The Malaysian Government is about to introduce a mandatory national healthcare system called 1Care, which will force all employees to give up to 10% of their monthly income to pay for basic healthcare. This has created an atmosphere of fear among the people as to the uncertainties of the medical facilities at available for them and their families.
While it may be a noble idea to come with a comprehensive national healthcare system to provide quality and affordable medical services for the people, it has be make sure the people at large, in particular the lower income group are ready for such a scheme, which will further drain their already meagre resources.
According to the planned scheme, despite paying a hefty sum every month, one;
1. Cannot choose the own doctor but go to the one assigned by a healthcare provider appointed by the government. These healthcare providers are usually managed by non-medical professions, and are basically run on profit-motivated financial systems.
2. Can only see the assigned doctor 6 times a year free
3. Can only see the doctor for one problem at a time
4. Get only cheaper generic medicine and not the patented drugs that are more costly.
5. If one wants a doctor of his choice or patent drugs he has to pay more for them.
It must be emphasised that healthcare is a basic need of every citizen and it is the sole responsibility of the government of the day to ensure that those needs are taken care. Every Malaysian deserves quality healthcare that is affordable and accessible. Cost should never be a consideration as it would be unethical to provide suboptimal treatment just because one cannot afford the best.
It is also the right of a patient to choose the doctor and the treatment he prefers. Compelling the people to pay for medical services and the doctors decided by others like a health care provider would be gross injustice to the patient. How can a healthcare provider whose sole motive is monetary profits be expected give to the best possible treatment for a client without considering the costs involved in the process?
Apart from being unfair to the patients, which should be main consideration, the provisions of 1Care also places a great disadvantage on existing medical practitioners. What will happen to their practice if the distribution of patients is taken over by a third party? Wouldn’t it be unfair to the senior doctors who would their lose their advantage over the newcomers for the years of experience in serving their patients?
Who and what criteria will be used to select the healthcare providers? Will it be based purely on merits? A large amount of money is involved in this project of proving healthcare to the people and the healthcare providers are in a position to reap huge profits. From past experience we know for sure there will be bias and cronyism in the process of awarding the contract.
There are many unanswered questions and doubts in the minds of the people regarding the 1Care scheme. The government should seriously reconsider its plans to rush into a very major overall of our healthcare system by introducing the mandatory 1Care service. Greater scrutiny and more debate on its benefits is needed before such a scheme is implemented.
The people are losing trust on its ability and real motives in carrying out such major privatisation of its responsibilities to the rakyat. Instead of undertaking more privatisations in the name of reforms, it should try to redeem the trust of the people. In this respect it would be more appropriate at this junction for the government to address the declining standards and accessibility of quality of health care available to the ordinary citizens who form the bulk of the populace. This may go a long way to help regain its rapidly vanishing image as a caring and sincere government that puts the interests of the people before itself.
Provision of quality health care for the people is a social and moral obligation of the government. It is truly a service that must not be transformed into a business enterprise to reap huge profits at the expense of the people.
Salient points – 1Care
1. The government plans to introduce a new healthcare system called 1-Care. It includes an insurance system to fund for healthcare.
2. The National Healthcare Financing Authority will be in charge of 1Care – and it is likely to be turned into a GLC.
3. Based on available information, every household will be made to pay up to 9.4% of gross household income for social health insurance. The payers will be the individual, the employer and the government via taxes, exact proportion still being worked out)
4. There shall be no choice. Everyone has to pay. There is no opting out. We have to pay upfront. It will no longer be fee-for-service; it is fee-before- service.
5. There has been no information on exactly how this payment will have to be made or how the government will collect from self-employed people.
6. The government will be expected to contribute to the insurance premiums of government pensioners, civil servants and five dependants.
7. But the problem is: 1Care does not cover all your medical expenses. Only for a prescribed basic list of what “you can have” healthcare items. Anything more than basic you will have to pay your own.
8. Your long-serving independent family doctor will have to join the system or will not be allowed to see you under the 1Care scheme. The robust, cost- effective independent clinics serving the country will be replaced by 1Care clinics.
9. You cannot pick your own doctor. 1Care will allocate a doctor to you.
10. If you want to see a doctor of your choice, you’ll need to pay for that from your own pocket. Your allocated doctor will decide when and which specialist you can see if the need arises (a process called gate-keeping).
11. The NHFA will pay GPs RM60 (present proposal) for each patient as consultation fees. It does not include medicine. Compare this with presently, for cough and cold visit, the GP would charge RM20-RM30 for consultation and medicine. With 1Care: consultation for GP visit is RM60 and this does not include medicine.
12. You cannot see your doctor as and when you feel the need arises. There will be a rationing system in place as well. There will also be rationing for specialist care with the GP as the gate-keeper. Likewise if you wish to see the specialist of your choice or go to a hospital of your choice, unless referred by your allocated doctor, you will also have to pay out of your pocket.
13. Even if you only see the doctor once in a year, you will not get a refund from 1Care. Your medical costs are prepaid in advance irrespective of whether you become sick or not.
You are also expected to make an additional co-payment for your visit. This is to discourage you from seeing doctors too often.
14. You will be prescribed only medicines from a standardised list of not-the- original medicines in keeping with WHO List of essential Medications.. This will save cost for 1Care and maximise profit for the insurance companies. Insurance companies will have major say in the price and the range of this standardise medicine list. It will likely to be the cheapest medicine.
15. The doctor will only give you injections. You’ll need to get all other medicines from a pharmacist, even if it means hauling three sick children with high fever along a hot, dusty busy street looking for the nearest pharmacy.
16. If you do not like what is given to you, you can get alternative care by paying out of your own pocket.