Frustration mounts over secrecy

During the forum on 11 Dec 2005, Coalition representatives expressed frustration over the secrecy involved in formulating the proposed national health care financing scheme.

Malaysiakini has carried a report with highlights of what transpired at the forum, organised by the Coalition:

Empty chatter irks healthcare coalition
Claudia Theophilus
Dec 13, 05 2:01pm

Even after a year of “regular discussions” with government officials, additional details have yet to emerge over the national health financing scheme, complains a coalition that is protesting the move. “We’ve been discussing this with health ministry officials for over a year now and it’s clear that the government is has yet to decide on the crucial aspects of the scheme,” said Coalition Against Healthcare Privatisation secretary Dr Jeyakumar Devaraj. “Even the list of illnesses in the essential health package is not ready. When we asked if heart disease will be included, the ministry said it is waiting for the consultant (to determine this).” Jeyakumar said the government is looking for a consultant to help flesh out the framework of the proposal, targeted for implementation in 2007. Mooted about 20 years ago, the scheme has yet to be finalised. Close to two million Malaysians comprising civil servants, senior citizens, hardcore poor and the disabled will reportedly be exempted from paying into the financing scheme when implemented. “Despite assurances of remaining fair and equitable with quality care for everyone, the government still intends for people to pay for healthcare. But it remains silent on the operational details,” he told a forum on ‘Health Financing Reform - Should We Be Concerned?’ on Sunday. About 120 representatives from civil society groups and individuals were brought up to speed on the proposal and the coalition’s counter-proposals. Copies of a dossier on the proposal and counter-proposals, official correspondence, minutes of meetings and news clippings were distributed. The half-day forum, jointly organised by the coalition and the Universiti Malaya General Staff Union, was held in Kuala Lumpur. Concerns about consultant Since the late 1990s, civil society groups have been insisting on full disclosure of healthcare proposals to thwart backdoor attempts that lack sound mechanisms. The healthcare coalition of more than 80 groups believes that a lack of information and transparency has left the proposed reform “full of holes”. Coalition chairperson Dr Subramaniam Pillay raised concerns over the source of funding for the consultant’s work. “It’s worrying that the government has chosen to accept United Nations Development Programme money for this, which means it will not be responsible for the appointment.” Subramaniam, a retired Universiti Sains Malaysia lecturer, said the arrangement could reflect the donor agency’s bias toward privatisation. “Also worrying is the lack of details as to how the consultant plans to consult Malaysians,” he said. He said one of the problems in the healthcare system is the mismatch between the number of patients and medical specialists in the public sector. “At the moment, government hospitals have about 75 percent of all admissions but only have 25 percent of local specialists, leading to poor quality of care in certain illnesses. “The government’s proposal touching on the private sector, including the introduction of private insurance, could come in at a later stage.” He blamed the exodus of doctors on such factors as piecemeal policies on creating private dispensaries and private wings in government hospitals, promotion of health tourism in private hospitals, and a hike in charges to be paid by migrant workers. Improving the pay and working conditions plus perks such as continuing education and training is the coalition’s answer to plugging the brain-drain. Subramaniam reiterated the concern over the imposition of premium payments, saying this would be impractical and that it could derail the health-reform agenda. “A mandatory monthly contribution is not practical as a large segment of the population is self-employed and not salaried. There will be administrative hurdles.” He said any health authority that is established must have the power to review contracts, access information and be provided with an adequate allocation to monitor the use of the health financing scheme fund. “It should be a transparent body established by an Act of Parliament with accountability ensured by representation of civil society groups.” Healthcare allocation During the discussion, participants called for checks on financial mismanagement and for procedural accountability. They said no one should be excluded from the system, including migrants workers, and suggested a Royal Commission on the National Health Policy to be established as part of a health sector revamp. Forum co-ordinator Dr Xavier Jayakumar said it is clear that people want an equitable healthcare system that does not impose a financial burden on individuals. “(For this reason), the counter-proposal recommends that the health budget be increased to RM16 billion.” It would mean raising federal spending on healthcare from 1.8 percent to three percent of the GDP. The World Health Organisation’s figure is 5 percent for developing countries. Other sources of revenue, he said, should come from taxes on alcohol and cigarettes, Petronas profits (about RM5 billion) and a proportion of the levy imposed on foreign workers (about RM50 million). Xavier said the forum participants will brief their respective organisations and provide feedback on the counter-proposals within the next few months. “We will hand over the final document to the prime minister and continue to dialogue with the government over the details of the proposed scheme,” he said. In the keynote address at the start of the forum, former health director-general Dr Abdul Khalid Sahan stressed that provision of healthcare is primary duty of the government. Relating how he had steadily opposed privatisation while in the ministry, he said the proposed healthcare reform should be undertaken as a project with specific terms of reference. “In view of the complexity of the exercise, it is best undertaken by an independent body external to the ministry. It would be a mistake to allow this to be taken in-house as another one of the ministry’s activities.” What Malaysia urgently needs, he pointed out, is a national health policy. “Two decades after the first study in 1984/85, and several years of subsequent related studies, we are still no closer to (having one),” he added.