3rd Discussion - (Jan 22, 2012 - On the need for 1Care concept of "reforms")
#taknak1care Many thanks for your learned response Datuk Dr Noor Hisham Abdullah, distinguished Deputy DG of MOH. To clarify, the admins on this page are a group of ordinary citizens concerned about the government's desire to implement 1Care at the ignorance of the general population. It's current provisions seem to be at apparent disadvantage to the rakyat, hence TakNak1Care.
If we understand your response correctly, the MOH is already in stage 2 (or 3) of the proposed 5 stage implementation process and nothing will stop 1Care's implementation. An online search of official documents show that the MOH's time frame for full implementation of 1Care is anything between between 2015 and 2020. That is very soon! All the more reason the rakyat have to be aware of what is looming ahead.
Although we agree that no figure has been officially announced yet, it is the structure of 1Care itself that concerns us. While we understand that healthcare costs are increasingly burdensome to government coffers, we are extremely concerned that new ways of taking rakyat money are being mooted instead of stemming the most immediate problem standing in the way of efficiency - billion-ringgit corruption and wastages that are hemorrhaging the country's finances.
If we are indeed mistaken, we hope you would be gracious to correct us with the concrete facts. We understand that there was a meeting with leading healthcare professionals late last year where certain concrete figures and flowcharts were presented. We also understand that all this was summarised in a Concept Paper. It would be great to know what is contained in that Paper so that the rakyat can judge for ourselves whether it is beneficial to us or not. After all, we are the ones who are going to pay for 1Care - through taxes and through direct contribution!
Otherwise, the rakyat cannot help but do all we can to look out for our own welfare.
Replies:
- Hisham Abdullah I agree with all your concerns and it is my concerns too but that doesnt mean we stop short and do nothing until the time comes t system collapse. We need strong public monitoring and engagement. We only have conceptual paper to develop it further likewise most countries are doing t same. We Must have transparency and accountability in implementation. Not a shadow of doubtJanuary 22 at 11:15pm · Like
(Note: this is contradicting his own statement that an implementation blueprint is being drafted, and senior MOH officials revelation that this blueprint is in the final stages of development!) - John Ng "We need strong public monitoring and engagement". That is precisely right. We all wish that. However, the government track record on these kinds of projects so far leaves much to be desired. I am certain that you will monitor for us. Even when this 1Care Healthcare Transformation, such an important project was first conceived and moved along, we were kept in the dark. My association and I were involved occasionally. Technical working groups ( TWG ) were meeting each not knowing what the other were doing, and non could see the overall picture, except for scratchy details that we pieced together from information collected here and there, to get us this far. We wished there were more transparency, and professional and public engagement from the beginning. Your engagement today is very good. We all learned a lot today, but many questions remained unanswered.January 22 at 11:44pm · Like
- #taknak1care Datuk, we are certainly very gratified that you do agree with all the points we have raised.
Reform is certainly very needed in this country - and not just in the healthcare sector. We have some ideas ourselves that could ensure 1Care's benefit to the rakyat. Unfortunately, even though the ordinary rakyat are the largest segment of stakeholders in the 1Care scheme and the ones who will have to ultimately foot the RM44 billion bill, we are not being consulted and our views are not being heard.
