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Sunday August 18, 2013 MYT 12:00:00 AM
Sunday August 18, 2013 MYT 12:12:56 PM
by audrey edwards
Taking care of people: A team of cardiologists and medical staff performing a procedure at the Institut Jantung Negara in Kuala Lumpur in this file picture.
Today, we launch ‘Talk Time’, a series featuring interviews with members of the new Cabinet who will talk about the challenges and plans they have for their ministries. We start off with Health Minister Datuk Seri Dr S. Subramaniam.
Q: What have you mapped out for your short, medium and long term plans for the ministry in healthcare for Malaysians?
A: One is, of course, what I announced on the day I took the post, that is we will pay greater importance to preventive healthcare, particularly against the non-communicable diseases (NCDs) problem (to) wage a war against NCDs. We will give that great importance because diseases like diabetes (and) hypertension have a major toll on Malaysians.
As the community becomes more affluent and the lifestyle changes, the risk of these kinds of diseases tend to increase.
According to the National Health and Morbidity Survey 2011, more than 15% of Malaysian adults have diabetes. The number for hypertension is much higher. So, we need to have a more vigorous attempt at making behavioural changes among Malaysians to reduce impact of these diseases. Although we have a lot of programmes, we are also going to review these programmes and see how we can achieve greater grassroots activities to ensure more success and better results.
We hope to identify community-based groups who will become our partners in this process. We will empower these groups by giving them the knowledge and tools so that they can be continuous partners with us in the war against lifestyle diseases. It cannot be an ad hoc programme; it should be continuous and well thought out so that it can have results.
The other thing is we are studying how we can optimise the ability of Malaysians to use the entire health structure within our country, including the public and private. Now there is a dichotomy that we have a privatised scheme which is more or less borne by individuals, whereas the public sector (government) is more or less entirely subsidised by the Government. But the group that probably uses the public sector hasn’t got the ability to use the facilities in the private sector so we have very overloaded government facilities and sometimes less utilised private facilities.
We are thinking about how we can bridge this, how we can actually create some initiatives to optimise usage of both areas.
> On the revamp on the war against NCDs, are you saying there is going to be a new structure?
No. We have a lot of structure within the ministry. We have an entire section on NCDs. We have one group looking into food, one looking into tobacco. But at the end of the day, it is to what extent all these things we are doing in the ministry will reach the people in the grassroots and how that will cause a structural change.
> That is the changing of the message that’s going to the masses. But it will take some time.
It is long term. It is a long-term behavioural change. People know it is harmful to smoke but yet they smoke. It is not good to take sugar yet they take sugar. The knowledge is there but the transformation is not there.
This is what we have to do, we are going to do through our interaction by empowerment. These people are already in the community, they are already working with the community so we allow them to engage better with the community.
> Would this mean a budget allocation?
Reallocation of budget, but basically we have a huge number of people on the ground working with us. Our target is (to have) within one or two years, 50,000 volunteers working on the ground.
> In terms of the private and public sector, there seems to be a perennial problem of getting both sectors working together and people are talking about how we are going to have the healthcare financing scheme mapped, including presenting something to the Prime Minister next year. How is that working out in giving universal access to Malaysians?
That’s the long term solution. Whatever we evolve in the long term will be with very extensive consultation with the public. They should know what we are doing. But within that, we can also see other opportunities. One area we are trying – we haven’t done it because there are cost implications – is to buy some services from the private sector. There are areas which are overloaded in the public sector that we can transfer to the private sector. But this requires willingness of both parties.
For example, rather than go to a government clinic, patients with diabetes and hypertension could go to a GP’s clinic to do the follow up according to the protocols and standards set by the Health Ministry, if it’s a person who cannot afford to pay and the ministry is willing to subsidise the care. But it should be something that the private sector is willing to do and at an affordable cost. This is the type of balancing that we want to achieve so that there can be optimal utilisation of facilities within both areas.
> It goes back to the money, doesn’t it? How is it going to be financed?
In many parts of the world, people contribute towards healthcare through some kind of insurance scheme. In Malaysia, so far we have evolved into two parallel systems: one is the public system which has evolved into something more or less free. Another is the private system where the patient pays for everything.
And it has worked so far. It has helped because the person who can afford it is provided good standards of healthcare. And for those who cannot, the Government will take care of them. But as medical costs increase, for the Government it is a big strain to take on. So that is why we have to move forward to a system which is more holistic. But there is no simple solution. Human nature is such that when you ask people to pay for something, there will always be resistance. We have to take it step by step.
