It is evident to most people who do not have a vested interest in the proposed public health financing scheme that the present public health system does not need to be restructured but just improved in order to achieve excellence.
The cardinal point for the government to remember, it bears reiterating at this point, is that the people’s welfare must be the paramount consideration in any reform of basic social services such as healthcare.
Although this appears to be stating the obvious, the current disquiet about the proposed 1Care healthcare system suggests that the Ministry of Health (MoH) could be distracted from this fundamental duty in its pursuit of a grand national health delivery plan.
To begin with, the MoH has failed the first test of accountability, which is grounded in full public disclosure. Considering that the government is embarking on a journey that would fundamentally change the healthcare system, the least it could do is to commit itself to fully engage the public it is meant to serve by providing complete details of its proposals as well as setting out a clear and meaningful process of public consultation.
At the time of writing, the ministry’s website contains only a brief announcement of the proposed scheme with an invitation to the public to provide suggestions for its consideration. There is an equally brief press statement from the director-general of the health ministry, released lately, which reveals that the MoH has developed a concept paper on the scheme, and that 11 key technical groups and committees have been established to take the proposal forward.
The obvious next step towards meaningful public engagement has not been done. The MoH merely has to post the concept paper in full on its website and lay out the format for the submission of public comments. Instead, some members of the public and the media were able to obtain copies of the document at a public forum on the issue organised by the Citizens’ Health Coalition in Petaling Jaya last Saturday. That too, courtesy of a speaker representing the private practitioners who decided to reproduce limited copies as a service to the public.
The MoH concept paper, which was prepared in August 2009, sought the “input and guidance of Economic Council members” to improve the ideas presented in it, provides sufficient details of the proposed restructured model, financing arrangements, cautions and benefits for anyone to provide informed feedback on the merits and demerits. Why the MoH has not shared it with the public is difficult to understand.
Ironically, the concept paper states that Malaysia’s healthcare system is a “successful, modern government-regulated health system that provides effective health services”. The justification for the restructuring exercise is the apprehension that “the present system of healthcare delivery and financing may not be sustainable in the long term”.
However, the paper does not seek to explain why government spending on health has remained relatively stagnant at 2.1% to 2.5% of GDP since 2001. This is less than half the 5% to 6% that the World Health Organisation recommends. In this regard, the question posed at the forum by Selangor exco member Dr Xavier Jeyakumar, whose portfolio includes health, is thought-provoking.
Noting that the national health financing scheme was first mooted in the Fourth Malaysia Plan (1981 to 1985) but left to simmer purportedly after negative feedback, Jeyakumar asked whether public spending on healthcare had been allowed to languish so that the case for revamping the system would be strengthened when under-resourced government hospitals were no longer able to cope with overwhelming demand.
This raises the question whether public health delivery could not be significantly improved if the allocation for health under the budget is increased through the judicious allocation of funds and reduction of wastage in the civil service.
It is also telling that healthcare has been designated as one of 11 industry sectors under the Economic Transformation Programme. While this is good news for the economy, the emphasis on healthcare as an industry must not be made at the expense of the government’s attention to delivering a high standard of service in public health. Unfortunately, experience has shown that the tendency towards the commodification of health services is very strong when market logic is applied to the health sector.
There is a proper place for value-added health services provided by the private sector, but these should complement a well-developed and adequately funded public health service and not cannibalise the basic service delivery that the public health system provides. Unfortunately, the record so far shows that the fears of the health watchdog groups are very real.
Already, some 70% of health professionals have moved to the private sector, where they treat about 30% of the population. Meanwhile, the 30% of health professionals who remain in the public service are drowning under the demand load from the 70% of the population who seek treatment in government health facilities.
The government should just fix that.
R B Bhattacharjee is an associate editor at the Edge.
This article appeared in The Edge Financial Daily, February 17, 2012.
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