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Who is calling the shots in health care?

The Coalition met Health Ministry Director General Dr Ismail Merican in Putrajaya on 14 March 2006. The meeting started with Ismail citing time constraints to the "star-studded" cast from the Coalition, giving them just one hour to cover all the issues.

There were around 40 people in the room - 30 from the Coalition and 10 from the Health Ministry and department. With the clock ticking away, it appeared from the start time was going to be a major constraint.

The Coalition members were led by some doctors - medical as well as PhDs. Among them were Datuk Devaraj (former MMA president), Dato Kumarasingam (former director of the Health Ministry's Pharmaceutical Division), Dr Chan Chee Khoon (Citizens' Health Initiative), Dr Xavier Jayakumar, Dr Mariam, Dr Nasir Hashim (PSM Chairperson), Dr Subramaniam Pillay (Coalition chairperson and Aliran exco member) and Dr Jeyakumar Devaraj (Coalition secretary). Also high profile were NGOs representatives led by the MTUC president himself, Syed Shahir. Other organisatons present included the Oppresed People's Network (JERIT), WDC, Suaram and the Nurses Union. Most of the major opposition parties' representatives were also present - from PSM, PKR, PAS and PRM.

DG defends full-paying patients' scheme

The Health DG had his own team of experts. Ismail Merican started with an attack on the media for not writing the facts. He started by explaining that there was no privatisation plan but just “full paying patients” and that they are undertaking a pilot project to determine the feasibility of the proposal. A pilot project is a pilot project, he said, and there is nothing to worry about. He said specialists won’t be tired; they cannot impose their own charges; they have to follow rules and conditions. He said that his Ministry is a caring Ministry - but then he imposed a strict time constraint on the discussions that followed.

Coalition raises its concerns

The floor was then open to the Coalition partners who spoke one after another starting with Xavier. Xavier stressed that health efficiency would be compromised with the new practice; he asked why there was a need to double-tax paying patients; why not just spend more money on funding the existing system?

Syed Shahir from the MTUC and Joachim Xavier from the Penang Office of Human Development (POHD) raised the issue of migrant workers having to pay much higher fees. Syed said that, internationally, it is an embarrassment the way we treat our migrant workers. Joachim added that the country was actually profiting from migrant workers - but his contribution was stopped short by the Ismail, who said, "Next?"

S Arutchelvan from PSM said that it appears that the government is washing their hands off its responsibility and is more interested in health tourism. The DG was definitely irritated with this remark. Koh Swee Yong from PRM and Maria from WDC also shared personal experience on how patients are suffering in government hospitals.

Other very straightforward questions were put forward: Have you done a study on the University Hospital? have the consultants been appointed? who are they? how are you going to segregate patients between paying and non-paying patients?

Ducking the issues

Then the Health Ministry officers responded. They said that their first-class rates had not been raised since 1982, to which Subramaniam, the coalition chairperson responded, "Who is stopping you from raising those?" The Coalition is more interested in the well being of the lower- and middle-income group, he said.

The Ministry officials continued to brief the meeting about disciplinary action that had been taken against doctors. But when pressed, they conceded that so far no government doctors had been dismissed. They also said that if a private doctor refers any patient, irrespective of the patient’s socio-economic status, they would be immediately told to pay first-class rates. If they are unable, then they can apply to the Fund. At this point, the participants were quite resigned as everyone knows how 'efficient' these Funds are.

But when more pressing questions were put up, the DG kept saying that these are cabinet decisions especially the proposal for private wings. He said no study has been done on the current private wings concept in UM and UKM.

On the migrant workers issue, he also ducked the question by saying that it is a policy matter but he would raise the issue again.

On the health financing scheme, he said, it would take a long time and would not be implemented in the 9th Malaysian Plan. He added very hesitantly that the health consultants are in the process of being appointed.

The DG also kept saying how efficient and excellent our health system is - comparable to any country in the world.

Coalition wants improved public health care system

Coalition chairperson Subramaniam said that we would need another date but said that the Coalition's position is not to run down the public health system but to support it. We want an improved public health care system.

The Coalition members were treated to a lunch. The DG left for another meeting, and the coalition members pondered if perhaps they should be meeting the Minister or the Prime Minister, as it looks decisions are not made here but higher up. It is time to take the struggle to a higher level.

Ismail Merican was efficient. He started and ended on time. But it is obvious that he does not call the shots. He is put there to defend the position of the State, which seems quite intent on turning the public health care system into yet another money-making machine.

