Publication : New Straits Times
Date : 11 July 2010
Section : Nation
Page : 12
Headline : It’s about rich helping the poor
KUALA LUMPUR: The government proposes to set up a health financing scheme that will give all Malaysians access to primary healthcare at any public or private clinic for free.
The scheme will also look at secondary healthcare coverage and the illnesses and treatments it might be able to cover, said Health Minister Datuk Seri Liow Tiong Lai.
Although much of the scheme has yet to be finalised, the rate of contributions is expected to be based on wage scales, in which the rich will pay more. The poor will not have to contribute to the scheme but will still be covered
"It works on the principle of the rich helping the poor, the able helping the disabled, the young helping the old, and the healthy helping the unhealthy. All kinds of illnesses will be covered under this scheme so that everyone will have access to good adequate healthcare," Liow said.
The funds will be administered by the proposed National Health Financing Authority, a statutory body under the ministry. New legislation may have to be passed and existing ones amended to make way for this scheme.
Regardless of how much one contributed, everyone would enjoy the same standard of care, said Liow.
Only workers aged 18 and above with an income that has reached a certain threshold, need to contribute. Children will be financed by their parents. The poor and disabled who have no income or whose income does not reach the threshold need not contribute.
For those who wish to stay in a suite rather than a standard room, they will have to pay the difference.
"The rich will still get to enjoy whatever luxury they want as long as they pay for it. Otherwise, they will get a standard room like everyone else."
To ensure that no one abused the free healthcare provided, he said patients would have to pay part of the cost (a co-payment) of the drugs and medication prescribed to them.
"For the poor and less fortunate, the government will take up the co-payment."
For this scheme to be realised, the Health Ministry will have to be restructured, the medical facilities and infrastructure it oversees upgraded and personnel and procedures streamlined-- something that could take "about 10 years or more".
But Liow is upbeat over the scheme. "We believe it can be done in four phases."
The first phase is strengthening the healthcare system like governance and standards of care; the second is to grant more autonomy to primary healthcare providers in areas like human resource and management; the third is to integrate all public and private clinics so that they are all linked under a common network so that people can access either one; and the fourth phase will be the introduction of the national health insurance under the national health financing scheme.
This is the first time that Liow is talking at length about the proposed scheme and what it may look like after he announced in June 2008 that the ministry would "relook" it.
He said it was time the government seriously look into this scheme, which was proposed during the Fourth Malaysia Plan (1981- 1985) because "although Malaysia has an enviable healthcare system among developing countries, it faces several challenges that affect its sustainability".
Among them, he said, was escalating costs.
"The annual healthcare budget for the ministry escalated from RM1 billion in 1983 to RM13.7 billion in 2009. In contrast, the total healthcare revenue collected does not amount to even five per cent of the annual healthcare expenditure."
The migration of healthcare professionals from the public to private sector has also increased the burden of responsibility among public healthcare professionals.
"In 2000, 54 per cent of doctors in the public system had to care for 80 per cent of patients nationwide. The remaining 46 per cent of doctors are in the private sector, but they only had to contend with 20 per cent of patients in the country."
Sixty per cent of specialists in the country are in the private sector, "but they only look after 25 per cent of the most complicated cases".
Liow said many patients were now making use of the private sector and there was an increasing trend of them willing to pay their own way. However, this exposes the individual to financial risks if they experienced some catastrophic event or illness.
"They are likely to become instantly poor if they are struck with some major illness."
With a concept paper detailing how the scheme will work, tentatively named "1Care for 1Malaysia", Liow said "the scheme will be better able to control escalating costs, lets consumers choose to go public or private, offers better quality care, is more effective and efficient, and more viable and sustainable".
"We are late starters in this. Many countries have their own health financing scheme in place but this is to our advantage because we can study the strengths and weaknesses in each system and come up with one that is best suited to us."
The ministry is still looking at the best mechanism for collection, rates and conditions of contribution, how to pay to the clinic or hospital, the illnesses to be covered, the ratio of co- payment as well as the financial implications to the government.
"We hope to gain more public feedback and debate on this," said Liow.
Frequently asked questions
Q: What is 1Care for 1Malaysia?
A: It is a national health insurance scheme in which every adult who earns an income has to contribute a certain amount towards the scheme. These contributions, together with the government's annual healthcare budget, will fund the healthcare of all Malaysians.
Q: How much do I have to contribute?
A: This depends on how much you earn. If you earn a lot, you contribute more. If you earn less, you contribute less. And if you are poor, you don't have to contribute at all.
Q: Does that mean employers do not have to provide healthcare for their employees?
A: Employers still have to. They will also have to contribute to the scheme. The details of who contributes how much has yet to be decided.
Q: What healthcare do I get in return?
A: Outpatient treatment and consultation fees will be free. But to avoid abuse of the scheme, patients need to pay part of the costs of medication prescribed to them. For the poor, the government will pay for their medication.
Q: Can I go to a private clinic?
A: A patient can go to any public or private primary healthcare facility (clinic), regardless of how much that person has contributed.
Q: How will the private clinics get paid?
A: Under this scheme, every patient (and his family, if they all live together) has to choose and register one general practitioner as his family doctor. The doctor will be paid a flat rate per patient per year.
Q: Why do I need to have a family doctor?
A: A family doctor will be able to keep track of your medical history and the medication you've been taking. The doctor will also know the health of your family and can take all this into account when assessing your health.
Q: Can I change the doctor of choice?
A: Yes, you can. You will then have to re-register.
Q: What if I have to be hospitalised or go for an operation? Do I have to pay for that?
A: The issue of who pays for secondary healthcare, and how much, is still being discussed.
Q: Does this mean that I don't have to pay for medical insurance anymore?
A: You will probably need medical insurance if you are hospitalised or are operated on, or to pay for additional luxuries. All these issues have yet to be finalised.
Q: If I never fall ill and never have to use the facilities under this scheme, do I get my contribution money back when I am old?
A: No. If you are lucky enough to have good health, your contribution goes towards paying for people who are unlucky enough to be ill, and for the poor who cannot contribute.
Q: What if I am poor?
A: If you cannot pay because you are poor, the government will absorb the cost.
Q: When will this scheme be implemented?
A: There are many things that have to be sorted out first, and this will take at least 10 years.
