National Health Plan

THE Health Ministry recently announced that the government is mulling over a national healthcare system. It runs on the principle of the rich subsidising the poor by contributing a sum to a financial pool.

There are many issues that need to be addressed before a revamp is even thought through. Our healthcare system is fragmented and driven by a free market policy. We have government funded and privately-run establishments. The sentiment among the public and insurance companies is that the private healthcare providers are inadequately governed. Health insurers have been increasing premiums for the past 10 years. Their excuse is that private hospital fees are increasing. And they only want "healthy" clients. If you have a history of chronic medical illness, forget about insurance or pay a huge loading fee. Will there be a substandard care provided by private hospitals when admitting a patient under the scheme? Will there be adequate controls to ensure consistency?

There are no price controls on medications. On the entire supply chain of providing healthcare services, the government must ensure that each contributing factor will be regulated. The public must be assured that if a doctor is paid by the health scheme, the patient is not shortchanged by receiving under par treatment. Will there be a cap on visits to a clinic? And after a number of visits for the same problem, will the doctor be compelled to refer the patient to a specialist or hospital and not wait to max out the allocation for the patient?

The health minister also said that each family must register a clinic as their family physician as to keep records. What happens when you are out of town and require medical attention? Will the doctor or patient be reimbursed? Will all the clinics be hooked up to the system to monitor patient mobility?

Employers pay Socso and EPF. If they are further asked to contribute to this new fund, it will increase their operating costs. Will the government reduce the quantum to this two funds if contribution is made to the health scheme by employers? Many companies take up group insurance schemes. If they were to further contribute to a new scheme, I am sure many if not all will scale down the benefits to reduce costs. The employees will be the losers.

Our medical system runs on a "one-stop centre" basis. Patients are examined by the doctor, treated and provided medication. Often a bill is issued that does not itemise the cost of medicines and consultation or treatment. Will itemised billing be mandatory? The government must ensure that doctors follow an approved essential drug list and are and not driven by pharmaceutical promotions. Any deviation from the list must be justified. We should not have a situation where the establishments benefit the maximum payout from the scheme and yet enjoy extra payment by the patient by coaxing them to take the "better drug"! There must be a list of reimbursed drugs’ list and the percentage of quantum reimbursed for each drug.

Whatever system we adopt, the government must ensure there is no cronyism, monopoly and or kickbacks to the key players.