Coalition raises host of questions at dialogue with Health Ministry

We need some answers now. The Coalition raised three main areas of concern during its dialogue session with the Ministry on 14 March 2006: the "full-paying" patients proposal, the secrecy over the identity of the consultants hired to design the blueprint for the proposed national health care financing mechanism, and the proposal to get migrant workers to pay much higher private sector medical fees for treatment in government hospitals.

Dialogue session between the Coalition (GMPPK) and Health Ministry director general Dr Ismail Merican

14 March 2006

Terlebih dahulu, kami, Gabungan Membantah Penswastaan Perkhidmatan Kesihatan (GMPPK) ingin mengucap terima kasih atas kesudian Yg Bahagia Datuk meluangkan masa berjumpa dengan kami untuk membincang beberapa perkara penting berkaitan dengan perkhidmatan kesihatan awam.

Antara perkara yang kami ingin membawa ke sessi dialog ini adalah

1. Cadangan ‘Full Paying Patients”.

2. Pakar Perunding untuk Skim Pembiayaan Kesihatan Baru.

3. Caj mengikut kadar swasta untuk pekerja asing.

Cadangan Full Paying Patients

Surat khabar NST 8 Januari 2006 melaporkan bahawa KP Kesihatan telah mengumumkan bahawa “specialists will provide private treatment after working hours at the Putrajaya and Selayang Hospitals by March “ dan “the scheme will be extended to all hospitals with specialists based on the outcome of a six-month trial period”

Pengumuman lanjutan oleh Yg Bahagia Dato yang dilapor dalam NST 23 Januari 2006 berbunyi “it will help provide better incentives and remuneration for our specialists …” dan “the full-paying patients will be attended to during normal hospital operational hours or extended hours if needed . ..”

Keratan akhbar berkaitan adalah disertakan sebagai Appendix I.

Kami, GMPPK, khuatir cadangan “Full Paying Patients “ ini akan menjejaskan kualiti rawatan untuk pesakit biasa. Rationale kami untuk mengatakan ini adalah seperti

berikut–

1. Pada masa ini hanya 30% daripada doktor pakar di Malaysia berkhidmat di hospital-hospital kerajaan, dan beban kerja mereka adalah terlalu berat kerana 70% in-patient di Malaysia masih dirawat di Hospital-Hospital Kerajaan. Selain daripada beban klinikal ini, doktor pakar kerajaan ditugaskan membimbing dan melatih doktor siswazah dan juga doktor yang sedang berlatih menjadi pakar, selain daripada kerja-kerja pemantauan lain. Pada takat ini mereka tidak ada cukup masa untuk menjaga semua pesakit dengan baik.

2. Perlaksanaan skim wad swasta di Hospital Universiti dan UKM Cheras sejak tahun 1998 telah menjejaskan kualiti rawatan pesakit biasa dan juga pengajaran pelajar perubatan.

3. Wujudnya kemungkinan penyelewengan seperti meminta pesakit menjadi “full-paying” jika mahu dapat awatan segera dll akan berlaku

Kami, GMPPK, beranggap sistem kesihatan awam negara kita adalah suatu asset yang amat penting pada rakyat dan harus dipelihara dan dikekalkan. GMPPK setuju pendapatan doctor kerajaan harus ditingkatkan, tetapi cadangan mewujudkan rawatan swasta di bawah nama “Full-Paying Patient” bukan kaedah yang baik.

Syor GMPPK:

• batalkan cadangan “Full-Paying Patient”

• menubuhkan Komisyen Perkhidmatan (Service Commission) berasingan untuk kakitangan kesihatan supaya gaji dan elaun doctor dan kakitangan kesihatan lain boleh ditingkatkan.

Pakar Perunding untuk Skim Pembiayaan Kesihatan Baru

Pihak GMPPK telah mengemukakan beberapa soalan pada Menteri Kesihatan terhadap bentuknya Skim Pembiayaan Kesihatan Baru melalui surat-surat kami bertarikh 4 Mei 2005 dan 21 Jun 2006. (Sila rujuk Appendix II) Antara soalan yang dikemukakan adalah

1. Apakah kuantum bayaran untuk seorang yang berpendapatan RM 1000 sebulan?

2. Apakah “cut-off point” di bawah mana pekerja berkenaan tidak dikenakan bayaran pada tabung kesihatan?

3. Adakah rawatan seperti pembedahan cataract, coronary angiogram, hemodialysis dan rawatan untuk leukaemia diliputi oleh “essential health package”?

