National Health Financing Scheme?

PLAIN TALK: Proper management of services needed
Brendan Pereira

Feb 13:
TWENTY. That is the number of years the Government has been mulling over the idea of abandoning the country's highly-subsidised healthcare in favour of a national health financing scheme.

Twelve.

That is the number of studies commissioned by the Government over the years to evaluate health financing schemes.

There is a reason why the authorities agonised for two decades over this issue.

They feared a political fallout, and preferred tip-toeing around an obvious solution to keeping the lid on escalating health costs.

Medical care is one of the most contentious and emotionally-charged issues, anywhere.

Governments have been known to pay a steep price at the ballot box for a misstep on health services.

In Malaysia, the potential for any health issue becoming a political minefield is serious.

As long as anyone can remember, Malaysians have only had to pay RM1 for a buffet of medical services at public hospitals.

It did not matter if you lived in a palatial home in Damansara or in a ramshackle hut in working-class Pantai Dalam.

If you were a citizen of this country, you were entitled to dirt-cheap medical services.

Anyone prepared to tamper with this system was either brave and responsible or had a penchant for dangerous living.

When Health Minister Datuk Dr Chua Soi Lek announced in December that the Government had decided to adopt a national health financing scheme, he expected a ruckus. Or at least some noise.

He said in a recent interview with The Sunday Times: "I want a debate on this issue. It is an important issue that needs to be discussed openly in a mature way.''

What he got was silence. Not a squeak from the opposition or probing questions from members of the Barisan Nasional ruling coalition.

Even the public seemed blase about this change in approach, perhaps lulled into believing that the government would always be in a position to subsidise medical services by more than 95 per cent .

Yet, introducing a health financing scheme is a big deal and needs to be thrashed out fully.

The Abdullah administration believes that Malaysia can no longer put off introducing a health financing scheme, not with the cost of healthcare rising every year.

The budget for the Health Ministry has increased from RM1 billion or 3.6 per cent of the National Budget in 1983 to RM7.6 billion or 7.1 per cent of the Budget in 2003.

"Obviously, the situation is not sustainable in the long-term," said Chua.

Prime Minister Datuk Seri Abdullah Ahmad Badawi gave the go-ahead for the health financing scheme in November.

Under the scheme currently in the final stages of fine-tuning, civil servants and their dependants, pensioners and their dependants, the disabled and the poor will still benefit from full coverage by the Government.

For this 10 million people, they will still be able to get medical treatment at public hospitals for a nominal fee.

Those not under this umbrella of benevolence will have to pay more for medical services.

This group includes the 11.9 million Malaysians who are working and earning decent salaries.

They will pay for their medical services through direct taxes, employee pension fund contributions, private health insurance and out-of-pocket payments.

How much some Malaysians will have to pay a month for medical services is still being worked out but the New Sunday Times understands that previous studies done suggest that each person will have to pay as little as RM35 a month to get basic healthcare services in public hospitals.

If they want higher end medical care, then they will have to obtain it at private hospitals and pay for it through their own health insurance or in cash.

Nearly two-thirds of Malaysians do not have medical insurance, a Straits Times survey last year showed.

Only 22 per cent of Malays had medical insurance, 57 per cent Chinese and 52 per cent Indians.

The study also showed that on average, many Malaysian visited doctors at least three times a year.

The National Health Financing Scheme calls for the setting up of National Health Financing Authority, a statutory board owned by the Government.

The authority will manage the health financing scheme. In all likelihood, it will contract other agencies to perform functions like premium collection, claims processing and the management of the medical services.

In reality, the success or failure of the scheme rests in the proper management of medical services.

The easy part of the scheme is collecting premiums and enrolling people into the scheme.

The tough part is making sure that the public does not feel they are being given sub-par medical care or a mere digits in a cost-driven system.

That is why it is critical that the National Health Financing Authority outsource critical functions of the scheme to reliable partners.

If the public feels that there has been a discernible drop in service once the National Health Financing Scheme starts, there will be hell to pay.

At that point, no amount of spin will be able to hush the critics.

----NST