Malaysia health plan turns septic

March 1, 2012

KUALA LUMPUR – A plan by the Malaysian government to privatize the public healthcare system and get consumers to pay for it through salary cuts is rapidly turning into a major election issue. Whistleblower doctors let the cat out of the bag this month by sharing details of “Icare” that the government had shared with doctors and select stakeholders.

The government at present pays 34 billion ringgit (US$11.2 billion) annually for a healthcare scheme that it wants to pass on to consumers under “Health Care Financing” that the public and conscientious doctors are opposing.

These doctors are fundamentally opposed to any scheme that requires citizens to pay a part of their earnings – in this case 10% of net monthly wages – if the cost of health financing is passed on to consumers.

The existing system, which consists of a network of government hospitals and clinics and caregivers throughout the country, provides cheap, affordable and effective healthcare.

“Why fix something that is working reasonably well,” said Dr Ng Swee Choon, deputy president of the Private Medical Practitioners Association, a group of doctors opposed to Icare.

“Malaysia has excellent healthcare coverage, as nearly 90% of the people stay within five kilometers of a government-run clinic or hospital,” he said.

Ng told a February 18 forum that the World Health Organization (WHO) had acknowledged in its annual report of 2007 that Malaysia had an effective and efficient healthcare system and had rated the service “excellent”.

Currently, 4.7% of Malaysia’s gross domestic product (GDP) is set aside for healthcare, way below the WHO recommendation of 8 or 9%.

“It’s more important to increase the bill of healthcare as a percentage of GDP than to go and change the system,” said another activist doctor, T Jayabalan.

The government is moving away from providing nearly free healthcare to a financing scheme that will be paid for by all citizens, he said.

The government, however, says healthcare is getting more expensive by the day and believes that a better option is one that is financed by citizens.

“Everybody is entitled to equal healthcare… there won’t be a private or government distinction,” said health minister Liow Tiong Lai of a scheme in which people contribute monthly in return for getting the best medical care available.

Those who can afford it patronize the expensive, well-equipped private hospitals that have sprung up all over the country, while others make do with crowded government hospitals that are under-equipped and under-staffed.

Icare is expected to pool resources under the National Health Corporation (NHC), which will foot the medical bills, assign the sick to a doctor and regulate treatment according to a fixed schedule.

Many people are not confident about giving a part of their wages to a government-managed NHC and fear it will be mismanaged and overtaken by cronyism and nepotism, like other public-sector outfits.

“We fear pilferage and that other forms of corruption would overtake the scheme,” said Dr Michael Jeyakumar, a lawmaker from the small Parti Sosialist Malaysia. “Right now the government is simply telling the people to wait quietly for them [the government] to tell what is best for them. This type of top-down policy does not work anymore.”

Health minister Liow last week said the opposition is spreading “false” details to confuse the public about Icare. He said the assertion that 10% of salary would be mandatory to finance Icare is false. “I myself will oppose the scheme if that is the case,” Liow told The Star daily.

But neither the health ministry nor Prime Minister Najib Razak have accepted a challenge from the opposition to release all the details. The government has asked Malaysians not to speculate about Icare and reserve judgment for when the system has been given a chance to develop.

The opposition Pakatan Rakyat has urged the people to vote out the ruling Barisan Nasional (or National Front). “The Front cannot be trusted with the people’s money,” said Jeyakumar. The opposition has rejected Icare as exploitative and is using the issue as campaign fodder for elections that are due by April 2013.

A top-down planning system is the hallmark of the National Front, which has ruled the country since independence in 1957 and is dominated by the United Malay National Organization party.

Moves to privatize state-run public healthcare can damage the National Front, which has projected itself as the protector of the socio-economic interests of its main constituency, the rural Malays.

Voters rejected the Barisan Nasional’s hold on power in the 2008 general election when nearly 49% abandoned the Front in favor of the incipient Pakatan Rakyat opposition coalition led by Anwar Ibrahim, a former deputy prime minister in the Front government.

The Pakatan Rakyat and the National Front are nearly equally matched for a return match in their contest for state power in a general election that is widely expected to be called mid-year.

“Many members of the public are unaware of the implications of the scheme,” opposition legislator Charles Santiago told Inter Press Service. “The federal government argues that Icare will make healthcare more affordable and its delivery more efficient to the public.

“But they are actually privatizing our healthcare services through a social health insurance scheme that will only further burden the people, especially the poor,” said Santiago who has started an awareness campaign in his constituency of Klang, 30 km west of the capital, Kuala Lumpur.

Health Care Asia
Home