MP Dr. Jeyakumar, Dr. Toh Kin Woon and Dr. JayabalanBefore the forum began, the audience listened to a brief run-down about the origin, aims and direction of the Sembang-Sembang Forum. They were reminded that it is not affiliated to any political group and exists as a public forum to discuss social and civil issues openly. Following that, Dr. Toh Kin Woon began the forum.
Dr. Toh began by reiterating health care as an important social service provided by the government to citizens which must be easy, accessible, adequate in supply and affordable to the masses. He hoped to see health care provided on the basis of need and not on ability to pay. He highlighted two key issues:
- Recently, the Ministry of Health (MOH) introduced the Full Paying Patient (FPP) scheme in four public hospitals in Malaysia including Hospital Sultan Bahiyah in Alor Setar, Hospital Serdang and Hospital Sg. Buloh in Selangor and Hospital Sultan Ismail in Johor. This scheme, which will be expanded to more hospitals soon, allows doctors in government service to charge full fees to those patients who can afford it.
- Dr. Toh also highlighted the implication of the current emphasis on medical tourism licenses as it means that it will affect pricing in private health care service. He emphasized that Parti Sosialis Malaysia has been the only group that has consistently campaigned against private health care. With that, he introduced Dr. T. Jayabalan.
Dr. Jayabalan
Dr. Jayabalan began his talk by presenting his slides which were originally prepared for the Health Action International Forum and was titled as Affordable Health Care. He emphasized that even though health care is a basic and fundamental right of citizens, our country does not have a coherent National Health Policy.
He gave a run down of post-independence developments. Initially, our health care system was well-developed system that that the British passed to the Malaysian government to look after expatriates and local government officials. By the time we achieved independence, some basic services and private health care were in place. Noticeably absent was rural health care. However, the situation has improved considerably over the last twenty years.
By the 1980's, the country went through debt and affirmative action and ethnic redistribution of resources was needed. TDM was the main architect of the change in structure of health care in Malaysia. The emphasis then was that private funding is necessary to pay for hospitalization. Soon after, we witnessed the restructuring of health care services which saw the corporatization and privatization of services. A new format of health care financing replaced the present system. In 1991, the privatization master plan was introduced whereby various hospital services were introduced including cleaning, waste management, biomedical engineering and pharmaceutical service.
Of late, there was the push to sell IJN which met with heavy resistance from the public. Some public hospitals such as in UKM and Universiti Hospital have private wings where patients do not have to wait as long but they have to pay more.
Dr. Jayabalan highlighted the fact that the drive to medical tourism is indirectly denying locals access to medical services because private hospitals would be wooing more foreigners. When they expand their services, they would be hiring doctors who are serving in government hospitals which would affect the quality of services available.
The Restructuring of Health Care can be seen in a few areas, namely:
1. Privatization - decisions appear to be made by EPU rather than MOH
2. Health Tourism
3. Proliferation of HMOs and private insurance
Implications of Private Wings in Public Hospitals
1. Manpower shortage as this situation will exacerbate existing problems
2. Inadequate infrastructure
3. Selection and costs of upgrading hospitals
4. Discrimination
Equity, accountability and accessibility of public health care services must prioritize the citizens. Dr. Jaya highlighted a few problems, namely:
1. Burgeoning private insurance costs
2. Spiralling health care care costs
3. Access to services restricted in some cases
4. Expensive medication
5. there have been cases where patients were given the wrong medication or wrong diagnosis.
Certainly, there are many problems besetting the health care scenario in our country. He concluded by citing a few main points:
1. The provision of health care and costing via market mechanisms are contradictory to the provision of coverage and equal access.
2. Private insurance is incompatible with public social insurance because of inherent problems.
3. There must be provision of essential health care services regardless of social mobility.
4. There has to be greater transparency in this area, particularly in the decision making processes.
Dr. Jaya concluded by emphasizing that it should be the Ministry of Health and not the Economic Planning Unit (EPU) that makes important decisions in the area of public health care.
Following that, Dr. Toh commented that Dr. Jayabalan had given a comprehensive presentation of health care with particular attention to recent trends and negative implications of those trends after which he introduced the next speaker, MP Dr. Jeyakumar.
