6th discussion (Jan 24, 2012 - On why govt chose to make the rakyat pay more instead of being responsible with taxes rakyat pay)
#taknak1care This
is a powerpoint slide (slide no.22) from a JANUARY 2009 presentation
called FUTURE OF HEALTH CARE FINANCING IN MALAYSIA by Dr Abd Rahim
Mohamad from the Planning & Development Division of the MOH. He
presented 2 options for healthcare reform. We would have chosen the 2nd
option. We think 99% of rakyat would too. Wouldn't you? But in the next slide of the same presentation, it becomes clear that the govt really has only 1 option in mind - make the rakyat pay more for the same thing.
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- #taknak1care The rest of the slides (24 until 35) go into great detail outlining the proposed financing mechanisms and implementation process. It's obvious that the govt is NOT considering any other option except making the rakyat pay more. Only the amount and the timeframe has not been confirmed yet.January 24 at 11:55am · Like
- Nuraini Arsad i don't mind further integration of public-private, if it improves outcome. the structural plan seems fine, but it is the funding proposal/system that seems questionable. i just don't like the idea of extracting more funding from citizens when, globally speaking, we are currently spending less of our GDP on healthcare as would be expected for our development status. it seems that we can cut some other ministries' expenditures, have better government procurement practices, etc. to make available the funds for healthcare from existing taxes.January 24 at 12:16pm · Like · 2
- Sharifuddin Abdul Latiff Yup. Cancel the RM9 billion SGPV order which is not even LCS class.January 24 at 12:19pm · Like
- #taknak1care Nuraini Arsad Exactly what any rational person would be thinking of first. Exactly what we are pushing for. And exactly what the govt refuses to anything about in favour of establishing SHI. We have some theories as to why that is...we're compiling the documents and will present at a suitable time. Tune inJanuary 24 at 12:29pm · Like
- DrChow Steven So what is wrong with our current healthcare system:January 24 at 2:39pm · Like · 2
- DrChow Steven Lack of integration
Changing pattern of disease pattern and socio demography
Greater expectations from public
Dependency on government subsidised services
Limited appraisal and reward system for performance
Conflicts of interest
Accessibility and affordability
Limited coverage of catastrophic illnesses
Private spending for health overtaken public since 2004January 24 at 2:39pm · Like · 4 - DrChow Steven This is what the MoH had said. But how does 1Care address this??January 24 at 2:39pm · Like · 2
- DrChow Steven The rakyat and the doctors would like to hear and see the detailsJanuary 24 at 2:40pm · Like · 2
- DrChow Steven 1Care is beyond teh state of conceptualisation.January 24 at 2:46pm · Like · 1
- DrChow StevenThe blueprint for implementation is being worked out .Technical working groups have been called to put in the nuts and bolts. The train to Everest have left the stationJanuary 24 at 2:48pm · Like · 1
- #taknak1care Reply from Datuk Dr Hisham Abdullah (Dep DG of MOH)
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 2:53pm · Like · 1 - #taknak1care Reply from Datuk Dr 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 2:54pm · Like
(Note: Again the DDG is contradicting himself saying there's no blueprint, only exploring concepts.) - #taknak1care Reply from Datuk Dr 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 2:54pm · Like · 1 - #taknak1care Reply from Datuk Dr 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 2:55pm · Like · 1
(Note: The DDG's entire hypothesis seems to be based on the premise of an entirely privatised healthcare system, which Malaysia does not have. So why base a "solution" on a situation that does not exist? Or is it that the govt really wants this "solution" so it needs to create a situation that needs it?) - #taknak1care Datuk, with respect, we will be blunt. Taknak1Care does not mean tak nak reform. All right-minded rakyat are thirsting for reform in many Malaysian matters and waiting for the govt of the day to bring it about. But the reform that the rakyat wants is to rein in govt corruption / wastages / leakages and privatisation policies which have given the rakyat little in terms of cost/benefit but greatly enriched the well connected few.
Thus, taknak1care simply means tak nak the kind of reform that does not tackle the root cause of inefficient healthcare, requires mandatory social health insurance, corporatisation of public healthcare, GLCs running the show and rakyat not having a choice / say in the matter.
With respect, Datuk. January 24 at 3:12pm · Like · 3 - #taknak1careWe do acknowledge that the level of service has improved in govt facilities, thanks to the efforts of the MOH. But then, isn't it the duty of the govt to ensure taxpayer's money is spent well in the first place?
I'm sorry, but to the rakyat, such improvements should not be something to be proud of - it should be a badge of shame that the govt has been such terrible stewards of taxpayers money for so long that it can no longer remember that once upon a time, Malaysian govt services were among the best in the region!
A return to high standards is indeed a welcome move. But it is now greeted with suspicion because it is done with the intention to prepare for the eventual corporatisation / privatisation of the entire Malaysian healthcare system.
