track your health records. If youAnything more, you pay out of your own pocket. use “too much” of their healthcare budget, you may be limited or denied healthcare in future. Unless you pay extra. GATEKEEPING: 1Care PHCPs will act as Gatekeepers - no one goes to a hospital or a specialist without their PHCPs referral. For example, you cannot simply see your own gynae or pediatrician anymore. You must first see your PHCP. If he thinks you need a specialist, he will refer you to one that HE is registered with. If you dont like that specialist, you have a “choice” of paying extra to see your own. PREVENT DISEASE: 1Care PHCPs have to ensure their patients stay healthy. This is because 1Care limits how many patients can be referred to specialists / hospitals. If too many patients are referred, 1CareSlide 9: “1CARE FOR 1MALAYSIA: PRIMARY HEALTHCARE” by Dr SafurahJaafar, Director, Family Health Development Division, MOH. may penalise the PHCP. 1Care may also put you on a waiting list until its budget allows you to go to a specialist / hospital. If you cant wait, you can pay extra to get immediate service.1Care also DOESNT pay for cases where your disease is soserious that you need very expensive long term treatment or CLAIMS:very expensive immediate treatment. 1Care expects you to PHCPs earn by claiming money from the SHI for patients theyhave your own cash or insurance for that. see. But they are given a fixed budget. So they cant see “too many” patients or they wont get paid. They may even beBut all the SHI premiums that you have paid in your entire penalised. So your PHCP may not see you if hes out oflifetime will NOT be refunded to you. Ever. budget. Youll have to pay extra to see another doctor.NOTE: All these points are contained in the 1Care Concept Paper. You can read it at: http://taknak1care.weebly.com/1care-documents.html
  5. 5. 1CARE – SOCIAL HEALTH INSURANCE (SHI) HOW MUCH, WHO PAYS AND WHO DOESNT? [6] IS THE 10% PAY DEDUCTION TRUE? The government strongly denies these figures are real. They insist that they put some meaningless numbers in their proposal to the Prime Minister. But we can calculate how the Ministry got their figures, based on official government statistics. RM44.23b (total health expenditure) divide by 28.3m Msians = RM1,562 RM972 (annual SHI per person) multiply 4.3 people per household = RM4181.50 We can also see that the Ministrys 9.5% estimate is the average amount needed to sustain 1Care - based on 2009 conditions. This will increase. According to Dr Hsiao (Harvard economist and 1Care consultant), “In every country, health care costs are increasing faster than wages. When that happens, the premium has to go up.”Table from the 2009 1Care Concept Paper [6] showing the Health Ministrys estimate of The Ministry is also exploring sliding scalehow much the new 1Care system will cost the rakyat. deductions, where the poorer pay less and the richer pay more. So you could end up paying much more than the proposed 9.5%!WHO REALLY PAYS THE 10%? WHO DOES THE GOVERNMENT PAY FOR?The government insists that the rakyat doesnt pay the whole10%. Its supposed to be shared between the employee,employer and government. They are only telling you half a lie.The truth is that the 10% is ALL paid by you. How?1. Your portion is deducted from your salary.2. Governments portion is paid with your tax money3. Employers pay their portion, but will eventually pass the cost back to you quietlyThis last point is confirmed by Dr William Hsiao, who is helpingthe MOH develop the 1Care implementation plan. 2009 1Care Concept Paper shows those who dont need to pay for the SHI. “ the burden of (SHI) on The government says they will take care of the poor by paying employers was actually for their SHI. Who are these “poor” people? The PM says families that earn RM3000 a month find it hard to make ends borne by employees ” meet. This is about 60-70% of the population (about 17-20 million people). But this table shows the government pays for only 187,172Dr William Hsiao poor people (0.7% of the population). These are only the hardcore poor – defined as a family of four who earns