Given the many and deep concerns, would a public referendum be in order? Meanwhile we await eagerly the details of the Concept Paper, if you don't mind sharing it here. That would put paid all the various arguments about who's wrong or right about 1Care and accurately inform the public of just where they stand at the moment.January 23 at 12:46am · Like - John Ng We are very grateful to Dato Dr Noor Hisham for taking time to converse with us today. We have to date not seen any concept paper. Yes, if it is not too much to ask, maybe Dr Noor will share it here with us. A public referendum !@! How I wish.January 23 at 12:56am · Like
- Hisham Abdullah We only have started the first stage of transformation that is strengthening of the existing healthcare services. The second stage is to study various models assisted by WHO and professor William Hsiao and team. He is among the leaders in healthcare reform. Someone just said why fix it when it ain't broken. Now if the consultants said to us its a matter of time of current system will crack with all the predicted signs and symptoms, likewise you already have symptoms of headache from hypertension. Question is do we will till we have a heart attack or do we fix it to prevent a heart attack? Our job in second stage to to plan for a feasible and sustainable model with the principle of maximal benefits package impact but minimal cost and burden to the rakyat. Question is how do we do it. This is what we are in to study cost effectiveness of the one care system. Again nothing has been agreed upon until everything has been agreed upon then we will certainly have to table to the government of the day. That's the reason why we are now engaging to the respective relevant professionals in the TWG groups. Nonetheless it's premature for use to speculate and make assumption on things we have not studied with details plucking from the air like 10%
Your salary goes to the scheme. Today we live in a world we need data to substantiate what we say and do. Let us study this but if the government today subsided 98% of the healthcare we all want better quality and efficiency of healthcare system, be it in the private or public system. I would suggest rather we condemn the system give it a chance and even if we have the solution ready at the end of the day not necessary the government of the day has to decide and her you need a strong political will as healthcare in this country affects each and everyone of us. As for the professional we tended to consolidate and work as a team. As for the lay person you should not be deprived to seek public system healthcare but also private too. We need to narrow the divide bridging the gap between the public and private. All your concerns are real in the implementation and I have no issues on that. Public empowerment to see this project implemented well for the health of the nation. The government of the day will have to decide to embrace the new system or not. We have to look at all angles what i am saying at his point of time is unfair to bad brand the one care system likewise with the analogy of smoking, don't you think so?January 23 at 1:01am · Like · 1 - John Ng Yes, all your comments are very sound. Preventive care is always good. It prevents disasters. BUT, when we have to ask that we lower cholesterol to reduce heart disease and control hypertension to prevent str0kes, we had much much medical robust data, published in multiple reputable medical journals before we embark on such a billion dollar industry. You are a clinician, You understand that. However, in the issue of this 1 care Healthcare Transformation, it was shrouded in secrecy. Until you so kindly engage with us, we were trying very hard to piece together from talks, speeches, formal didactic talks, TWG sessions and " friendly" sources here and there. We do not have any data on why we must prevent and what are we trying to prevent. We are very concerned as it involves more taxes, on a very strained household income for many families.What more when we see the current situation performing satisfactorily. The government is even so impress with the present system that it is vigorously embarking on medical tourism, meaning that we are bring outsiders to use our system for profit. That must means that they feel that the present system is good enough. Why else will you do medical tourism? Adding to more taxes, we are also very very concern that our hard earned money may be "leaked" and wasted. We have many many times asked the government to stop the "leakages", without much success. Are we then to prevent a perceived (lack of data ) "inefficient system", worsen household income, and have the money leaked away. Should we not step back, improve the present through increase in healthcare budget with money currently leaking away. That will then not further burden the people.January 23 at 8:04am · Like · 3
- Hisham Abdullah Thank you for your posting. Yes I understand and agree with you some of the issues raised. They are real issues. In principle healthcare transformation must be better then the existing system in terms of quality of care, equity, universal coverage. Your real concern on the implementation for accountability and transparency goes without saying plus all the good practices. This is where we are and to talk further on details we have not reach there yet. We need to prepare a blueprint first. Study the details like you said it well clinical data following the in depth study. We are not doing this in secrecy and that's why we are engaging the professional to the TWG groups. The principle we need to look at is how can we come up with a maximal benefits package with minimal burden to the people. What is the cut off line of sustainability and what additional adjustment we can make. Again I thank you for the concerning implementation and I feel from this engagement this is the real concern.
