If the Health Minister doesn't know, then who does?

Very strange. Health Minister Chua Soi Lek doesn't seem to know anything about the consultants who are supposed to look into the proposed health care financing scheme - or so he says. He doesn't seem to know anything about their terms of reference either. Apparently, the matter is in the hands of the Economic Planning Unit (EPU), which comes under the Prime Minister's Department.

Changes in the way health care is going to be financed will affect the entire delivery system in the country. And yet the Health Minister does not know what is going on? Unbelievable.

Chua says:

“No consultant has been appointed. We’re still looking at the (TOR). I will let you know when the time is right.”

But the EPU said on 24 January that the consultant was expected to start work in February. So which is which?

Here is the Malaysiakini article in full:

Healthcare scheme: Minister in the dark?

Claudia Theophilus

Feb 15, 06 10:43am

Health Minister Dr Chua Soi Lek adopted a defensive stance when he was asked for an update on the National Healthcare Financing Scheme at a press conference in Kuala Lumpur yesterday. He also flatly denied any knowledge pertaining to the appointment of a consultant for the project or the stipulated terms of reference (TOR). The Economic Planning Unit (EPU) in a letter dated Jan 24 to the Coalition Against Healthcare Privatisation, a group of 81 non-governmental organisations, trade unions and political parties, had revealed that consultancy work will begin in February. “Then you ask the EPU since you know more than me. You can even ask my KSU (secretary-general)... he will not know,” Chua retorted when told of the letter. “This (healthcare financing) is not a new issue. It has been discussed for over 20 years. Are you aware of that?” he asked the journalist concerned in an irritated tone. The coalition is firmly opposed to any privatisation of the country’s healthcare services and its attempts for details of the proposed scheme have met with continued silence. On Dec 14, the group wrote to the EPU for a copy of the TOR but was rejected on grounds that it was a classified document. Pressed for the TOR, the minister said: “No consultant has been appointed. We’re still looking at the (TOR). I will let you know when the time is right.” Right and wrong On what he considered as the right time, he replied: “Your questions are not wrong but your timing is wrong. The place is also wrong. “This is not the right forum. If I start talking (about this now), then we’ll be stuck here until 1am,” he said to laughter from state health directors who were also at the press conference. Ministry secretary-general Dr Mohd Nasir Mohd Ashraf and health director-general Dr Mohd Ismail Merican were also present. When pushed for a firm reply, Chua’s curt answer was: “If you persist, I will say ‘I don’t know’ and I will stand by it.” His was clearly reluctant to field questions on the national healthcare financing scheme and his answers were punctuated with a series of “I don’t know”. “I will not talk about this (scheme) now. I will not answer any questions on this,” he declared right at the start. Asked when the scheme will take off, he said: “I’ll let you know when the time is right.” On a question over the expected time-frame, he replied: “My response is, we’ll make it public at the right time. See, you want to know everything about us.” He said the government should not be expected to respond to “every other question” raised by the coalition. “They have been to my office. We’ve had discussions with them on this. We cannot be responding to questions as and when they think of it.” Politicising healthcare Appearing upset, he then tried to shift the focus to a new training module aimed at instilling courtesy at service counters that was launched at the Institute of Health Management here. The coalition has actively sought official response on several issues including how much control the government will have in determining the form of the new scheme, who the stakeholders will be and the consultant’s TOR. On Monday, over 20,000 leaflets were distributed by the coalition in a protest campaign at nine general hospitals nationwide in a move against the privatisation of healthcare services. Asked for comments, Chua blamed “some quarters and opposition parties” for politicising the issue. “It is not our intention to privatise healthcare. What we are saying with regards to allowing for private clinics in government hospitals is to prevent abuse by the rich at the expense of the poor,” he explained. He said out of the 10,000 government doctors, less than 20 would be involved in the project at the pioneering hospitals in Putrajaya and Selayang. “I don’t understand how this could affect public healthcare as claimed. Priority (for treatment) is not given to private patients but is based on clinical considerations,” he added. There are plans to extend the pilot project to all government hospitals if it is successful in the pioneering facilities.

Chua's response to blitz raises more questions

Health Minister Chua Soi Lek has responded to the Coalition's leafleting blitz yesterday by arguing that the proposal to allow government specialists to provide private treatment to patients after working hours does not amount to privatisation.

He said it is to help the specialists earn more money, optimise their professions and skills, and stop them from being "abused" by patients who can afford to pay for their specialised services.

Saying some non-governmental organisations and opposition political parties are politicising the issue, Chua explained that the country has about 10,000 government doctors and only fewer than 20 may be entitled to offer private treatment only at the Putrajaya and Selayang hospitals.

He said the move has yet to be implemented and it is still being discussed.

"Thus, it is impossible for the coalition to say the move will affect the training provided by the specialists to housemen and the quality or standard of a hospital," he said.

Chua said the ministry will also have guidelines for specialists who will be involved in the business to ensure private patients are not given priority.

He said priority will only be given based on clinical condition or specific requirements by the patients.

"There are rich people who go to the hospitals to have operations and it is reasonable to make them pay more.

"For example, a liver transplant operation will cost around RM3,000 in the Selayang Hospital.

"The same operation will cost around RM200,000 in private hospitals," he said after launching courtesy courses and training modules for the ministry's service counters.


Read the full article from theSun.

Chua says that only 20 specialists (out of 10,000 government doctors) will be allowed to offer private treatment, but remember, the two hospitals involved, Putrajaya and Selayang, are part of a pilot run, which may later be extended to other hospitals.

At first glance, the proposal to allow government specialists to provide private treatment may not look appear like outright privatisation. But it is privatisation in the sense that the government is privatising the financing of the wage increments for these specialists.

Instead of increasing health care spending from the pathetic 2 per cent of GDP to 5 per cent as recommended by the World Health Organisation (thus allowing government doctors to be paid more), the government wants patients to pay more.

If the experience of other countries is any guide, patients will still have to put up with long queues to see government specialists. But more affluent patients will most likely be able to cut the queue by enlisting for "private treatment", which will enable them to obtain prompt treatment from the same specialists. These more affluent patients will most likely also be able to "choose" the most experienced or accomplished specialists. Will this be fair to low-income patients who will have to settle for inferior treatment? Can the Ministry guarantee that this won't happen?

This mentality of asking patients to pay more (instead of increasing budget allocations) reveals the neo-liberal mindset of the government. This mindset can be seen in several moves over the last 14 months to push the health care financing burden on to patients, namely:

- the proposal to set up private dispensaries in government hospitals;
- the proposal to get foreigners (including migrant workers) to pay first-class rates in government hospitals; and
- the budget focus on boosting health tourism in the country.

Coalition activists blitz hospitals with thousands of leaflets

In a coordinated blitz, Coalition activists launched a lightning leafleting campaign at nine government hospitals today, distributing more than 20,000 leaflets to patients, hospital staff, visitors and other passers-by.

Activists distributed the leaflets in general hospitals in Penang, Perak, Kuala Lumpur, Kedah, Negeri Sembilan and Selangor. The leaflets titled "Do Not Destroy Government Hospitals" expressed alarm at the move to allow government specialists to provide private treatment to patients after working hours.

The public were urged to send their complaints in writing to the Prime Minister and the Health Minister.

Read the full report on the leafleting blitz by the Barefoot Journalists blog.

Privatisation by other names

Civil society groups worry that private sector interests will soon dominate the country's water and health care sectors and burden the public -- despite government assurances that these areas will be spared privatisation.

Authorities are busy revamping the way these two sectors are managed and financed, and the coming months will be crucial as blueprints and enabling laws are formulated.

See this IPS article