Coalition expresses concern over role of private health insurance

The Coalition was finally able to meet Health Ministry officials to discuss the proposed National Health Insurance Scheme. Coalition representatives made it clear to the Health Ministry that the main "stakeholder" should be the Malaysian public and so their interests must be protected.

Here's what happened at the discussion:

Discussion Session with Health Ministry officials

9.00 am – 11.00 am, 27 Sept 2005 at the Health Ministry office in Putrajaya

Participants:

• Health Ministry (KKM):
  

Dr Normah, Timb Pengarah Perancangan & Pembangunan, Dr Rohaizat and Dr Mahani – all from Unit Perancangan & Pembangunan.

• Coalition Against Health Care Privatisation (Gabungan):

Subra (Aliran), Maria (WDC), Mohd Noor (PAS), Xavier Jayakumar (KeAdilan), Vinothan and Ng Soo Siong (MTUC), Nasir and Kumar (PSM), Kumarasingam and Devaraj.

• Urusihat (An association of MCOs dealing with companies):

Zulkifli Mohd (secretary) and one other person.

Important Issues discussed

• Subra started out by thanking the Health Ministry for arranging this meeting. Said that any change should not be hurried, and that the government must be open and allow discussion, and not push it through parliament. Should not privatise. Any change should improve health care for the rakyat.

• Dr Normah replied saying that

- there will not be any privatisation

- government has been studying for the past 30 years. So can’t say government is rushing.

- Will be very careful as health of the population is involved.

• Dr Rohaizat then presented a Power Point presentation

- A National Health Financing Authority will be set up to oversee the National Health Fund which will pay for both Out-patient and In-patient care from both government and private health care providers.

- The Objectives are:

o Risk sharing – therefore community rated

o Greater integration of public and private

o Better regulation of health care providers.

o Greater equity and accessibility

o Enhanced social solidarity.

o Benefits for all Malaysians.

o A win-win situation for all stake-holders

- The PM agreed to the scheme in November 2004, but asked that a consultant’s input be obtained.

- All the MPs were briefed on 23 March 2005. They have agreed!

- MTUC and FOMCA have been briefed and they have agreed.

• The Gabungan members then asked several questions (Answers by KKM in italics):

- Will Acute Myocardial Infarction be covered by the “Essential Package” that is mandatory for all?

o Not sure what the essential package is yet. Waiting for the consultant's report. But if not included then people will be still covered by the safety net.

o Gabungan objected saying that coverage must be comprehensive.

- When you have a third party payer, health care costs will increase exponentially. What are the mechanisms to limit this?

o Still looking at the mechanisms. Maybe will not have fee-for service. Might have capitation payments, or allocate funds to hospitals by “Case-Mix” data or use DRG criteria to determine payments. Also may have to use co-payments. Also concept of GPs as the gate-keepers. Waiting for the consultant's input.

- What is the role of private insurance?

o To make up the difference between what the Health Fund can cover for treatment in the private sector and the actual cost of treatment in the private sector.

o Gabungan protested, saying that this would expand the market for private medicine and aggravate the exodus of health care personnel from the public sector and thus weaken it further.

o Gabungan also pointed out that if the proposed new system was to respond to market forces then those with additional buying power at their disposal, i.e. the rich with their additional private insurance, are going to get better and preferential treatment.

- Who is the consultant? Can we meet him?

o The consultant has not been appointed as yet. The Terms of Reference for the Consultant have been drawn up and sent to the EPU, which will finalise it. The UNDP is providing the funds for this study. It is expected that the consultant will be appointed by the end of the year, and that he/they will take about a year to complete their study. Civil society groups will be given ample opportunity to give their views and feedback.

o How come the Health Minister and the DG have both said that the new scheme will be implemented next year, when the details have yet to be worked out?

o There are lot of “neo-liberal” consultants out there who will quite happily come and advise us to dismantle our health care system.

• The Gabungan members then made the following comments/observations:

- The major principles and objectives seem good. But there are no operational details. These details will determine whether or not the new scheme has a chance of achieving the objectives.

- What you have sketched out is a major change of the health care system in Malaysia. This has to be discussed at depth with the public as well as with the health care providers.

- There is already a 3-tier system of medical care in Malaysia. We are afraid that the new scheme will make this worse.

- You cannot talk about a win-win situation. If the rakyat are to benefit then they must get good care at reasonable costs. Therefore the earnings of the health care providers, the private hospitals, health insurance companies all have to be capped.

- You cannot say that you have taken 30 years preparing for the scheme. Your various studies have all remained official secrets. The public knows very little. Even now, the basic operating details are not available.

- Calling everyone “stakeholders” misrepresents the situation. All stakeholders are not equal! The needs of the one stakeholder – the rakyat – should be the main determinant of any future health scheme.

- We want to be called for any further dialogue – we represent a large number of civil society groups - so we should be invited. We are prepared to come.

- We appreciate that you have the best interest of the rakyat at heart. But are you guys really in charge? We think that there are powerful corporate interests who can influence the cabinet to make certain decisions and overrule you guys in the KKM.

The meeting ended with Subra telling the KKM officers that the Gabungan isn’t opposing for the sake of opposing. If we are convinced the new scheme will be better for the rakyat than what we have now, then we will support it. So, if the officers in the KKM are also for the rakyat, then they should consider the Gabungan as their ally – we can raise issues and ask questions that civil servants cannot.