RECENTLY I read about the concern expressed by a respected colleague over the plight of migrant workers who may not be able to afford medical treatment should a new fee structure be imposed on them.
Many will just go underground and hibernate and if they are harbouring infectious diseases, they will spread the infection to those around them, including Malaysians. The result would be an escalation of our public health burden and more challenges to our public health system.
We are already seeing a resurgence of communicable diseases like MDR (multi-drug resistance)-TB and malaria due to the influx of migrant workers, some of whom have entered the country illegally.
An estimated two million illegal migrant workers are in our country and some may actually be covert sources of infection.
So what do we do? The Health Ministry must take remedial measures to at least reduce this potential risk to our community. It is impossible to control communicable diseases if those infected do not come forward for treatment either because of apathy, ignorance or inability to pay for medical care.
Migrant workers may come to this country legally or illegally. For those employed legally, the onus is on the employers to ensure their workers have medical insurance. Those who do not comply should be taken to task. Treatment should preferably be sought from private clinics and hospitals unless there is an emergency.
If workers prefer to patronise the public sector, they should be allowed to do so provided they pay the full charges. The insurance coverage may, of course, be limited and if so, the workers would have to fork out the extra payment from their own pockets.
The challenge is how to catch those who are employed illegally, and that is the responsibility of the Home Ministry. But the implications are deadly serious if the illegal workers are ill. Making treatment inaccessible to them by pushing up the cost of healthcare or by imposing punitive measures will aggravate matters and, again, Malaysians will be directly or indirectly affected.
I am sure the Health Ministry in their wisdom know what needs to be done.
In the meantime, we wait with bated breath for the Government to introduce healthcare reforms including some form of healthcare financing in view of the many challenges facing this country, such as increase in healthcare costs, rising public expectations, changing disease pattern and demographics, a growing ageing population, variations in distribution of delivery and varying quality and standards of care in health services.
Some may argue that this is not the best time to introduce a financing scheme but I guess there can never be the right time for this. I have presented the proposal to three Prime Ministers and although they thought it was a good idea they preferred to wait, probably anticipating the wrath of the public who are so comfortable with the current subsidised healthcare.
There is a need to ensure adequacy for financial risk protection so that no one becomes impoverished from paying for necessary healthcare. There is an increasing rate of healthcare spending due to fragmentation of the health system and a high private portion of spending.
We cannot stop the rise in health expenditure but we need to control how fast that increase or acceleration is. Global evidence shows that the rate of increase in health expenditure is better controlled under a publicly managed health financing system.
It is time we revisit this issue and initiate discussions with relevant authorities and stakeholders before the Government runs out of ideas and cash to cope with these mounting challenges.
Continuity of care instead of episodic and fragmented care, addressing the current public–pr ivate dichotomy of healthcare delivery, responding to increasing public scrutiny and demands for performance and accountability are major concerns. Our country, which is famous for its robust rural and primary healthcare services, would be hard pressed to preserve this record of ensuring equity, efficiency and effectiveness of health spending and accessibility to basic healthcare without initiating reforms.
Revisiting the 1Care proposal introduced some years ago but shelved for various reasons may be a good start. A more detailed explanation to stakeholders on the merits of the proposal would have swung the balance.
Integration of public and private sectors, starting incrementally with outpatient services for the young, the infirm and the elderly may be the first step provided both sectors give the same quality and standards of care.
Quick solutions are needed but any change in policy should only be done after getting extensive discussion and feedback from healthcare professional bodies, consumer groups, stakeholders and the public to understand the implications and ramifications of whatever new policy is intended and avoid the flip-flop syndrome.
TAN SRI DR MOHD ISMAIL MERICAN
Former director-general of Health
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