4. Adakah ahli untuk”National Health Advisory Council” dipilih oleh orang ramai atau dilantik sahja oleh Menteri?

Jawapan yang diberi untuk soalan-soalan ini adalah kerajaan sedang menunggu kajian dan nasihat Pakar Perunding. YB Menteri Kesihatan telah mengumumkan di surat khabar (The Star, 26 April 2005) bahawa kerajaan akan menetapkan pakar perunding terhadap Skim Pembiayaan Kesihatan Baru ini. Surat pihak EPU bertarikh 24 Januari 2006 menyatakan Pakar Perunding telahpun dikenalpasti dan akan memulakan kerja beliau pada bulan Februari 2006. (Appendix II) Dr Chua telah memberitahu para wartawan pada 14 Disember 2005 bahawa “The details are being determined by the expert, who will study all the implications.”

Kami ingin tahu

1. Siapakah pakar perunding yang dilantik? Sudahkah beliau mula tinjauan beliau?

2. Adakah terma rujukan beliau mewajipkan beliau berjumpa dan mendapat ide dan maklumbalas kumpulan NGO, dll kumpulan masyarakat supaya dapat mengambilkira pandangan kami sebelum memberi keputusan beliau? Bolehkah GMPPK dapat tarikh berjumpa dengannya?

3. Adakah cadangan untuk memberitahu keputusan pakar perunding ini supaya orang ramai dapat memberi maklumbalas sebelum kerajaan buat keputusan muktamad terhadap bentuk skim pembiayaan baru?

Pada kami, GMPPK, adalah amat penting untuk memperkukuhkan sistem kesihatan awam, dan segala aspek Skim Pembiayaan Baru harus memelihara sistem kesihatan awam. Pandangan GMPPK mengenai sistem pembiayaan kesihatan adalah terkandung dalam laporan bertajuk “The People’s Alternative” dan sesalinannya adalah disertakan sebagai Appendix III. Kami harap dapat sempatan membincang aspek-aspek Alternatif ini dengan Pakar Perunding dan juga dengan pihak Kementerian Kesihatan.

Caj mengikut kadar swasta untuk pekerja asing.

Menteri Kesihatan, YB Dr Chua Soi Lek telah membuat pengumuman akhbar pada 22 Oktober 2005 bahawa semua pesakit asing, termasuk pekerja asing, akan dikenakan caj mengikut kadar yang diamalkan di sektor swasta (Rujuk Appendix IV). Pekerja asing pada masa ini dikenakan kadar kelas pertama. Jika cadangan Menteri Kesihatan dilaksanakan, caj terhadap mereka akan meningkat tiga kali ganda!

Dalam sessi perbincangan yang diadakan oleh GMPPK pada bulan Disember 2005 di Universiti Malaya, beberapa peserta telah membantah cadangan meningkatkan caj rawatan terhadap pekerja asing. Antara sebab yang dikemukakan adalah:

i. Pekerja asing sedang menyumbang ke pembangunan ekonomi negara kita. Oleh itu adalah adil mereka juga dapat menikmati sedikit daripada kekayaan negara ini.

ii. Pekerja asing merupakan satu lapisan masyarakat berpendapatan rendah yang tidak berkuasa dan mudah ditekan. Suatu masyarakat yang penyayang harus memberi perlindungan yang sempurna pada lapisan seperti ini.

iii. Jika caj rawatan adalah tinggi, pekerja asing akan cuba mengelak daripada datang mendapat rawatan, kerana mahu cuba rawat diri sendiri untuk mengelak daripada membayar. Kelambatan dalam mendapat rawatan akanmenjejaskan kesihatan rakyat Malaysia sekiranya pekerja asing itu
mengidap penyakit berjangkit seperti TB, malaria atau typhoid.

iv. Ikut kenyataan Datuk Abdul Rahman Bakar, Timbalan Menteri Sumber Manusia, di Parlimen, negara kita sedang mengutip levy sebanyak RM1.8 bilion setahun daripada kaum pekerja asing (Sila rujuk Appendix IV)

Syor GMPPK

Membatalkan cadangan meningkatkan lagi caj terhadap pekerja asing di hospital kerajaan. Kerajaan harus memakai sebahagian daripada duit levy yang dikutip untuk mensubsidikan kos rawatan pekerja asing di hospital kerajaan.

