National health insurance scheme should be considered, say experts

PETALING JAYA: The government must be open to considering setting up a national health insurance scheme, say experts.

Under such a scheme, people would have the choice of going to a public or private healthcare provider, thus relieving the burden on public hospitals and clinics, said Prof Dr Sharifa Ezat Wan Puteh of Universiti Kebangsaan Malaysia when contacted on Wednesday (June 14).

"Services would be paid through reimbursement packages by the government," she said, adding that the reimbursement packages were paid through premiums provided by the population, or could be partly subsidised as well.

Taiwan, South Korea, and Singapore were some of the countries that had a form of national health insurance scheme.

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Prof Sharifa Ezat pointed out that for those without private health insurance policies in Malaysia, private medical services were out of reach.

"Most of us are not covered by insurance. That's why we flock to the public healthcare system and that's why we have a huge backlog and the healthcare system is collapsing as it cannot sustain this.

"That’s why Malaysia should incorporate a national health insurance scheme," she said, adding that "sin" taxes were not the only mechanism to fund escalating healthcare costs.

Aside from a national health insurance scheme, said the recommendations of the Health White Paper to reform financing of Malaysia’s cash-strapped healthcare system were the way to go.

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Prof Dr Sharifa Ezat said the government’s proposal to revise the fees at the Health Ministry’s public facilities according to a patient’s income bracket was one way to improve healthcare services.

"At this point in time, healthcare costs are increasing and we are not able to sustain it in the long run.

"What needs to happen is improving the fee structure. In a way, it’s like cross-subsidisation, where the higher-income people need to pay more so they, in a way, will indirectly subsidise the poor who are accessing public healthcare services," she said.

She added that the rate recommended for lower-income patients was between RM5 and RM10 per visit, compared with the current RM1 and RM5 consultation fees for outpatient and specialist visits, respectively, at Health Ministry clinics and hospitals.

"The upper M40 and T20 will need to pay more for the service in healthcare centres, facilities and hospitals. So far, they have not been charged privately unless they go for the private wing or first class," she said.

Prof Sharifa Ezat added that the practice of means testing to examine the financial state of a person to determine eligibility for public healthcare services has been in place in other countries, and said this was something that Malaysia could look into.

"In some countries, you can't access free or subsidised health services and you need to go private because you're either insured or have better payment ability, or your willingness to pay is higher.

"That sort of scenario needs to be in place in Malaysia as well," she said.

Universiti Putra Malaysia epidemiologist and biostatistician Assoc Prof Dr Malina Osman said she also all for a national health insurance scheme.

On the move to revise the fee structure, she said specific mechanisms should be considered in order to cover those who cannot afford to pay for services, such as low-income groups.

Public health expert Datuk Dr Zainal Ariffin Omar said the government had a huge task ahead to make people understand and accept some of the issues raised in the Health White Paper.

The former Pahang health director said some of the recommendations could be quite sensitive, considering the country’s current political and economic climate.

However, he said it was inevitable that the government must look for new ways to finance the health system and achieve the targets of the Health White Paper, adding that the current RM1 and RM5 fees charged by the Health Ministry were minimal compared with other South-East Asian countries.

"The focus of the new system would be to harmonise the current dichotomy of healthcare delivery between the public and private sectors, to increase fees for the public health facilities from RM1 and RM5 to a reasonable amount, as well as to develop a system for certain groups such as the B40 and M40, and to develop the system of fees from social and insurance schemes for the rest of people.

"The focus is also on outsourcing the services of public facilities including treatment and hospitalisation to private facilities with some form of financing mechanism.

"Politicians, policymakers and the public should really understand and comprehend the basic issues and the recommended strategies," added Dr Zainal.