However we in the public sector will focus in the step one transformation of strengthening the existing healthcare services in the public and hope the private will follow. We need to embark on quality care at every level. As I said earlier we are focusing on three areas. Retention program, decongestion program and smart partnerships at every levels. Some of our initiative is like pain free hospitals concepts combining pain as the 5 vital signs, minimal invasive surgery small scar less pain and acupuncture in pain management. Less pain means shorter hospitalisation, more daycare cases and introduce community services. Some hospitals in the public hospitals are receiving many referral from the private as well as from the regional countries. This is simply because of the quality of care and we need to address the cost, we shouldn't subsidise these group of patients. Payment is not an issue but unfortunately our public system is a subsidised one. We welcome medical tourism and will continue to support. If this is our forte we should go all out for medical tourism. Medical tourism is based on good quality of care and cost. At the end of the day you me and the public wants a quality healthcare system which is transparent and accountable, efficiency in deliveries with maximal benefits and minimal burden to the people. We have to consolidate and work together for this change be it in the private or public sector.January 23 at 10:48am · Like
(Note: Again, the question arises, does the govt no longer see healthcare as a social responsibility? Why complain about medical tourism and the wrongness of public hospitals subsidising the rich (tourists?) These are problems easily solved with govt regulations. Instead of that, the DDG seems more keen to monetise public healthcare - to be paid for by the rakyat through mandatory SHI, no less!) - Hisham Abdullah Happy Chinese New Year to all Malaysian. Xin Nian kueh leJanuary 23 at 11:23am · Like
- John Ng Great Dato Dr Noor. Strengthening the existing public hospital system will have all our support. We are very very proud that there is a static healthcare facility within 5Km of 90% of the population, I must say that in my experience, the public sector is now much better compared to 5 years ago. Strengthening the private sector needs minimal work. The issue here may be controlling fees or capping fees. Private Hospital fees as we have said repeated cannot be open ended- "the sky is the limit". There must be a profit, but there must be a cap too, like doctors fees. What more to say that 90% of private hospitals are government linked of which the government through Khazanah or PNB or KPJ. One circular from you or your office will effect a fees control, if you wish to. If you care to do that, the private healthcare expenditure will come down. At the moment, it is artificially inflated by the GLCs to meet their bottom line. Healthcare is a social responsibility. Profit CANNOT be the only motive. There must be compassion and mercy and social responsibility, just as doctors are asked to do. The private sector is very very happy to work together with the MOH to integrate even without a transformation. We are all under you. I sense that the public private divide is in many ways perpectuated by MOH and the public sector. Involve us in your work and discussion. Maybe appoint a private practice person into your ministry for excvhange of ideas and discussion. we like to work with you. Maybe it is our history. It is time to work together, even without any expensive 1Care Transformation.January 23 at 1:59pm · Like · 2
- #taknak1care FYI, Dr John Ng is speaking on behalf of the FPMPAM, whereas taknak1care is a civil society initiative.
January 23 at 2:39pm · Like · 1 - Hisham Abdullah I thank you for your comment. Yes indeed we have to come together as one. What we need is to off load our patients back to the gate keepers. Here we would like to involve all GPs as the gate keepers. When the government transformation of strengthening the services succeed the impact will be on the GPs if we have a dichotomous system example is when we introduce better facilities and care, better locum rates etc. on the other hand in the hospital setting we are try to decongest the clinic and admission. You only need to come to the hospitals if necessary, however now public are beginning to bypass GP and straight to consultant even for minor illness. We don't want the public to pay even if they see a GPs but from their health coverage. For example monitoring of the blood tests and follow up can be done by GP link to the hospitals. In essence we need to integrate, innovate and to me more efficient in healthcare deliver looking at quality, there is no issue on this but also on the cost. Going to government clinic and hospitals is almost free. Now if the public have healthcare coverage we will off load blood investigations and follow up with the GPs, come to government hospitals when necessary. Similarly the long queue in KK will reduce as patients have a choice to see the doctor in KK or GPs. We may consider implementing the coverage in stages. This has been a good engagement and perhaps we should have talks and discussion in this to take this partnership to next level. January 23 at 3:39pm · Like