> If this is finally coming into being, it would mean better healthcare. Those with pre-existing illnesses like NCDs now can’t get insurance coverage but this could be different in the future. Would that be a message the ministry would like to translate to Malaysians?
It becomes universal. True. Last time they had this thing about 1Care but before it was even discussed there were already rumours on the charges. Rumours went around that virtually paralysed any form of discussion. There will always be a reaction to anything new. The best is to take it step by step, one by one and make people part of the programme to do it.
> What are you going to do in providing universal access?
Different things. One we are looking at is how the Government can use some of the components of private healthcare within the present structure. We are doing this on a small scale now. For example, when we don’t have radiotherapy facilities within the Government, we send patients to private facilities. Where we don’t have scan facilities in certain areas, we send them to private ones. If the cost effectiveness is there, we will do it on a larger scale.
The other one is, of course, the universal funding system. We want to do a fairly good study before we make any proposal. The studies are at a very early stage. We have had appointments (dialogues) with the people, a suitable consultant to do the study. That process is being done.
> Recently, on the issue in Penang, you mentioned it was due to poor communication skills. Is the ministry considering improving the communication skills of the medical sector?
We are concerned about the younger generation of doctors and their exposure. As the number of doctors has increased, our ability to give them adequate exposure in their early years of training within the ministry has been affected. As a result, you see this kind of situations.
We are looking at how we can make sure, particularly during houseman training period, that they have adequate contact with patients and management of patients under a supervised environment, which we all went through during our housemanship.
Unfortunately, we can’t do this now because of the number of doctors. My time was very long ago, nearly 30 years ago, but even then you only got a few officers per unit. Now you have a situation where some units have hundreds of officers. When that number becomes so huge, managing them and giving them adequate training and exposure is a challenge for us.
We have some ideas at overcoming this. Maybe we can have a more structured training (programme), including communication skills, so they have the opportunity to learn in the process.
> Will this be during training, in medical school or housemanship or will it be a continuous process?
It should be at all levels. The training of a doctor is a continuous process. It doesn’t end at any time. It starts at medical school, continues in hospitals and is a continuous process.
> Does this mean communication skills will be put in as KPI for staff?
It’s already in the structure, the curriculum, of a lot of medical schools but we probably will look at it to see how to enhance and monitor it and even give training to younger doctors. To be able to relate this particularly in our country, which is multi-lingual (and) multi-cultural, you have to communicate the correct thing. Say one thing, the fellow understands something else and everything goes wrong. It’s very different.
> How often does the ministry receive complaints?
It’s quite a regular thing. I don’t think our ratio or percentage is higher than other countries in the world but we do have the occasional reports with the way they were treated or the way it was communicated.
> With your medical background, how easy has it been to take up this post?
It has helped a lot. If you ask my staff, they would tell you that I know exactly what is happening. I can understand the issues. For a non-doctor, it would be a difficult task because all the issues are related to health. I’m not saying it’s impossible or that those who were non-doctors here didn’t do a good job. But I am sure they would have got into a difficult time trying to actually get the grasp of it. So for that reason, my learning curve would have been faster.
> In relation to that, it would give a clearer approach because you are a medical doctor. So how healthy or sick is our healthcare system?
Despite the limitations, we have an excellent healthcare system in Malaysia because healthcare is accessible to all Malaysians. That is the most important thing. Even in the most remote village, we have a structure that provides basic healthcare and I think that is our strength.
We have one of the better systems among the developing countries and probably even a system comparable to a developed country.
To developed countries, health is a bigger issue for them. Even for Barack Obama (during the last US presidential election), healthcare reforms were a main thing. So even in countries like that, health is an issue. It’s a political issue. And it’s an emotive issue so even they (US) haven’t found a solution to the issue. The British national health system, one of the oldest systems in the world, was crumbling for a long time under the weight of increased costs so that is an issue a lot of people had to deal with.
I think Malaysians are very lucky. For the very little they pay, they get very good healthcare. Our challenge now is how we can continue this and at the same time keep Malaysians happy.
> Are there any concerns over the TPPA?
As far as the concern on the drugs and all that, our stand is clear. Our right to have generic medication at reasonable cost cannot be compromised by what is agreed with the TPPA. On opening up the market, we have no qualms.
There is this issue of whether our local players will be able to withstand the competition of unrestricted flow but I think that in an open economy, we can’t protect for too long. There cannot be any obstacles to the ability to provide good care, good drugs, (or) generic drugs at a cheap rate.
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