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Saturday December 3, 2011

Better healthcare for all

The 1Care for 1Malaysia plan seeks to restructure the healthcare system so that quality services will be provided based on the principle ‘use according to need, pay according to ability’.

MALAYSIA aspires to become a high-income nation by 2020. The Government Transf-ormation Programme and the Economic Transformation Program-me, formulated and implemented in the 10th and 11th Malaysia Plan, provides the platform to achi-eve this goal.

The health sector is not excluded from this wave of improvements. 1Care for 1Malaysia is the proposed transformation plan to restructure the healthcare system so that quality services will be provided to the population based on the principle “use according to need, pay according to ability”.

As Malaysia moves towards a high-income nation status, more healthcare services will be needed. This is to cover the requirements of a larger population; higher life expectancy resulting in greater numbers of elderly; changes in disease patterns with more chronic illnesses; advances in medical technology and higher client expectations.

Therefore, private investments and the continuous contribution of the private sector are encouraged. However, with the existing healthcare financing situation, greater private health sector development would widen the gap of access to healthcare services for the rural population compared to the urban population; and between those who can and cannot afford to pay.

Under the 1Care for 1Malaysia plan, everyone, regardless of his ability to pay, has the choice to use either public or private healthcare.

Greater emphasis will be given to strengthen primary health services, with a fundamental focus on promotive and preventive care. Using the family doctor concept, every person will register with a family doctor of his choice for his primary care needs. This doctor can be from the public or private sector. Patients will not incur any charges when receiving care from their doctor for services within the defined benefits package. However, patients may be charged a small co-payment for prescriptions and certain appliances.

Patients requiring specialist care or hospitalisation will be referred by their family doctor. This will promote optimal use of specialists and hospital services for those who really require higher level care. When referred, patients may choose to go to a government or private hospital. Patients do not have to make any additional payments for specialist services and hospitalisation that are within the defined benefits package.

To support the health service delivery reforms, the health financing system must also be transformed to pool together different sources of funding for health; better manage the nation’s health funds; and control dramatic rises in healthcare costs.

Currently, Malaysia’s health system is funded by two sources.

Government and private funding account for 55% and 45% of total health expenditure, respectively.

Public funding comes from Government General Revenue, while private funding includes out-of-pocket spending (OOP), private health insurance and financing by employers.

The Malaysia National Health Accounts estimated that the country spent RM33.7bil for health in 2009. This was less than 5% of Malaysia’s Gross Domestic Product (GDP) and lower than the OECD average of 9.7%.

Healthcare cost escalation is an issue that has been voiced more frequently in recent years.

Global evidence shows that as a country becomes richer, its healthcare spending grows faster than GDP growth. In 13 years, from 1997 to 2009, Malaysia’s total health expenditure increased at an average of 12-13% per year, higher than general inflation.

If there is no health financing reforms, Malaysia’s health spending is estimated to reach RM102bil by 2020. This increase will be borne more by individuals and families, through OOP spending and private health insurance.

The proposed health financing transformation is a combination of Government General Revenue and Social Health Insurance (SHI). It involves pooling contributions from the self-employed, employees, employers and the Government.

Emphasis is given on the shared responsibility of individuals, families, communities, the corporate sector and the Government to fund the costs of healthcare services together. This consolidated fund will be managed by a government organisation responsible to the Health Ministry.

Currently, there are patients who are not able to pay their healthcare bills, especially when obtaining services from the private sector. The existing system of financial risk protection is inadequate and so patients may bear a high burden of healthcare cost. Through SHI, this problem can be addressed with regular smaller pre-payments. Therefore, catastrophic spending through OOP payments, at the point of seeking care when ill, can be reduced.

SHI contributions are dependent upon the financial ability of each family. Through cross-subsidy, the rich, young and healthy contribute towards the needs of the less fortunate, elderly and sick.

The vulnerable and poor will still remain protected through government financing for the same package of benefits. Delivery of public subsidy to identified target groups will be more transparent, fair and equitable.After many years of close scrutiny, deliberations with stakeholders and feedback from various quarters, the ministry presented the concept paper on 1Care for 1Malaysia to the Prime Minister and members of the Economic Council on Aug 11, 2009. A follow-up report presented on March 22 last year provided additional information and feedback.

Consequently, the ministry received the mandate to develop the 1Care blueprint over these two years.

The blueprint will work out broad implementation steps for a comprehensive approach to the transformation process.

It will also identify strategies to tackle key issues that are anticipated including an effective strategic communication plan to better communicate progress and gather constructive feedback.

Currently, 11 Technical Working Groups have been formed to provide suggestions, technical input and knowledge on the 1Care blueprint content. Several committees oversee the development of the blueprint and provide guidance and policy directions to this effort.

Various stakeholder consultations have been and are being conducted to get input and concerns, as well as update progress.

These include workshops, seminars and research on various components of the health system transformation. They foster much needed capacity-building and understanding among key stakeholders.

The ministry is also engaging a group of experts to assist in the detailed development of this transformation process by bringing global knowledge and experience in areas which Malaysia has little expertise.

This will ensure that the blueprint addresses the multiple aspects of a comprehensive health sector transformation effort to enhance the quality of life of Malaysians.

In addition to improving the health status of the population, 1Care for 1Malaysia will also promote social solidarity and equity in healthcare.

In line with the country’s aspiration to become a developed nation, the transformation of the health system, through the sharing of health resources, is imperative to fulfil the needs of the people.

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