- Hisham Abdullah On the issue of fee schedule we do have the revised fees to be announced soon. But more importantly it's the non professional fees that is escalating and doctors take the blame. In US of the total hospital bills the professional fee is only 20% of the entire hospital bill. We don't have a mechanism to regulate non professional fees. I hope we will not reach the situation in the US in years to come. Ther are many issues. We can discuss and innovate to improve the healthcare in this country. That is the first step of one care transformation. As time goes on we will see the need more than ever. I believe this will evolve over time. After we are professional and our medical fraternity needs to come together as one, transform for the people and from the people. Patient first and we need good performance in all sectors January 23 at 3:49pm · Like · 1
(Note: Yes, it is escalating due to massive outsourcing / privatisation of public healthcare support functions and profiteering of private hospital owners! Again, these problems can be easily solved with regulation. Why is the government not even considering this? Why the push for an SHI to cover the symptoms - rising costs - without treating the real cause - profiteering and privatisation?) - John Ng Well said, Dr Noor Hisham. We must indeed come together. Talking and discussing is always good, be it at Putrajaya Block E or in our KL office or any other suitable venue. On the issue of non professional private hospitals, I think it is the political will. A mechanism can surely be found. For example, I do not see the difficulty to draw up a fees schedule for the common admissions, limit the mark-up and cap fees. It is in many ways easier, as most of the private hospitals, as mentioned earlier, are government linked. On the issue of GP clinics, we in the FPMPAM were greatly surprised and the GPs were stunned, when the government, almost overnight, began opening up 1Care clinics in urban areas in the neighbourhood. The aim maybe nobel, but certainly discussions with and involving the GPs would have been reasonable, especially right after regulating the GPs with a new Private Healthcare Facilities and Services Act and its accompanying fees schedule. That did not score the government any brownie points with the GPs. Now we are again asking the GPs to trust the government.January 23 at 5:08pm · Like · 1
- John Ng But from this chit chat over facebook, we can both see that communication both with the public and with medical professionals could have been better. I am already getting very positive responses from my committee, encouraging me to engage with you more. We certainly look forward to having you Dato Dr Noor Hisham to be with us on the 12th Feb 2012, 4pm at the Global Business and Convention Center, to take up the discussion on this issue of Tak Nak 1 Care, organised by the NGO. I would also like to propose that the MOH involve the private sector more in their projects that involve health issues in Malaysia in general and private practice in particular. I thank you so much for talking to us.January 23 at 5:14pm · Like · 1
- #taknak1care Gentlemen, thank you for using this Facebook Page as a medium to vigorously address issues related to 1Care.
Whilst we are grateful for the productive exchanges, please bear in mind that the largest stakeholder group for the 1Care program is still the ordinary citizens, and not the medical fraternity. It is for the rakyat that this Page was created whereby pertinent questions and/or concerns can be attended to.
We have a few items in the pipeline which will be posted here for further discussions in due course. Stay tuned in.January 23 at 5:35pm · Like · 1 - John Ng I apologise. I got too carried away.January 23 at 5:37pm · Like · 1
- John Ng So sorry. Let us also hear the views of the public.January 23 at 5:38pm · Like
- Hisham Abdullah Indeed this is for the rakyat, the first step is the medical fraternity can come together and agree to issues and set the platform for discussion. More importantly is to understand the subject matter concerns and challenges in hand. At the end of the day rakyat must have the maximal benefits and quality of healthcare better than what we have today but with minimal burden on cost. That's the principle in hand.January 23 at 5:43pm · Like
- #taknak1care Thank you again, gentlemen.January 23 at 5:46pm · Like
- Hisham Abdullah Perhaps John Ng can organise a private discussion with your society, I am more than happy to share our future direction of healthcare and what we can do best for our rakyatJanuary 23 at 5:51pm · Like · 1
- John Ng Gr8 idea. Will forward suggestion to President FPMPAM. Thanks once again.January 23 at 6:17pm · Like
- Suthakar Balan Datuk Dr.Hisham Abdullah, Sir, Under 1care, there will be Primarycare physicians as a main gatekeepers, May I khnow what will happen to the existing GPs. Will they be addressed as Assistant Primarycare Physicians ?January 23 at 6:23pm · Like · 2
- #taknak1care Datuk Hisham Abdullah, thank you for engaging the ordinary rakyat here. Just to clarify: although Dr Ng has been most vocal, he speaks on his own capacity and does not represent the taknak1care movement. taknak1care only represents the interests of the ordinary rakyat, who are the most affected by 1Care.
