THE CHANGING LANDSCAPE OF HEALTH CARE

Posted by Unknown On Sunday, March 21, 2010 10 comments
Sembang-Sembang Forum held a forum on What Is Wrong With Our Health Care System? at Kompleks Penyayang yesterday afternoon. The speakers were Dr. Jeyakumar Devaraj (MP Sg. Siput, Parti Sosialist Malaysia) and Dr. T. Jayabalan (Worker’s Health & Safety, Penang) including a guest speaker Puan Rozita bt Ahmad. The forum was eloquently moderated by Dr. Toh Kin Woon.

MP Dr. Jeyakumar, Dr. Toh Kin Woon and Dr. Jayabalan

Before 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!

10 comments to THE CHANGING LANDSCAPE OF HEALTH CARE

  1. says:

    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

  1. says:

    Unknown Dear Anon @ 10.25pm

    You have voiced a pertinent observation and I believe many know the answer to your question. It is a very saddening situation and the fact remains that while some companies reap mammoth profits, the rakyat, in particular the poorer ones, have to pay the price for this gross indifference.

    Take care and have a great week.

    Best wishes

  1. says:

    ahoo We just need more like minded doctors to make an impact to our society. They need to put pressure on the govt whenever they are faced with policy that is harmful and not beneficial to the people at large.

    The OA had their march recently. The people had theirs much earlier and also the lawyers had their too in Putra Jaya. So what is stopping the doctors to do likewise if they know that they have been had ?

    We look forward in seeing more committed doctors who believed in their calling and have taken to the hippocratic oath of serving the sick and the poor. Let not money be the only cause for them to serve. Let us continue to watch & pray for the lost and poor.

  1. says:

    Apa Nama In Malaysia, the first question a doctor asks when he sees a patient is : Do you have a medical card? In other words, do you have an insurance policy for health-care?

    The treatment that follows?
    Your guess is as good as mine!

  1. says:

    Unknown Dear ~wits0~

    Thanks for sharing the link. There are very good comments there worth reading and considering...

    Take care and have a good week.

    Cheers

  1. says:

    Unknown Dear ahoo

    Like you, I hope that more and more doctors will have the desire and dream to moot for change in our health care system, with the interests of the rakyat in their hearts.

    Life is so short and money is certainly not the heart of life.

    May their hearts be convicted and strengthened to do what they know is morally right.

    Take care and thanks for your sincere response.

    God bless!

    Cheers

  1. says:

    Unknown Dear Apa Nama

    You have highlighted a very real problem that exists today - both in Malaysia and even more so in US.

    It is saddening that many sectors are so profit-motivated that the element of humanity is diminishing.

    Take care and God bless you for your caring spirit.

    Cheers

  1. says:

    Murali Dear Paula,

    Thank you for sharing your experience and the happenings at this 'sembang-sembang' forum on health. It's always a pleasure to note opinions of the learned speakers and the participants during such a discourse, but sadly, lots have been lost in translation.

    By reading the comments by the readers, in particularly ahoos and apa namas, i find that perception of healthcare in Malaysia is still very lacking. By no means am i trying to ridicule the readers or their comments, that is not my intention, but the 'spin'ful media have faired brilliantly in masking the truth.

    My friends,

    Did you know that the working hours of government doctors is against whats enshrined in labor laws around the world? Only in Malaysia does the labor law exempt the medical field from FAIR PLAY and DECENT HUMANLY WORKING HOURS, because of necessity. So necessity justifies abuse of doctors? Why OAs march, and lawyers, but not doctors?

    Doctors are not allowed to have unions..

    JPA scholars who've studied medicine locally(more so abroad i should assume!) are bonded 7-10 years with the government, at their mercy..You can be denied promotions and pay increments without an option to appeal, and NO one can survive the complex process, or the time they entail..

    Even today,a government medical doctor ONLY earns an overtime wage of RM2.08 per hour(passive on calls) and RM6.25 per hour (if active calls-staying in hospital). U mean for the work, responsibility and care we give whole-heartedly, ALL that we deserve are USD 0.69 cents to USD 2.08 per hour?

    And is it ever published in any paper/publication how we still work the next day after on calls, meaning some of us work 24-48-72 hours straight..

    I have seen doctors get involved in motor vehicular accidents when driving back home after their on calls from a long night and day with less than 1 hour of sleep.. I have seen miscarriages of pregnant doctors who were worked to the brim..doctors sleeping on stretchers as there is no place for them to sleep at night etc etc..sigh..

    Its not about the money. These doctors are just asking to be paid for the work they have done, no more, based on acceptable standards worldwide. Is that too much to ask?

    I guess when lawyers and other professionals have a 5 year compulsory service with the government and paid the same wages and worked the same hours, maybe only then will THEIR EYES OPEN to what suffering goes on behind the scenes..

    Private wings in government hospitals. Another big sigh. The same hospital specialist doing an operation for a private paying patient at 5.01pm using government facilities, but being paid handsomely for it vs. doing the same operation for a poor patient as PART OF HIS ROLE IN THE GOVERNMENT, which does NOT say that care of a government patient ENDS at 5pm does it?

  1. says:

    Murali Part II...

    GROSS CONFLICTS OF INTERESTS, happening in abundance and ultimately, patients suffer. BAD IDEA from the word go..

    1-Malaysia Clinics. SIGH again. Paying RM1 to be seen by a non-doctor? Its like going to a bank and asking for an overdraft from the bank managers PA? Apples and oranges eh? NOT obvious enough for the people?? And to say its to prevent GPs from overcharging. What hogwash..GPs work hard and their experience and dedication are beyond such simplification amounting to dollars and cents. How many GPs out there charge so much anyway? We'd happily pay RM 60 for a KFC bucket combo but not RM 40 for a doctors consultation?

    I am tired, and i could go on for days regarding issues plaguing the medical field.

    I beg all Malaysians to keep an open mind, that a large population of doctors out there, both in gov and in private care very much for patients, BUT have their hands and feet tied so hard that the very thought of speaking out loud or marching on the streets will be met with joblessness, shame and more.

    People would say conspiracy hogwash, i say reality. There is more. Can you stomach more?

    Goodnight readers, and i'm so sorry for rambling on like this Paula. Its a topic close to my heart, and i care dearly. Just wish there was a way to make a change before Armageddon.

    Take care dear friend..

    Mu

  1. says:

    Unknown Dear Mumu

    Thank you so much for such a passionate and moving response to this post. I wish you had been there to hear it from the horse's mouth. I wonder if you would mind if I posted your comment as a separate post. This honest expression of a dedicated doctor needs more airing that others may know that it is NOT easy to be in this noble profession.

    Take care and see you on Saturday for dinner :-).

    Hugs and much love from the family

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