First Discussion (Jan 22, 2012 - Re: Existence of 1Care)
_#taknak1care Still thinking 1Care is a fantasy or hearsay? Have a look at this:
United Nations Development Programme
Country: Malaysia
Project Document
Project Title: 10MP/NI56 - 1CARE FOR 1MALAYSIA – SUPPORT FOR BLUEPRINT DEVELOPMENT OF THE HEALTH SECTOR REFORM AND TRANSFORMATION
Executing Entity: Ministry of Health
Implementing Agencies: Ministry of Health
http://www.undp.org.my/files/editor_files/files/UNDP%20prodocs/1Care%20Prodoc%20Final.pdf
Replies:
United Nations Development Programme
Country: Malaysia
Project Document
Project Title: 10MP/NI56 - 1CARE FOR 1MALAYSIA – SUPPORT FOR BLUEPRINT DEVELOPMENT OF THE HEALTH SECTOR REFORM AND TRANSFORMATION
Executing Entity: Ministry of Health
Implementing Agencies: Ministry of Health
http://www.undp.org.my/files/editor_files/files/UNDP%20prodocs/1Care%20Prodoc%20Final.pdf
Replies:
- Hisham Abdullah 1care is no fantasy, KKM is studying the healthcare transformation and looking into various model. We need to look at the strength and weakness of healthcare system and guided by WHO to come up with the model. We should not reinvent the wheel and at the end of the day the healthcare transformation must be better than what we have today.January 22 at 5:02pm · Like
- Hisham Abdullah Little can prejudice the healthcare transformation and change for a better efficient public and private system more than fear and doubts in its implementation. As such we the public and private healthcare professional should consolidate and integrate our effort to see through the implementation to be transparent and accountable in every areas. We shouldnt politicise this but give input and our concerns if needed be. We have been talking on this for the last 20 years and we have to change for the better regardless who is the government of the day.January 22 at 5:08pm · Like
- Hisham Abdullah One care transformation already started in MOH. The first step is strengthening of the existing public healthcare system, otherwise we may not be able to compete in quality and facilities. We have implemented the retention package for our doctors to reduce the brain drain, started looking at decongestion of the hospitals by emphasising on services like daycare, Day of surgery admission, pharmacy via post, low risk Centers out of hospitals, satellite specialists clinic out of hospitals. One can see and feel the improvement and changes in the lasts 3 years. January 22 at 5:13pm · Like
- Hisham Abdullah We are in the conceptual stage and what we need to study is maximal healthcare package benefits with minimal cost and burden to the rakyat. Now in the public sectors we spend 16billion and only collect back 2 %. On the other hand we wouldn't want to burden the rakyat but looking at various options and models. At this point of time nothing has been agreed upon until everything have been agreed upon by the public and as such we need to studio the cost analysis. However there is already lots of assumption and speculation and bad branding of the system like this TAK NAK. I wonder where they pluck the figures from without substantive data to support.January 22 at 5:25pm · Like
(Note: How do you implement a transformation plan of something that does not exist yet? Datuk Dr Noor was never able to answer this question clearly. - #taknak1care) - Jamalul Azizi Datuk Noor Hisham Abdullah: I must admit I did not know much about ICare till I read your posts here. I am aware that at least GPs are concerned about ICare. I trust that MOH can allay their fears.January 22 at 5:32pm · Like
- Hisham Abdullah It's not easy to bring change to a society, the fear of the unknown, let alone talk in the implementation. Healthcare involve everyone in this country and we MUST ALL come hand in hand, consolidate of team effort to see healthcare is equitable to all, Rich or poor in this country. However I totally agree with the concern of accountability and transparency of the implementation and as such we all must be the stake holders to monitor the performance of the implementation.January 22 at 5:56pm · Like
- Hisham Abdullah Nonetheless if our intention is to create doubts and fear of the worst in implementation, do we stop to change? Do we accept not to improve the system until when the day comes the existing collapse completely? Chine being a socialist country has transformed in the last 20 years and here we are still lag behind time.January 22 at 5:59pm · Like
- Jamalul Azizi Datuk, Can I share your thoughts with other colleagues? ThanksJanuary 22 at 6:01pm · Like
- #taknak1care Datuk Noor Hisham Abdullah, thank you very much for engaging with us. The information that we have posted here were provided by doctors who have attended various briefings organised by your ministry. While we concede that nothing is written in stone as yet, we have read the various proposal documents. Like you, our concern here is to ensure that the Rakyat get the best deal in terms of medical care.