I'm sorry Datuk, but the rakyat have had enough of privatisation policies.January 24 at 3:13pm · Like · 4 - Raj Kumar Maharajah Most Doctors I speak to are either unhappy or unsure of what 1Care is instore for them. The public is being kept in the dark.January 24 at 4:06pm · Like · 2
- Suthakar Balan What I feel is this going to be another PPSMI, rakyat kept in dark, sudden onset of implementation, failure of the system will be noted and gradual withdrawal of the system after few years with wastage of billions n billons of ringgit and they will say"MEMARTABATKAN KESIHATAN RAKYAT DAN MERPERKUKUHKAN KOS RAWATAN " AND causing confusion to public which on to use 1care or existing system, like what is happening in certain schools they can useBM, BI. It is up to the principle to decideJanuary 24 at 9:19pm · Like · 4
- #taknak1care Suthakar Balan When was the last time you saw a corporatisation / privatisation exercise reduced in Malaysia? Never right? That's why we the rakyat got to fight tooth and nail to make sure 1Care never materialises.January 24 at 11:54pm · Like · 3
- Suthakar Balan #taknak1care, I am with you to fight against 1care,January 25 at 9:00am · Like · 4
- DrChow Steven Sorry Datuk Hisham, your comment on GPs is unfair. I do not agree with your comments about our GPs. I know many GPs in my many years with the Federation.
This is the usual standard operation procedure of “GP-bashing” when one wants to find fault and look for convenient excuse to intervene. The GPs system of this country have done an excellent job. They handle >60% of all the outpatient visits. Patients get treated appropriately with minimal hassle, minimal waiting time. Clinics are open at time convenient to patients and the community. Cost is reasonable and is the cheapest compared to all the Asian countries in the same level of socio-economic development. Patients have a choice of which doctor they want, who they trust and who can give them the care and comfort in time of illness. If their quality of care is not up to the mark, they will be dead wood in the free market.
Of course there are bad guys around and they are the minority. Surely you PHFSA can take care of that without having to demolish/dismantle the whole system.January 25 at 8:57pm · Like · 5 - DrChow Steven Once again, Datuk Hisham, I must disagree with your observation.
We have not forgotten how the Private Healthcare Facilities and Services Act 1998 and Regulations 2006 were just laid upon the private medical community the fateful day of 24.4.2006. The so-called engagements were just not there. Every time we asked, we were told that the regulations were not yet ready so there was no need for any discussion till then.
We remember also the jailing of Dr. Basmullah for failing to register in time under the Act. How on earth can a duly qualified doctor, registered with the Malaysian Medical Council dutifully working as a simple general practitioner for the past 20 years should suddenly on 1st November 2006 become an illegal practitioner, arrested and hauled to court to be slammed with a RM250K fine, failing which he was sentenced to a jail term of 3 months.
Yes, we were told that the Act was never meant to criminalize doctors and their practice but to control quacks, charlatans and their likes. It was to regulate the “business of medicine”. When it over and done with, even the ex-Minister of Health during whose watch the PHFSA was enforced, was to confess that “it was not meant to be that way”.
Today we see enforcement officers appearing clinics during the busiest and inconvenient hours demanding inspection and ordering doctors and staff around with loud and abusive voices.
I am sorry Datuk Hisham, we are actually seeing transformation for the worse at the ground level. We tell our members to be prepared for the worse. Sorry Datuk, doctors are indeed terrified and fearful of criminal punishment for administrative failures in their practice. We wish all officers in the MoH are as compassionate and understanding as you when it comes to the crux.January 25 at 8:58pm · Like · 8 - Raj Kumar Maharajah its unfair to do a colonoscope and OGDS at the same time on anyone without explaining the procedure and taking consent from them first, thats what we learnt in medical school...but how come the Govt can do it to doctors and the public ?January 25 at 9:03pm · Like · 1
- DrChow Steven With 1Care, the present robust, cost-effective,independently- run GP clinics will be completely demolished and be replaced by a single contractor ie the 1Care clinic. Patients' choice will be curtailed, cost will go up, waiting list and consultation by appointment will be the order of the day (as in the NHS GP system); dispensing will be separate- patients debilitated by days of high fever, mothers with sick children in tow will have to lug themselves across hot dusty traffic-jammed streets looking for the nearest pharmacist for their medications. And it is not for free as you would have already paid upfront and there will be co-payment (OOP) as well and if you don't like the cheap not the original medications, you have to pay for your medicine of your choice,January 25 at 9:24pm · Like · 2
- Raj Kumar Maharajah i dont understand what is wrong with the current system we have ?January 25 at 9:28pm · Like
- DrChow Steven Why on earth must we go around destroying the robust primary care system that has evolved over the past 60 years in this country?A good GP with one clinic staff can look after thousands of patients at minimal cost in good times and in bad. Waiting time is minimal, patients are seen and treated in one stop, administrative cost is minimal. If he is a bad guy, free market forces would have closed his practice long ago.We must treasure this system, not dismantle it. Why don't the MOH do a nation-wide survey and see what the patients want?January 25 at 9:30pm · Like · 5
- Suthakar Balan Too many medical schools, too many production of doctors, the gov at present unable to cope n also in future . 2009 ho = 700, 2010 ho = 7000 ++, , 2014 HO = ??10,000, only way gov can rid of this mess is 1care, by giving burden to doctors n rakyat.January 25 at 9:43pm · Like
- Raj Kumar Maharajah A GP works 14 to 24 hrs a day. Sees any cases at anytime without any appointment needed. Consultation at RM 6 for kids and RM 10 for adults. Can 1Care offer anything better than this to the Rakyat ? The Govt should not play hide n seek with health and education. January 26 at 12:20am · Like
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