FEB 4 — Supposedly based on the UK National Health Service (NHS), the
1Care scheme is said to be aimed at financing the supposedly increasing
costs of public health care while making it still affordable to the
lower-income group.
But we fear that, like most other “restructuring” schemes in the
past, 1Care will deliberately result in the escalation of costs to
ordinary Malaysians and the outsourcing of contracts to corporate
interests — financed by public funds.
The direct beneficiaries — private hospitals, health management
organisations, pharmaceutical firms and those administering the national
health financing fund — are likely to profit handsomely from this
scheme at the expense of the public.
We recall how the costs of pharmaceuticals soared after the
Government Medical Store was privatised in 1994. A similar rise was seen
in the costs of general hospital support services after they were
privatised.
The mantra of so-called cost-effectiveness that is often promised
with such restructuring or de facto privatisation schemes is highly
questionable. Critics of the 1Care scheme justifiably claim that the
quality of health care treatment will plunge. The new health care
financing authority may impose limits on the number of hospital visits
by a patient or introduce financial incentives for GPs to limit their
number of referrals to specialists in the effort to trim costs and
improve profit margins. The welfare of the weak and the poor will be
sacrificed without any qualms on the altar of greed and profit.
In effect, 1Care will provide massive public subsidies for private
hospitals. Payments out of the national health care authority’s funds
(raised from the public via taxes and monthly public
contributions) will
serve as large subsidies to boost admissions, the occupancy and the
bottom line of private hospitals and GLC-owned “private” hospitals.
(With such a scheme in place, even government hospitals could end up
behaving like private hospitals.)
An analogy would be the use of public funds given out as PTPTN study
loans, which effectively acts as a huge government subsidy to private
colleges, which have mushroomed. The cost is borne by indebted ordinary
students, who have to make long-term study loan repayments.
Malaysians will probably have to pay 6-10 per cent of their monthly
income in contributions to the 1Care fund. A significant chunk of this
money will go towards the administration costs of the fund. The pockets
of ordinary Malaysians could be hit even further if they opt for a GP of
their choice. What about those who are unemployed or unable to afford
health insurance contributions? How will they be able to get medical
treatment under this new scheme?
There is basically not much that is wrong with the existing public
health care system that cannot be fixed with a greater allocation of
government funding and more effective management of personnel and
resources. At present, the government spends around two per cent of GDP
on public health care — a pathetic amount well short of the
internationally recommended 5-6 per cent. Why not allocate more funds to
our general hospitals, which already provides universal coverage to
anyone who needs treatment, instead of squandering public funds on
useless projects or allowing massive corruption to persist?
We call upon the government to reconsider its plan to implement this
massive scheme. Spare the ordinary rakyat — already suffering from the
effects of inflation — this additional heavy financial burden. Just
allocate more funding to our general hospitals and ensure that it leads
to a distinct improvement in the quality and efficiency of our general
hospitals.
A government of the people has the responsibility and moral
obligation to protect the interests of the rakyat — and this includes
their health care. Tak nak 1Care! — aliran.com
* Dr Mustafa K. Anuar is honorary secretary of Aliran.
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