MP Dr. Jeyakumar
MP Dr. Jeyakumar began his presentation by stating clearly that Parti Sosialis Malaysia is the only party that has been actively campaigning against the privatisation of health care. He explained how the Essential Health Benefit Package works and the role of GPs and how the profit motive seems to be the main motivating factor. Following that, he also discussed the issue of generic vs branded medicine and highlighted a few controversial statements by some public figures which were most worrying.
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At the same time, he informed the audience that in April 2008, the MOH has given licenses for 45 new hospitals. He questioned who would be the staff that would provide the medical expertise. These new hospitals cannot pinch from the government hospitals, especially at this time when there aren't enough doctors to go around. Also, it is not fair that the government spends so much to train doctors only to have these pinched by the private sector who will be charging higher fees and earning bigger profits at the expense of the rakyat.
MP Dr. Jeyakumar then discussed issued related to the privatisation of General Medical Store and how despite these issues, their contract has been renewed for another ten years. He also reiterated that government hospitals are important training grounds for medical students, junior doctors and para-medical staff and the necessity of passing on information, knowledge and skills to the next level. As such, he stressed that as custodians of public health care, the government must develop, maintain and strengthen the health care system in our country. He was particularly concerned as recent statements by the DG of Health, Ministry of Health and even the PM seems to undermine the existing health care system.
Dr. Jeyakumar reminded the audience of Aneurin Bevin's statement made in 1952:
"No country can call itself civilized if an ill person is denied of medical aid because of lack of means."
The market cannot provide everything we need in public health care and he stressed the necessity of government intervention to ensure people get those social and merit goods they deserve and need.
He brought to light certain changes which seem to indicate a shift from the social democratic system to a neo-liberal economic system. For instance, whereas in the past health care services were provided by the government, we now have a free market type of system in the provision of health care services. As such, there seems to have been a shift from social responsibility to self-interest. Whereas in the past, capitalism was viewed as a necessary evil, it now appears to be the highest form of human social organization.
MP Dr. Jeyakumar threw a challenge to concerned parties to find out what is happening in the area of health care and to find the causal factors in order to come up with effective social strategies to solve existing problems. He noted the shift of political power from the working class to the political class.
In his closing note, Dr. Ton Kin Woon expressed how refreshing it was that Dr. Jeyakumar had correctly identified the root cause of problems besetting health care problems - the shift in thinking from social democracy to one of neo-liberalism. He cited how the move to rely on indirect taxes, a regressive tax, as a source of revenue is a good example of neo-liberal life.
Dr. Toh then invited Puan Rozita bt Ahmad who gave a first-hand witness account of how she lost her husband as a result of bureaucratic problems. Her husband, 49, suffered from shortness of breath one day and was rushed to a public hospital whereby he was informed that he needed to pay 19 000RM (cash or bank draft) for three stents. They did not have the money but had EPF funds. They failed in getting a letter of guarantee from EPF and efforts by DAP to solicit for funds came to late as her husband succumbed to heart failure. This was one tragic example of how the pay first clause in the public health service saw the demise of one heart patient.
Following this, there was a lively discussion in the forum with questions raised by various members of the audience including Mr. Darshan Singh, Mr. Lim Kean Chye (founder member of the Malayan Democratic Union), Datuk Seri Dr. T. Devaraj, Mr. Lee and others. The meeting ended with a round of applause to the speakers and the chair.
I left the forum with a heavy heart and wondered why PSM is the only party that is concerned over the health care system. Many other points were raised and it is just impractical to list them all. Suffice to say that there are many issues in this area which must be tackled by our leaders on both sides of the divide. The crown is not who wins the election but the quality of health care of our citizens which bring untold benefits both in the short-run and the long-run. I earnestly hope that there will be other leaders such as MP Dr. Jeyakumar and Dr. Jayabalan who truly have the welfare and physical well-being of citizens in their heart.
Please leave a comment if you wish to share your views on this topic. Thanks! Have a nice day!
Unknown Dear ~wits0~
How saddening! Who then suffers? The people, of course!
Sighs...May the rakyat rise to the occasion and effect change when the opportunity arises.
Take care and thanks for sharing, ~wits0~.
Shalom