If the government is serious about reforming health care, it would do well to listen to Parti Sosialis Malaysia (PSM) Sungai Siput MP and secretary of the national Coalition Against Health Care Privatisation, Dr Michael Jeyakumar Devaraj.
Jeyakumar (left), a chest physician, has spent his working life caring for some of the poorest people in Malaysia.
He served 16 years as a government doctor until, he says, local MIC strongmen exerted political pressure on government health officials to force him out.
He then spent 13 more years looking after patients, whether well-off or poor, in the private sector.
He has cycled to rubber estates to teach tappers' children, and has stood up for urban pioneers threatened with eviction.
He also spent a month in jail, under the Emergency Ordinance, as part of the authorities' ham-fisted efforts to discourage Malaysians from taking part in the Bersih 2.0 rally last July.
Jeyakumar told Malaysiakini that the government's proposed 1Care reform is incurably vulnerable to corruption.
"I honestly believe that we should not proceed with any reform with the present bunch of kleptomaniacs in office!" he said candidly.
"We need to have institutional checks and balances to (stop) the widespread pilfering of public assets before we allow the creation of a RM40 billion health fund."
The People's Proposal
The People's Proposal, a blueprint for health care reform, was drafted by 81 civil society members of the coalition way back in 2006, when foreign consultants were already drawing up new health care insurance plans.
The People's Proposal stated clearly that the Malaysian government must meet its responsibility to provide equitable and adequate health services to the rakyat.
The People's Proposal urged that the government health budget be increased to a healthier 5 percent of the gross domestic product, as recommended by the World Health Organisation.
As an illustration of under funding for public health, in 2008, government health care spending was barely 2 percent of GDP or RM14 billion. Compare this to RM14.7 billion spent, for example, on defence.
The People's Proposal also insisted that the government must involve civil society groups in the planning of any reform, to ensure accountability.
Any proposed national health authority must be transparent and must be established by an Act of parliament.
"The government's primary focus must be on strengthening the present public sector health care delivery system… comprehensive health must be available for all, irrespective of their ability to pay," the coalition urged.
The proposal also demanded that any "essential package" provided by a national health insurance fund for GP or hospital care "must include all treatment options available in the present public health delivery system".
This reasonable requirement has been met by vague and unconvincing assurances by the health ministry that all will have access to "basic care" packages, if the national insurance scheme goes ahead in the face of angry resistance.
Testing the waters
The government is currently testing the waters of public opinion with half-baked "consultations" with stakeholders – predominantly private doctors and pharmacists.
It has failed to meet any of the modest demands of The People's Proposal.
Private health care exploded in the 1980s, thanks to Mahathir's orgy of privatisation. Since then, 30 percent of Malaysia's specialists in public hospitals have been looking after 70 percent of the nation's patients.
Jeyakumar pointed out that improving public health care would reduce demand and spending for private treatment.
When asked regarding reforms to limit out-of-pocket (OOP) spending on private health care, he replied: "Easy! We should put a moratorium on the expansion of private hospitals. No new private hospitals, and no expansion of beds in the existing hospitals."
This reversal of Mahathir's privatisation efforts would certainly meet with resistance from crony companies linked to the ruling party, for they run chains of lucrative private hospitals.
But Jeyakumar argues this would "lead to the increase in the quality of care in the public hospitals as more of the specialists will stay back in the government sector… the 'push' or fear factor driving private hospital admissions will abate, and the prices will go down".
"The freeze of private hospital expansion would help reduce the 'pull factor', while improving service conditions in the government sector – best attained by setting up a separate service commission for government health workers (instead of having the pay fixed by the Public Services Department or JPA) – would reduce the 'push factor' for brain drain."
Some conscientious doctors, in private and public practice, agree with Jeyakumar.
Limited demand for expensive private care would always exist, they say, since some patients value choice and personal comfort above all other considerations.
"You can't discourage someone who wants to eat at a buffet at a flashy hotel every day," one senior doctor said. "But if you improve the funding and management in the government hospitals, you'd definitely reduce demand for private care."
There are other, more immediate ways too, besides 1Care to reduce government expenditure on health.
The abolition of the privatisation of hospital cleaning and technical services to Faber, Radicare and Pantai, and of cartels such as pharmaceutical supplies by Pharmaniaga and health screening by Fomema would slash costs.
Open tenders for companies supplying and building hospitals and clinics would make public health care far cheaper and safer.
But it is clear that Jeyakumar's proposals, and these lucid ideas for reform, are not the voices heeded by the politicians and corporations behind 1Care.
KERUAH USIT is a human rights activist – 'anak Sarawak, bangsa Malaysia'. This column is an effort to provide a voice for marginalised Malaysians. Keruah Usit can be contacted at keruah_usit@yahoo.com
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