We as concerned citizens have a few issues that we would like your input. If you don't mind, we'll be putting them up on separate threads so the discussion can stay focused and not be led astray into unintended topics.
Our first issue is going up if you would like to enlighten us.January 23 at 6:40pm · Like · 1 - Hisham Abdullah Yes agree but whatever we discussed earlier is very relevant to the people and is on one care transformation. I was explaining the first step of transformation of one care. Sorry if I have used you site to wish all Malaysian happy Chinese new year. January 23 at 6:46pm · Like
- John Ng Sure, You are perfectly right. I am speaking on behalf of FPMPAM, and not TakNak1Care, I will be happy to help if I can contribute. Thanks.January 23 at 6:47pm · Like · 1
- Hisham Abdullah Perhaps I have spent enough time here and thank you once again for allowing me to have the discussion.January 23 at 6:48pm · Like · 1
- #taknak1care Dr Hisham Abdullah we truly appreciate your input as it has clarified certain things about 1Care, which in turn has raised more specific questions that the rakyat would like answers to. We regret that you may not want to further discuss this crucial issue here, but we understand that someone of your esteemed stature may not be in the best position to answer them. We the rakyat will certainly continue to strive for the best solution for ourselves and work to ensure that the govt of the day commits to a truly fair and equitable healthcare reform. Thank you Datuk!January 23 at 7:37pm · Like · 1
- #taknak1care Suthakar Balan There is a proposal that all GPs (public and private) will have to undergo training to be 1Care certified. This is to streamline services offered as all GPs will provide a standard benefits package and be equally paid under 1Care. The information we have states they would be called Primary Healthcare Professionals (PHCP)January 24 at 11:08am · Like
- Suthakar Balan Thanks for the info, Last year I just completed Diploma in Fam.medicine under Academy of family Physicians. I had to struggle because of long working hours n less time to study. The next step is FRACGP, which really needs midnight oil burning. I wonder wheather these qualifications recognized by 1care?January 24 at 12:19pm · Like
- Hisham Abdullah Thank you for the posting, all GPs and FM physician public and private will come together as one. The training may be a form of continous medical education as what we learned in the past may be obsolete in the present likewise in surgery. Yes all will be considered. Thank you for posting the stages of transformation in you wall. I would like to explain this.