Sekali lagi pihak GMPPK ingin mengucap terima kasih pada Ketua Pengarah Kesihatan atas kesudian beliau berjumpa dan berdialog dengan kami. Kami harap proses berdialog akan diteruskan dan segala pemindahan ke sistem kesihatan awam akan diberitahu pada masyarakat awam dan dibincang sebelum diputuskan.

Dr Subramaniam Pillay
Pengerusi GMPPK

Syed Sharir
Presiden MTUC

----------------
Appendix I

Keratan akhbar 8/1/06 dan 23/1/06

Appendix II

Surat GMPPK bertarikh 4/5/05 & 21/6/05

Jawapan KKM bertarikh 25/5/05

Keratan Akhbar 26/4/05 & The Star 14/12/05

Surat EPU bertarikh 24/1/06

Appendix III

The Peoples Proposal.

Appendix IV

Keratan akhbar 23/10/05

Keratan akhbar Star 28/10/05.

After sustained pressure, TOR finally revealed

It's finally out. After sustained pressure from the Coalition, the Health Ministry has revealed the terms of reference (TOR) for the consultants it is engaging to design a detailed blueprint for the implementation of the national health care financing mechanism. The terms were revealed in a letter to the coalition dated 22 February 2006 from Dr Rosnah Hadis, director of the Ministry's planning and development division.

The terms of reference cover the following areas:

1. Reporting issues, challenges, gaps, and strengths in the existing health care and financing mechanism.
2. Determining the sources of finance, including the shape of the National Health Insurance scheme, which will cover aspects such as the rate and level of contribution and the exempted groups.
3. Determining and recommending the appropriate provider payment mechanism such as case-mix.
4. Determining the health care benefit packages.
5. Studying, proposing and determining the organisation and function of the authority or body under the Health Ministry that would manage and implement the health care financing mechanism.
6. Analysing the implications of the proposed mechanism from the legal, economic, and quality standpoints and evaluating its affordability to the people.
7. Coming up with a detailed action plan for implementation.
8. Discussing and clarifying with the public and carrying out social marketing to promote the mechanism.
9. Developing the human capital and information management systems necessary for the creation and implementation of the mechanism.

Unfortunately, the identity of the consultant remains a secret. The following is the letter received from the Ministry:

Page 1

Page 2

Lampiran

Meanwhile, the Health Ministry says the Coalition is "confused" about the proposed "full paying patients" scheme and it is therefore inviting the Coalition for a dialogue on 14 March at Putrajaya.

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

Sorry, we can't tell you, it's confidential, says EPU

It's a secret, says the government's Economic Planning Unit.

The Coalition has received a reply from the EPU on 27 January 2006 to its letter dated 14 December 2006 (see below).

Basically, they are saying that they will take into consideration the Coalition's suggestions and proposals in appointing the consultants who will be tasked with formulating the national health financing mechanism. The consultants are expected to start work in February 2006. But, sorry, the EPU can't release the Terms of Reference because it is... why, "sulit" (confidential) of course.

If the government is going to be so opaque re the TOR, then can we expect transparent behaviour when it comes to administering the fund, outsourcing services etc?

Here is the letter from the EPU:
EPU Letterhead


24 Januari 2006

Jeyakumar Devaraj
Secretary,
Gabungan Membantah Penswastaan Sistem Kesihatan

Tuan,

TERMS OF REFERENCE FOR THE CONSULTANT FOR THE PROPOSED HEALTH FINANCING SCHEME

Adalah dengan segala hormatnya saya merujuk kepada surat tuan bertarikh 14 Disember 2005 mengenai perkara di atas.

Unit Peranchang Ekonomi (UPE) mengucap terima kasih di atas cadangan dan saranan yang dikemukakan oleh pihak tuan. Sehubungan ini, cadangan dan saranan tersebut akan diambil kira dalam pelantikan juruperunding dan pelaksanaan Skim Pembiayaan Kesihatan Kebangsaan (National Health Financing Scheme) di negara ini. Merujuk kepada permohonan untuk mendapatkan salinan Term of Reference (TOR), UPE tidak dapat mengedarkan TOR tersebut kerana ia adalah dokumen sulit. Untuk makluman pihak tuan juga, juruperunding dijangka akan memulakan kajian pada Februari 2006.

Sekian, terima kasih.

BERKHIDMAT UNTUK NEGARA

Saya yang menurut perintah,

Signed

(Datin Shamsiah Haji Dahaban)
b.p Ketua Pengarah
Unit Perancang Ekonomi. 