lessIn one of his consultant reports, Dr Hsiao explained that, than RM500 a month! [8] So if a family of four earns only“(SHI payments) imposed on employers were passed back RM501/month, they have to to pay the 10%!to employees over time in the form of lower wages orlower pensions and other fringe benefits.” Hsiao says, “In This table also shows that the largest group that theother words, the burden of payroll tax on employers was government pays for are not poor or needy cases at all!actually borne by employees.” [7][6] All these points are contained in the 1Care Concept Paper. You can read it at: http://taknak1care.weebly.com/1care-documents.html[7] You can read the interview with Dr Hsiao here: http://bit.ly/ze89ea[8] For statistics on Malaysias poverty levels, visit these sites: http://bit.ly/wahNEk, http://bit.ly/k4Y3S,
  6. 6. 1CARE – SOCIAL HEALTH INSURANCE (SHI) PAYING MORE BUT GETTING LESS HEALTHCARE!SHI SYSTEMS PROVEN: THEY DONT WORK! CASE MIX / CASE BASED:The government says our world-renowned health system is A very complex method to budget for the number of patientsunsustainable. They claim 1Cares SHI will make healthcare needing different types of care. For example, Hospital A has acheaper and better. But international studies show that SHI budget for 3 heart attacks, 7 broken arms, and 5 fevers asystems dont work! TWO World Bank studies conclude: week. If more cases come in, the SHI wont pay for them. “ There is no evidence that SHI countries enjoy CO-PAYMENT: Even after paying 10% a month for 1Cares SHI, you STILLbetter quality health care than countries with tax- need to pay when you see the doctor! financed health systems ” [9] BENEFITS PACKAGE:“ SHI systems...more expensive than tax-financed A list of what the SHI pays for [12]. No one knows exactly what 1Cares package is. But the Ministrys 1Care Concept Paper systems, do no better in terms of most health estimates that your 10% deduction is only enough to pay for outcomes...may do worse ” [10] about 6 clinic visits a year, or 1 specialist visit a year, or 1 hospital stay in 11 years. [12]It doesnt work because a SHI system is only concerned withmoney, not peoples lives! This creates many problems. The SHI wont cover the most serious and expensive healthcare needs such as cancer, kidney disease, heart disease and AIDS. [12] You have to pay on your own if you have these diseases. And treatment for any one of these could easily cost well over RM200,000! This is unacceptable, because the government knows: - 25% of the population gets cancer by age 75, - 10% suffer from kidney disease, and - the No.1 Killer in Malaysia is heart disease 1Care makes you pay so much yet gives so little in return and abandons you when you need it the most. And the government is doing this on purpose! WILL 1CARE REALLY RATION HEALTHCARE? Yes! Like all insurance, 1Cares main focus is to pay out as little as possible so that money stays in the fund. And 1Care needs a lot of cash to maintain its many, many NEW supportSlide 14: “TOWARDS PUBLIC PRIVATE INTEGRATION: ASPIRATION FOR organisations and their activities. [12]1CARE” by Dr. Azilina Abu Bakar, MOH The rakyat will never fully know how much they are beingITS ALL ABOUT THE MONEY denied healthcare. But Dr Rozita Halina Tun Hussein, DeputyWith 1Care, the rakyat pays the SHI. The SHI then pays the DG of the Health Ministry, confirms that there will be rationing:doctors and hospitals when we use their services. Thegovernment says this way, we all get healthcare but dont haveto worry about paying the expensive bills. [11] Not true.Again, we have to re-look at some of the big words in the slideabove to understand what they really mean.GLOBAL BUDGET :It simply means “fixed budget”. Doctors / hospitals are given afixed amount, and they can only use that much and no more.This ALWAYS leads to “rationing” - healthcare providers willtry to give as little service, materials, drugs, etc as possible sothat they wont run out of money.CAPITATION:A fixed fee. 1Care pays PHCPs a flat rate for every patient, nomatter what service they give Theres no reward for better care Slide from: “IMPLICIT & EXPLICIT BENEFIT PACKAGE: PROS & CONS” presented by Dr Rozita at the Prince Mahidol Award Conference, Thailand,or penalty for poor service. So doctors have no incentive to January 2012. (Implicit - only top officials know which services 1Careimprove their care towards their patients. excludes. Explicit - PHCPs know too. But patients wont ever know.)