January 24 at 12:23pm · Like - Hisham Abdullah The stages of implementation 5 stages have started. We have talk on healthcare reform more than 20 years but at least we have started. The principle in hand is to increase the quality of healthcare in the public sector within the current existing system with minimal cost of course. So when I came to office we started the retention package to decrease the brain drain. It's is still ongoing and our doctors are generally happy but more to be done. Next to talk on quality and performance. If you read and do some research we have published on performance monitoring internationally. Here we introduce the. Decongestion program, addressing long waiting time, parking problems etc. we look in dept and introduced efficiency for example the pain free hospital concepts. Integrating pain as the 5 vital signs, minimal invasive surgery and acupuncture. We believe less pain shorter hospitalisation, more daycare cases, start community clinic and visits, introduce back Lowe risk centre out of the hospitals and simple surgery LA cases of of hospitals like cataract centre. Some are done I partnerships with NGO or with other ministry cutting cost. Now when the quality continue to improve we see more patients, longer queue in the public sector. Say if we have world class department or hospitals we will attract more patients rich and poor, locally, regionally and internationally. However even the foreigner pay minimum despite the first class charges as its a subsided by government. And the funding is limited January 24 at 12:33pm · Like · 1
(Datuk's comments from here on were actually replies to other threads so they may not make much sense to read here. We have reposted his replies in the relevant discussion threads and you can read them there or here if you like.) - #taknak1care Datuk Hisham Abdullah If you don't mind, we will post your reply on the thread itself for easy reference. Thank you for taking up the discussion with us again. Very much appreciated!January 24 at 12:41pm · Like
- Hisham Abdullah Even if I have 20% increase old of patients. So we introduce the case in to study the funding and quality are. For a specialist or doctor if I see 10 patients a day or I see 100 patients the salary is the same. If you are efficient you be given more work. This is the system we have now. With case mix we can see the performance and costing of the dept and hospitals. So now if depts and hospitals are autonomy as in stage two of reform funding will be based on the performance. Autonomy is not privatisation or corporatisation. So the more patients you see the more funding you will get from the GT. somehow in the current system if I see 200 patients last year and 200 patients this year, on follow up,is accumulating. Can you imagine if I am 10 years in service, we can't discharge to KK as they are already congested. Some of the regular blood monitoring, follow up and treatment can be discharged back to the GPs. Come to hospital only if necessary. That's the reason why we must get back the gate keepers. Otherwise we need more specialists in this country and less GPs. That's why we come to stage two and three of reform. The question is how best to do it with maximal benefits and impact to the rakyat and minimal cost and better still at I cost. I believe we have to make a difference is healthcare towards high qualitycare for the people. January 24 at 12:43pm · Like · 1
- Hisham Abdullah I believe in this transformation in stages and trying to make a difference to improve the healthcare in this country looking at quality, competency and performance. I am still practising as a surgeon and would like to see changes in a more cost effective way. We must have a system of reform with universal coverage and equity, with this reform rakyat may access to either a public or private hospitals based on their performance not costing. Today we are seeing more patients from private and regionally referring back to government hospitals January 24 at 12:53pm · Like · 1
- Hisham Abdullah John was talking on to regulate the non professional fees, yes it's a good idea but on what basis what evidence do we have to cap the rate? So we should introduce casemix study looking at the costing before we can implement this. For example you build a hospital at cost of 50 million and another at cost of 500 million, we can have the same rate can we but more important how to we set the standard of payment of non professional fees. This is what we need to study on.January 24 at 12:58pm · Like
- Hisham Abdullah I see there lots of questions and confusion. I must say reading and responding this has taken much of my time. But I hope to clear the air as much as I could.January 24 at 1:00pm · Like
- Hisham Abdullah Sorry for the typo error and self correcting textJanuary 24 at 1:00pm · Like
- Suthakar Balan Thank you Datuk , for your valuable explanations.January 24 at 1:13pm · Like
