A proposed health insurance scheme by the Health Ministry will worsen the brain drain in public hospitals if no holistic plan is in place to address it, says Dr Michael Jeyakumar Devaraj.
The former PSM Sungai Siput MP said that so far, no clear details have been forthcoming on the proposal.
He said the scheme, which was being proposed in the 2019 Budget, had not involved consultation with the stakeholders.
"I would like to appeal to the Minister to make public the details of the insurance policy that the Ministry is thinking of introducing, so that interested parties and individuals can debate it and give feedback," he said in a press statement late Wednesday (Oct 10).
Dr Jeyakumar said there were claims that the Government was considering taking out insurance policies for B40 families that entitled them to treatment worth RM10,000 per year at private hospitals.
With an estimated three million B40 families, the total payout would be RM7.5bil a year if just a quarter of this group were to use the insurance, he said.
Such a policy would be quite popular initially as the B40 families would have the option of getting treatment in private hospitals without having to make an initial contribution to the scheme while private hospitals and insurance companies would also benefit from it.
"The scheme being proposed by the Health Minister and his deputy will exacerbate some of the problems that the government health care system is facing," he said, citing similar schemes in the late 1980s.
Then, Tun Dr Mahathir Mohamad liberalised the healthcare system by allowing for-profit private hospitals to be set up. (Prior to that, only non-profit private hospitals were allowed in Malaysia).
Dr Mahathir's argument then was that the rich should be encouraged to pay for treatment at private hospitals so that Government expenditure on health care could focus on the poorer half of society but the policy damaged the public healthcare system, he said.
"At this point in time, only 10% of the specialist doctors with more than 10 years' experience post specialisation remain in government service while 90% of the experienced specialists are in the private sector, which caters for 25% of the in-patients in the country.
"This leaves 10% of the nation's experienced specialists to handle the 75% of inpatients admitted to government hospitals.
"Is it any surprise then that there are delays in getting specialist treatment in government hospitals, or that mistakes occur because there are not enough specialists to adequately supervise the younger doctors?" he said.
Dr Jeyakumar said that this resulted in a wide gap in Malaysia's healthcare delivery system whereby the 25% who can pay get prompt state-of-the-art treatment in the private hospitals while the 75% who depend on government hospitals encounter delays, long waiting lists, difficulty in accessing the senior specialists in government service and the risk of serious complications because of sub-optimal care.
He said that the insurance scheme would lead to more demand for private healthcare and encourage specialists from the public sector to leave, resulting in the quality of services in public hospitals to deteriorate further.
"This may force the B40 to top up the insurance that the government has initiated for them. This is because the RM10,000 given to them will not be enough to cover all the health needs of a family if a serious illness strikes.
"The problem with this insurance proposal, like the liberalisation policy introduced by Dr Mahathir 30 years ago, is that it does not consider the health sector holistically.
"Both proposals fail to appreciate that changes in the private sector impinge on the public health sector in several ways.
"We have to seek out the potential impact of such changes and avoid making decisions that might undermine the public healthcare system of our country," he said, urging the Health Minister to safeguard and further develop the system.
Among PSM's proposals to improve the healthcare system in Malaysia are:
- Increase the federal health budget by 15% every year until it reaches 4% of GDP. It is currently only 2.1% of GDP (RM26bil out of a GDP of RM1,273bil).
- Declare a moratorium on further expansion of private hospitals to stop specialists from government sector leaving. Allow the private hospitals that exist to continue, but do not allow them to expand their bed capacity or to set up new branches. Do not approve new private hospitals for now.
- Create a separate Service Commission for government healthcare workers and adopt the pay scale that IJN uses to make government service more attractive for health personnel. Provide a three-month sabbatical for specialists every five years of service in the government for them to pick up new skills.
- Do a forensic audit on how medicines, other goods and also services that are being purchased through third-party intermediates.
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