[9] “SOCIAL HEALTH INSURANCE REEXAMINED” by Adam Wagstaff, Development Research Group, World Bank. http://bit.ly/w8aMoo[10] “SHI VS. TAX-FINANCED HEALTH SYSTEMS-EVIDENCE FROM THE OECD” by Adam Wagstaff http://bit.ly/wuaQnl[11] “Better healthcare for all” - 7th para, The Star, 3 DECEMBER 2011 http://bit.ly/wJYVsE[12] Point No 46 & 55, Annex 6: 1Care Concept Paper, http://taknak1care.weebly.com/1care-documents.html
  7. 7. 1CARE – IS IT CONFIRMED OR NOT?FACTS SPEAK FOR THEMSELVESThis is Dr Rozitas profile printed in thePrince Mahidol Award Conference 2012programme book. It clearly states that: “ 1Care for 1Malaysia has been accepted by the Government of Malaysia ”This is an international conference,jointly organised by the WHO and WorldBank. It was attended by over sevenhundred senior healthcare policymakersfrom around the world.The government tells the rakyat that“nothing has been decided” and theyare still “looking at which concept toadopt.” But they told the whole worldthat 1Care has been accepted andthey are working to implement it!Can we trust ANYTHING they tell usabout 1Care if they can lie to itscitizens so shamelessly like this?The government thinks we are allfools who will believe anything! HOW CLOSE ARE WE TO COMPLETE PRIVATISATION? Policy: Privatised: Facilitating: Facilitating: Facilitating: The 1991 Privatisation Selected healthcare services. Hospital Information System, Patient’s purchase of Mandatory private health Private practitioners allowed Teleprimary Care and Oral implants and prosthesis insurance for foreign workers Master Plan officially to practise in public hospitals Health Information System - have shops in hospitals listed healthcare to be - public providers introduce patients to sales reps Integration: Outsourced: Integration: Locum arrangements - 1992 - Corporatised: ICT systems development Training schools – public doctors in private Institut Jantung Negara Outsourced: (to be privatised with and support – HMIS, THIS John Hopkins with Perdana Catering services Facilitating: Acquisition: FOMEMA - mandatory 1994 - Privatised: Buying private hospitals – Outsourced: medical check ups for all Government Medical Store. Sabah and Sarawak radiotherapy, urology, Pharmaniaga monopolises dialysis, radiology manufacture, purchase, 1CARE storage and distribution of all INFO SOURCES: drugs and medical products Outsourced: “PUBLIC-PRIVATE INTEGRATION Transgenic mosquitoes for IN HEALTHCARE DELIVERY - Dengue control PAST AND PRESENT” Policy: Dr Rozita Halina Tun Hussein, MOH In 1996, the 7th Malaysia Plan stated that “corporatisation “REVISITING PRIVATISATION IN and privatisation of health Concession: Methadone programme Private build & maintain. MALAYSIA: THE IMPORTANCE OF facilities and services will - Authorise GPs and later INSTITUTIONAL PROCESS” MOH rent then transfer community pharmacists. ownership to government – by Shankaran Nambiar, Malaysian - Govt gives methadone FOC Institute of Economic Research 1996 - Outsourced: Women and Child Hospital - patients pay GPs Integration: Training schools – http://bit.ly/w54z2A clinical waste management, John Hopkins with Perdana “OWNERSHIP AND HEALTHCARE facility maintenance, Land Swap: Semi-privatised: SERVICES IN MALAYSIA: laundry services, MOH institutions on prized UMMC, HUKM, CRITICAL ISSUES” commercial land, private Privatised: biomedical maintenance, Hospital Selayang, by Raja Rasiah, Makmor Tumin, sector to build new Monitoring of privatised janitorial services Hospital Putrajaya Nik Rosnah Abdullah, Uni. Malaya complexes on private or MOH services and consultancy http://bit.ly/ydynRC land – 1NIH research contracted to SIHAT And various other news sources
  8. 8. 1CARE – WHAT WILL HAPPEN WHEN IT STARTS?

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