We do hope that we will be able to continue engaging with you and the Ministry of Health. We also hope that the parties responsible for drafting the final form of the national healthcare scheme will take on board the views of the Rakyat. After all, we are all stakeholders in any national healthcare scheme that is introduced and implemented.January 22 at 6:05pm · Like - Hisham Abdullah In one care the rakyat will have the choice to go to the public system or the private system. The it's based on merits. More patients will be off load from the government system back to the GPs as the gate keepers. Why do you think our hospitals get congested. First the cost is cheap and secondly the quality is improving, but more importantly the system itself was relevant in the past but may not be in the present. We continue to see patients year in and year out but continue to accumulate rather than discharge back to the gatekeepers. We have to be more efficient if we specialist say like me continue to see all kind of general cases it will be a waste of my talent and government resouces as I am train to do more difficult and complex cases not that I am not able to see general cough and cold. The system must improve to support good efficient practice bridging the gap between the public and private healthcare in this countryJanuary 22 at 6:06pm · Like · 1
- #taknak1care We are also concerned about the projected cost of healthcare with 1Care, said to be over RM44 billion a year. With the state of government departments and GLCs today, we want assurances that the bulk of the money will go towards providing the Rakyat with access to quality healthcare and not buying somebody condos and luxury cars. Please forgive the bluntness but you must understand our concerns for the future of healthcare in the country.January 22 at 6:12pm · Like
- Hisham Abdullah I totally agree with all your concern but we in the Ministry is looking into the concepts of implementation. Nothing has been decided and the rakyat will be the first to know, however we must give a chance for the new system to develop, as I said regardless who is the government of the day. But to put bad speculation and assumption is not going to help. Killing the change prematurely will be detrimental to us all. Give the system and blue print to develop assisted by WHO. Listen to facts not assumption and bad speculation. It's sad for me as a professional looking at means to improve the healthcare system before we could plan already shot down. Are you all saying our initiative is similarly to TAK NAK SMOKING? Please be responsible professionals to safeguard our healthcare.January 22 at 6:12pm · Like
- Hisham Abdullah We all agree that we need to increase the GDP to 6 % or so. Healthcare sector is the fasting and largest growing economy in the world. The public system spend 16 b and collect only 2 per cent and the system we have in place, the processes etc are not efficient. Who will want to invest in such economy when you only collect 2 per cent? Now if we ask the government to increae the GDP from 16 b to say 30 billion, again we will only collect 2 per cent. What is more important is the efficiency how we do things, more productive and based on payments scheme. Now if my quality of my centre improve to world class more patients we come to my hospitals thinning out my resources and low cost. However we don't want the patients to pay much but need to study the taxation, employers, civil servant etc. we will continue to pay for the poor.January 22 at 6:21pm · Like
(Note: What is the purpose of government hospitals if not to provide quality healthcare to those who cannot afford to private healthcare? Has the government stopped seeing healthcare provision as a social responsibility and now thinking only of getting a satisfactory ROI? - #taknak1care) - #taknak1care Absolutely, Datuk Noor Hisham Abdullah. We agree with you about the deficiencies of the current system and we support every effort to streamline it to ensure greater efficiency.
We are not here to create fear. Rather we want to bring the whole subject out in the open for discussion and scrutiny now. We don't want to see another Bill being rushed through Parliament, blindsiding the Rakyat.
That's why, we are extremely gratified that you have chosen to engage with us here. Thank you. We hope that you will use this page to share with us your work in progress as well as gain feedback from the doctors and patients you would otherwise not have the opportunity to hear from.January 22 at 6:22pm · Like - Hisham Abdullah With collection back to the healthcare in the public say 80 % we could increase public funding to 30 b and another 15 b in the private. This will be a good healthcare ecosystem to improve the quality of care and hopefully sustainable. We can talk this on concepts. January 22 at 6:23pm · Like
(Note: Firming up the quantum and implementation details is going WAY beyond the conceptual stage! And charging 80% of public healthcare costs that have risen drastically due to massive privatisation and wastages back to the public? Why doesn't the govt fix the problems it created in the first place before making the rakyat pay more and more?" - John Ng Is there anything wrong with the present system that a few extra dollars cannot fix? Is burdening the people with more taxes, the way to go? We have NOT made bad assumptions. A natiional social health system must mean more admins ( about 10% more ) to run the system. It must mean rationing of care, because access may be universal but treatment options are limited to packages, so not universal. All you need in the present system is to contain hospital cost, which you must with the national health system that you are proposing, BUT unwiling to do so now. We wonder why??? 90% of the private hospitals at the moment at government linked company owned. One circular from the highest office will control private hospital excesses. Doctors fees you have controlled by law.January 22 at 6:27pm · Like
- Hisham Abdullah I agree with you but as I said earlier we have not decided on the details. To scrutiny the details when we don't have t yet and we cannot pluck any figure without a proper study with concrete data in hand. If that is your concern let allow the consultant to do the study and see what cost benefits we can come with. Let me ask you how would you now in the present system refrain abuse to the system?? Cost is free anyone can walk into the hospitals bypassing the GPs. Once upon a time GP practise is lucrative and relevant now the role in gate keeping is compromised by hospitals doing primary care. January 22 at 6:28pm · Like