These were the Coalition's letters to the EPU and the UNDP asking for the consultants' terms of reference.

Gabungan Membantah Penswastaan Sistem Kesihatan
2A Jln Sitiawan
Lim Gardens
30100 Ipoh

14 December 2005

The Principal Assistant Director
Economic & Planning Unit
Prime Minister’s Department
Putra Jaya

Dear Ms Daisy Rajoo

Terms of Reference for the Consultant for the Proposed Health Financing Scheme

The Forum on Health Financing Reform organized by the Health Coalition on 11th December 2005, went well with about 130 people from a large variety of civil society groups participating. I am enclosing a set of the documents that were given out to the participants that day.

One of the suggestions from the floor was that we should ask for a copy of the Terms of Reference for the Consultant who is supposed to give suggestions as to how the new Health Financing Scheme should be implemented.

Would you be able to let us have a copy of the Terms of Reference? Do let us know.

When do you expect the Consultant to start work?

Please let us know.

With sincere regards

Jeyakumar Devaraj
Secretary
Coalition Against Health Care Privatisation
H/P 019 5616807

---------------------

Gabungan Membantah Penswastaan Sistem Kesihatan
2A Jln Sitiawan,
Lim Gardens
30100 Ipoh

14 December 2005

The Coordinator
UNDP
Kuala Lumpur

Dear Dr Richard Leete

Terms of Reference for the Consultant for the Proposed Health Financing Scheme

The Forum on Health Financing Reform organized by the Health Coalition on 11th December 2005, went well with about 130 people from a large variety of civil society groups participating. I am enclosing a set of the documents that were given out to the participants that day.

One of the suggestions from the floor was that we should ask for a copy of the Terms of Reference for the Consultant who is supposed to give suggestions as to how the new Health Financing Scheme should be implemented.

Would you be able to let us have a copy of the Terms of Reference? Do let us know.

When do you expect the Consultant to start work?

Please let us know.

With sincere regards


Jeyakumar Devaraj.
Coalition Against Health Privatisation
H/P 019 5616807

Better treatment for full-paying patients; inferior service to the poor

In Ismail Merican's response to P Ramakrishnan's criticism of moves to allow government specialists to provide "private treatment" after working hours, the Health Ministry Director General said that the Aliran president had based his comments on an erroneous inference. Ismail said:

...the inference that the Government will extend the working hours of specialists — requiring them to provide "private treatment" after working hours — is erroneous.

But look what the NST had to say on 8 January 2006, in particular the first paragraph of its report. It clearly says that specialists will be allowed to provide "private treatment" after working hours.


Ismail also said:

At present, the Government is subsidising 98 per cent of health services provided by the ministry. In no way will this new scheme jeopardise the provision of patient care for non-full-paying patients.

To say that the government is subsidising 98 per cent of health services paints a distorted picture. The money is not coming out of the Cabinet's pockets. It is not charity from the government. Rather, the funds are from hard-earned taxpayers' money and it is only right that this money should be used for essential services for the people such as health care. The whole idea of taxation is to provide an element of cross subsidy so that nobody is denied such essential services because they cannot afford to pay.

Right now, the government is only spending a paltry 2 per cent of GDP on health care - well short of the 5 per cent recommended by the World Health Organisation. If the government were to spend more of public funds on such a critical area as health care, it wouldn't need to come up with fanciful ideas and ill-thought-out schemes to raise money to pay its specialists, doctors and other medical personnel. It would have enough funds to pay specialists and doctors higher salaries without taxing patients a second time through higher fees. (Remember, the public have already paid for public health care services the first time through taxation.)

Finally, Ismail may give us all kinds of arguments and assurances that his proposal for "full-paying patients" (to allow specialists to earn more) will not affect the poor. But the fact remains: once government specialists discover which side their bread is buttered, they can be expected to gravitate to the full-paying patients and spend more of their time and energy with them. Gradually, the non-"full-paying patients" will be subjected to second-class service, longer queues, and crowded wards.

This will result in two classes of patients and two types of services. In effect, better treatment from the best specialists will be provided to the rich (full-paying patients) while inferior service will be dished out to poor patients. Specialists will quite naturally devote more of their time and attention and energy to patients who will contribute more to their take-home income and less to those who cannot afford to pay. In the end, it will be the poor who suffer. So how can Ismail say that the poor will not be affected?