- #taknak1care Thank you Datuk for your time and effort. We would like to invite you to post directly in the relevant thread above (the one with the 5 stages implementation slide) as this is relevant to that topic. This is so that discussions stay focused and on topic. Thank you for understanding.January 24 at 1:14pm · Like
- Hisham Abdullah Yes I did the posting but after typing in the info it was lost. Not sure why after I click send. January 24 at 1:15pm · Like
- JooLee Tan Datuk Hisham, if you press the SHIFT key when you press ENTER, you'll be able to paragraph your thoughts.January 24 at 1:18pm · Like
- Hisham Abdullah Thanks for the info, my typing is obviously lacking behind my flow of thoughtsJanuary 24 at 1:25pm · Like
- Hisham Abdullah We have studied the NHS model, there is strength and weakness in the system. I have discussed this too with the royal college of physician. Three strength in this system is performance monitoring looking into quality and standard of performance. Mind you the famous doctor death has all the paper qualification but not performance. Question how do we measure performance? GMC now not only registered qualification but performance monitoring. This is following the Bristol incidence and more recently in Oxford too. The weakness is again long waiting list and they are addressing.January 24 at 1:54pm · Like
- Hisham Abdullah We can set up more hospitals and clinics with the noble intention for the rakyat. Now with good quality of care and performance more rakyat will come to public system. The intention is noble but what will happen to our GPs and gate keepers? Why can't we integrate them to the system? We can but it's now patients will have to pay out of pocket. In essence our healthcare must be based on quality and performance, we need to address the cost payment in GPs and private hospitals. We hope to achieve minimal cost better still at no cost for our rakyat to the private or public hospitals. I hope we can discuss and interact this issue intelligently and professionally ccertainly not by emotion and confrontation approach. I repeat nothing has been agree upon just yet, model and proposal can come and go, we need to study every model and proposal, the sustainability and feasibility. This is where we need to engage the professional and public if we have the blue print but we dont have yet. I am only sharing general conceptsJanuary 24 at 2:02pm · Like
- Hisham Abdullah Another question is can we minimise the cost. If the government continue to subsidise from the GT as what we have today to maintain the public system. If a policy is made in this country all employer must provide healthcare coverage to their employees the package form healthcare transformation under MOH. So all employees can seek treatment with the capitation to public and private perhaps one consideration. As I said it would be the best interest of rakyat to get the best quality care with minimal cost or no cost in public and private hospitals. Question is can we achieve this, can we sustain this system if so? If we need to pay minimal what is the minimal? Again question on accountability, transparency goes without saying. We do have fear, doubts and disbelief, let's explore this further, I would like listen and learn what and how best we can improve the system further. January 24 at 2:15pm · Like
- Hisham Abdullah One care is the name given to reform and transform the existing care in the public system. Reform in term of cost effective funding, qualitycare, improvement in service deliveries, efficiency is our facilities. Performance based monitoring and funding. Tak nak one care means tak nak reform. Reform must start in our public system in the existing system. First three stages of healthcare reform or transformation under this one care is in the public sector and we hope the private will follow in line with qualitycare. At the stage four addressing the issue of costing that's the main concern for all. At this stage we don't have the details in hand. As for me I will focus on the 3 stages in the public system, a nation working together for better healthcare.January 24 at 2:30pm · Like
- Raj Kumar Maharajah Datuk Hisham Abdullah, many GPs are worried as to what will happen post 1Care. I am in the TWG held monthly at the Academy of Medicines by some officers from MOH. However at every meeting things seem uncertain.We have been just discussing and discussing for about a year now and we are worried. We fear things will be just forced down our throat when the time comes.January 24 at 2:38pm · Like
- #taknak1care Datuk Hisham Abdullah and Raj Kumar Maharajah, we've re=posted Datuk's replies under the latest 2 postings above as it is relevant to the issues we presented there. Please continue the discussion there as this thread is deviating from the original topic posted. Thank you very much!