(Note: If congestion is the problem, the govt can very easily legislate gatekeeping without having to implement SHI.) - John Ng Anyway, I would urge you to presnt the MOH case on 12th Feb 2012 public forum. We just want the rakyat to hear both sides of the story, and then decide. GE 13 is coming soon.January 22 at 6:30pm · Like
- John Ng In this issue, we are also just letting the Rakyat know. We did not wish for the porridge to be cooked, taxes raised and then cry over spilt milk. In this issue, the rakyat, with your engagement, is now better informed. When the time comes to choose, they will know better and how to choose.January 22 at 6:38pm · Like
- Hisham Abdullah The first rule of management is to listen to our patients. We professional must come together to listen and see this through. United we stand divided we will fall. If its good for us, we should support as we are the gatekeepers of healthcare in this country, without fear or prejudice. All i am saying here is to give the system a chance to develop, let us all monitor the performance, give positive input, instead of fall short on talking for another 20 years. I am a trained endocrine surgeon. in our training Professor Khalid kadir advises us to be the thinking surgeon and we must understand the hormones, how to control and how to adjust according and once patient is well prepared then plan for the surgery. Likewise in healthcare transformation we are doing the same.January 22 at 6:39pm · Like
- John Ng Why fix something when it ain't broken, especially if it includes more taxes in these very difficult times. There are 40% of Malaysians out there living on RM 2,000 a month.January 22 at 6:40pm · Like
- Hisham Abdullah Are you all happy with the service that the government system only collect 2 % of the 16 billion a year? Are you happy that our system continue to be abused even by those who can afford, rich and famous? Do you think this system is sustainable even though if government continue to inject more funds to it? How can we improve efficiency in public system to avoid brain drain in this liberalise world.January 22 at 6:47pm · Like
(Note: What is the percentage of rich and famous abusing the cheap quality govt system? 1%? 2%? Do we need to reinvent an entire new system for that when some simple enforcement of regulations will do? - John Ng We agree that the collection must be better. BUT the poor collection is due to many factors, including political reasons NOT to collect. This must be studied and improved. Healthcare is a universal right. The brain drain, thanks to all your efforts, have slowed down to a trickle, caused sometimes by the push to leave.January 22 at 6:54pm · Like
- John Ng The system is sustainable. Please advise the cabinet to enforce a fees schedule in the private hospitals. The majority belongs to you. That will drop cost of private healthcare and patients will benefit. The public hospitals have improved, credit to you and your team. It could be better, but no need to up taxes, which will burden the people. Let us talk more at the public forum.You will have your say, I promise.January 22 at 6:57pm · Like
- Hisham Abdullah Again we are not saying to increase the tax. Unless and until you work in the public system then you can tell how to improve the system. Why fix it when it's not broken? Well when it's broken it's all too late for another national disaster. Why must continue to improve the efficiency and services based in merits and performance. Let me give you an example if I see ten patients a day in my clinic or if I see 100 patients I still get the same pay. Tell me about efficiency here. However if the patients I see is reimburse by healthcare the more patients I see the money incentives I will get will encourage doctors performance. However if we practice what we do is what we get then for some we may do all the unnecessary things and not discharge the patients. So we new capitation and indeed good regulator to make sure things are done as required. Performance monitoring based on quality. GMC has moved on from merely registration of qualification to additional performance monitoring. This is where we need case mix monitoring and ensure quality care to our public January 22 at 7:11pm · Like
(Note: Again, does the govt no longer think that providing healthcare is a social responsibility to taxpayers? Is profitbility and bottom-line thinking the driving force in government now?) - Hisham Abdullah The fee schedule is not the answer as this only covers the professional fees. Its the non professional fees we are equally concern. In US doctors fees perhaps less than 20 % of total professional fees.
January 22 at 7:20pm · Like - Hisham Abdullah Do you all think it's fair to have this tak nak logo in the first place? It's one believe and already embraced this of tak nak no matter what you say it's not going to change him or her. What is right is right even no one else believe in it, what is wrong is wrong even though everyone believe in it. We must not wrong the right neither can we right the wrong. Let's us all consolidate and be professional and keep our integrity high based on transparency and accountability January 22 at 7:36pm · Like
- Lilian Yong How is the government going to implement this system fairly without overburdening the approx 10% of rakyat that actually pay taxes? Anything that involves paying more taxes business is madness! gst is coming. Taxes are already higher than singapore or hk . govt should learn to manage its budget! Money is flowing out of the nation“s coffers from holes and loopholes greater than craters on mars. Corruption, inefficiency and the dirty stinking poticians will bleed the so called 1 care fund faster than....???!!!. borrowing money from epf, then now create 1 care fund so can borrow from that too...not falling for this.when corruption is eradicated, then talk to rakyat bout this. Before that, stop thinking bout new ways to korek duit rakyat. January 22 at 9:23pm · Like · 1
- John Ng That is our fear too. We are very worried of a government ponzi scheme, to get money under whatever excuses to cover account deficit holes, and we do not get whatever we are promised.January 22 at 9:45pm · Like
- #taknak1care Datuk Dr Noor Hisham Abdullah, thank you for taking time to engage us. Rather than reply again on this rather long thread, we have posted a new conversation. It would be goof if we could continue our discussion there. Thank you.January 22 at 10:57pm · Like