THE burden on patients who opt for private medical care in our country, particularly those who require high-cost and long-term care, is getting increasingly heavier. Majority of patients who seek private medical care are those who had purchased private healthcare insurance worth between RM30,000 and RM50,000 years or decades ago. An RM100,000 coverage policy which was considered more than adequate 20 years ago is now barely enough for a major illness with the accelerated inflation and exorbitant medical and hospitalisation bills in the last few years.
For those with chronic illnesses that require multiple admissions, it is rare nowadays to receive a bill of less than RM15,000 per admission, even without any operative procedures done. One major operation would render the patient financially bankrupt and unable to pursue follow-up adjuvant therapy.
In the past, many of these patients were referred to the “safety net” function of government hospitals for further therapy. In 2017, the Health Ministry expanded its full-paying patient (FPP) scheme in more than 32 government and university hospitals in order to retain specialists in the service. Since then, patients referred to government hospitals from the private sector are charged a full first-class rate, which sometimes can be even more expensive than in the private sector.
Although patients can still opt for subsidised treatment, in practice, the majority are channelled into this FPP scheme. It is also note-worthy that the neediest patients are most likely to succumb to this pressure out of sheer necessity. With this safety net removed, one major illness or complication can now wipe out an entire family’s financial resources.
For the young and newly working population, things are not getting any better. Last year saw an average increase of 10% to 15% in the premiums for medical insurance. A RM100,000 coverage policy for healthy young adults in their 20s or 30s now cost about RM2,500 to RM3,000 a year in premium payments. Bear in mind that majority of these people not only have to support their growing family but also their aged parents. The financial burden of medical protection for the family is severe indeed.
For these reasons, the insurance industry had reported a stagnation in collection of medical premiums to around RM3.14bil a year for three years from 2015 to 2017 (Bank Negara Malaysia monthly statistical bulletin, 2019), which means that there is a decreasing number of new customers and increasing drop-out of existing customers who cannot afford the premium inflation.
Coupled with rising claims, it has resulted in negative growth of gross earned premium, at -2.9%, -0.5% and the highest ever of -16.4% in 2017. Premium increase to maintain profit margin and counteract this falling trend was counter-productive and resulted in further spiralling the costs.
With the intense privatisation and oligopolistic commercialisation of healthcare in the last 20 years, we are now further away from the original aspirations of the people and heading straight into a highly-commercialised, expensive, inefficient and deteriorating quality of industrial healthcare.
In this market-driven economy, both the medical profession and patients alike are marginalised to become subservient to foreign private commercial interests.
We should learn not to repeat the global experience over the past 40 years which led to the failure of the Alma Ata declaration of “Health for All” in 1978. The former director-general of WHO, Dr Margaret Chan, stated in her World Health Report 2009 that achieving the targets of the Alma Ata declaration in 1978 had largely failed and in its place, three “particularly worrisome trends can be characterized: “health systems that (1) focus disproportionately on a narrow offer of specialised curative care, (2) focused on short-term results which is fragmenting service delivery, and (3) laissez-faire approach to governance which allowed unregulated commercialisation of health to flourish.”
People who opt for private healthcare are responsible for nearly 50% of Malaysia’s medical expenditure, amounting to nearly RM36bil a year. The government must recognise that this group helps to reduce public healthcare expenditure and enables it to re-direct the funds to those most in need.
It is therefore the inalienable duty of the government to ensure that this group is protected from exploitative market behaviour. The public-private dichotomy must end and ways and means for meaningful and constructive private-public cooperation must be pursued.
I would call on the Health Ministry to immediately remove administrative barriers and establish appropriate mechanisms to ensure that patients who have to seek help in public hospitals would not be jeopardised, and the well-intentioned safety-net mechanism of the government can be fulfilled.
In the longer term, it is important to restore medical care to its original purpose of care. Commercialisation should be reduced, and this will paradoxically enhance private sector participation by a fair, just and sustainable system such that all stakeholders will have a seamless and constructive platform of cooperation in our healthcare commons.
Healthcare of the nation is now an exceedingly complex enterprise extending across many areas – from education, economics, engineering, pharmaceuticals and IT to finance, insurance and economics. It is no longer the responsibility of the Health Ministry alone but of the entire nation.
While the WHO Astana declaration of 2018 pronounced “no one is left behind”, it is also appropriate to say that no one is left behind in one’s responsibility to help restore the healthcare of the nation to its caring and humane nature.
DATUK DR S. H. LEE
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