Datuk, again we are very grateful for your effort here. We will be posting a reply soon to further the discussion. If you don't mind, perhaps you can search this page's latest posts to continue the discussion? You don't need to reply this post, just click on this page's "Wall" section on the top left side of the screen and it will show the latest postings. Thank you.January 24 at 3:01pm · Like - Hisham Abdullah I hope John Ng will organise a session for me to talk to the GPs rather than discuss this here January 24 at 3:01pm · Like
- Raj Kumar Maharajah Datuk, I have spoken to D Mary Cardosa and she has agreed to hold a meeting at the MMA House tentatively on Feb 18th. The PPSMMA Chairman who also attends the TWG's is supposed to brief all of us at this meet. May be it would be good if you could attend too Sir ?January 24 at 3:05pm · Like
- #taknak1care Datuk Hisham Abdullah we have made a reply in the comments section of our latest posting on the page.January 24 at 3:15pm · Like
- Hisham Abdullah i am sorry i am not able to post my comments in your latest posting. as i have said earlied all your concerns are very real and they are my concerns too. The main reason i went into admin is for healthcare transformation for better quality of care, efficiency , cost effectivenes etc in MOH and perhaps for the nation. i will focus on the three stages of healthcare reform based on quality and performance, this will also involve the private sector indirectly. as i said all your concerns are real issues. at least at the end of my service i have tried my best to transform healthacre within my capacity.January 24 at 3:36pm · Like · 1
- John Ng Yes, exactly, our reps come back from TWG more confused then clear. Anyway, Dato Dr Noor, we keep emphasizing that the present system is good. We are all for performance based monitoring. GPs may need refreshing and must imbibe the CME culture. There is no need to re-certify them as some have suggested in the TWGs. We do need specialist to keep log books of what they have done and their outcomes. we are all for continual performance improvement. We do not need a whole system change for this.We mus minimise cost, especially in the private sector. As I have said before, it can be done. At one meeting, I even volunteered to do it. I understand that after that meeting, the Association of Private Hospital met with the DG to object.January 24 at 4:10pm · Like
- John Ng But the Public is very very keen to 1. Know what is in store for them. 2 Why we need to change, when the present is still serving us well, especially if the change means more taxes from the public. To them all those talks about performance is a medical performance issue. 3 They are concern about the cost of admin fees, and the ration of care, in the choice of care, the time of care and also the type of care. We are very very concern whether close public monitoring is possible and whether the government will engage the people and professionals before pushing through the 1Care Act, should they win GE 13.January 24 at 4:17pm · Like
- #taknak1care Datuk Dr Hisham Abdullah, believe us when we say we can understand your position. But the rakyat cannot accept to the 1Care framework that you are operating within. The framework / concept itself is the problem. We have posted a possible alternative healthcare model for the rakyat's perusal.January 24 at 4:36pm · Like
- Hisham Abdullah either way either system our aim is to improve the healthcare in line with qualitycare, in line witj maximal benefits and impact to the public and minimal cost. the model must be sustainab,e with the resources available. i am discussing on what the present situation of health redorm by strenthung the existing system, which is within our means to do so, stage 2, autonomus of depts and hospitals so as funding given based on performance of hospitals, cut wastages and improve effieciendy and competency. third stage, primary healthcare reform, public and private clinics funded by GT ti see and treat patients and in preventive medicine too. this 3 stages can be done and should be done with the current GT. we in MOH would welxome to listen to your comprehensive alternative of your healthcare model.January 24 at 4:45pm · Like
- #taknak1care Thank you Datuk Hisham Abdullah for yours and the MOH efforts in these areas you have mentioned. If Malaysian healthcare reforms focused on these 3 areas while also battling corruption, leakages and wastages within the system without resorting to making the rakyat pay more, there would be no taknak1care page. We wait with bated breath to see if the rakyat's will is honoured by the govt of the day.January 24 at 8:02pm · Like
- JooLee Tan What does CME mean?January 24 at 8:03pm · Like
- John Ng Continual medical education.January 24 at 8:05pm · Like
- Hisham Abdullah Well at least that is what I am going to do. The first three stage of one care healthcare transformation. As for stage four, as I said my principle is maximal benefits and impact to the rakyat with minimal cost but better still if no additional cost. This we have to study in dept on micro costing. If minimal what is the baseline of minimal in return for good quality care. I myself wants to know and what other alternative and options available to achieve universal coverage, equity and good quality care. January 25 at 12:08am · Like
- Hisham Abdullah Increasing the healthcare budget alone may not be solution for good quality care. Good governance, introducing casemix monitoring of quality and performance to get value for money, good return of investment, cut wastages are all the basic fundamental of healthcare enhancement. This is exactly what I am trying my best to do and indeed a tall order but at least I try to make a difference in the public system for the people. I am an establish breast endocrine surgeon in this region but I only benefit one patient at a time but if i can improve the healthcare in this country it will benefit the whole nation. Our vision is let us all one nation working together for better healthcare. If any of you have ideas, better ideas do share with me as I would love to listen how best to improve the healthcare in quality and performance in this country. January 25 at 12:17am · Like