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Where’s the national health scheme?

“Give me until the end of the year and I’ll make public the draft plan and the public can debate it.”


Health Minister Datuk Liow Tiong Lai announcing that the ministry needed to have a “relook” of the proposed National Health Financing Scheme even though in 2008, 24 years had passed since the idea was first mooted and various feasibility studies had already been conducted.

Liow said a previous study on the scheme by an Australian consulting firm had not been satisfactory and contained recommendations that were not viable for the Malaysian economy. He also said the government would not go “full gear” into the proposed insurance scheme as it would anger citizens because of the economic situation at the time. (Source: National Health Financing Scheme: Two decades on, another relook, New Straits Times, 8 June 2008)

“A lot of work has already been done. Many seminars have been held and ministry representatives have studied the models of other countries, reviewed working papers from the private sector and studied recommendations from relevant groups.”

Former Health director-general Tan Sri Dr Abdul Khalid Sahan, who questioned the need for more public debate on the scheme. He was one of those behind the idea for the scheme when he was the Health director-general in the 1980s. The scheme was first mooted during the Fourth Malaysia Plan (1981-1985).

Dr Abdul Khalid said the delay in implementing the scheme was not because of a lack of information or debate, but “inefficiency and the lack of follow-through of recommendations by whoever was in charge.” (Source: National Health Financing Scheme: Two decades on, another relook, New Straits Times, 8 June 2008)

“The proposed scheme is still not finalised.”

“We also have to go through the mechanisms with Bank Negara before doing the same with the National Economic [Advisory] Council and then talking to the stakeholders.”

Liow, telling reporters it would take another year before the scheme, designed to provide affordable healthcare, could be implemented. He acknowledged that discussions on the matter had been ongoing for two decades. He attributed the delay to various quarters that would be affected once the scheme came into force. (Source: National Health Financing Scheme to be implemented next year, The Malay Mail, 4 March 2010)

“It’s not like the higher your salary, the higher you pay. No, not like that. It’s a flat rate. It’s a minimal amount.”

“If the rich want to have better service on top of what they have, they can buy insurance.”

Liow, in announcing that the proposed scheme would charge a flat rate regardless of one’s economic class. (Source: Proposed health scheme charges flat rate for all, says Liow, The Star, 11 July 2010)

“Those who can’t afford to pay will be fully paid for by the government.”

“They (clinics) will be paid a flat rate…say RM40, so if the cost of the treatment and medicine is more than RM40, then the extra will have to be paid by the patient.”

Four months after saying discussions were still underway with various stakeholders, Liow reveals some details about the premiums for the National Health Financing Scheme. The minister said patients would have to pay part of the cost if the cost of their treatment exceeded the flat rate. He also said those earning below a certain to-be-determined income level would be exempted from paying premiums. (Source: Flat rate contribution for healthcare scheme, theSun, 11 July 2010)

” …about 10 years or more”

Liow says the scheme could take more than a decade to be realised, adding that the Health Ministry believed it could be done over four phases. The four phases would entail restructuring the Health Ministry, upgrading the medical facilities and infrastructure it oversees, and streamlining personnel and procedures, among others. (Source: Healthcare for free, New Straits Times, 11July 2010)

“It is only one scheme. Our policy is the rich pays for the poor, so we are looking at this. It is a proposal and it’s still being studied. The richer may pay more; the poor may pay less or not pay at all.”

Liow clarifies in Parliament, telling reporters that the scheme would not work on a flat- rate basis after all. He also reiterates that the ministry wants public feedback, saying more studies on the scheme’s implementation were needed. (Source: No Flat Rate, theSun, 13 July 2010)

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6 Responses to “Where’s the national health scheme?”

  1. Tan says:

    It took the Americans decades to reform and pass the healthcare reform bill after a change of guard. So, naturally I do not think it will happen in another decade or so unless Malaysia too, changes the guard at the federal level. In Malaysia, unless the PM dares to push forward the reform bill notwithstanding any political setback, it is status quo. If the Health Minister is really cares about the Malaysian poor and middle income group, he should have presented the proposal for cabinet approval instead of calling for more forums and dialogues with the stakeholders, after all they have all been consulted once too often. It is time for action and not rhetoric.

  2. 2nd class says:

    The NHS will NEVER be implemented. This is because Malaysians generally think that government should bear the cost 100%. They are not even willing to pay even RM1 per month. Look at what happened with Indah water, many still do not pay the bill despite that the rate could be low with few ringgit per month PER HOUSEHOLD.

    The rich will never pay because they think that they can afford the private healthcare of their choice and why should they pay something that they would not utilize. The middle class will never pay because they think this as a burden.

    For which ever NHS, enforcement will be a big headache. Would the public or private hospitals and clinic reject the patients if they are not covered? The next thing that will happen is a surge of complaints to the media, and government especially will have a bad image and everything will be back to square one which is ‘FREE’ heatlhcare for everyone.

    The challenge of NHS is to have such a scheme that the rakyat PAYS nothing and government subsidises less, which is impossible. Whichever side (government or opposition) suggests an NHS involving a month or even yearly premium, is asking for political suicide.

    Notice that every health minister will say something about NHS but rest assured that they will remain NATO (no action talk only).

    So the only choice that government has now is to increase the health budget (though this will only solve the problem partially and temporarily) and invest in human capital. Also the gov must abandon the idea of health tourism or even ban new private healthcare as this is the single most significant factor which drains the most experienced medical staff from public healthcare and deteriorates its quality.

  3. matdene says:

    If you don’t want to pay a penny for healthcare, then expect healthcare rationing and possibly higher taxes for the middle- and upper-end income earners. If you want to have healthcare on demand, you have to pay for it. No money, no talk. You cannot have it both ways.

  4. Sean says:

    “If you want to have healthcare on demand, you have to pay for it. You cannot have it both ways.”
    Except in those countries where people don’t have to pay for healthcare and get it on demand. Did you see the BBC article about the UK being the best place to die?

    The report is here at The Economist Intelligence Unit (the take-home message might be “live in Malaysia, die in the UK”, perhaps):

    where it notes: “In Spain, one study found that in 2006 a shift away from the use of conventional hospital treatment towards palliative care, an increase in homecare and lower use of emergency rooms, generated savings of 61% compared with expenditure recorded in a 1992 study.”

    It seems reasonable to expect that a national health infrastructure could go a long way to avoiding inherently more expensive ‘on demand’ interventions and push back some of the costs associated with premature incapacity and death. It’s the difference between investment and gambling, if you like glib.

    I think what you can expect if you have a fully paid National Health Service is that one day your government will start an expensive invasion somewhere shortly after gutting your nation’s industrial capacity, blow the nation’s reserve on high-stakes poker, and then sell the NHS because it was obviously to blame all along. I think if you want decent quality of healthcare for all, you have to make sure you don’t vote for someone who will use it as a convenient national scapegoat for their own financial incompetence.

    • matdene says:

      Maybe these areas (like palliative care) works best in a NHS type system. But what about other areas? For example, waiting time for consultation: Government-funded hospitals takes weeks or months, private hospitals might be within days. Choice of drugs for treatment, you get what you need but might not be what you want. You may want Panadol Actifast but you get a generic paracetamol for fever. You might want a en suite hospital room but you are given a shared room. You will be alive and kicking, but you won’t be getting first class service.

      Sometimes in rare cases, life saving treatment will be refused on grounds of cost and effectiveness. You need to keep in mind that when you spend a lot of money into one person, would this affect another group of patients from getting good healthcare? So in the end we might not get the treatment we think we need because we are spending more than what we are given with.

      A NHS-type healthcare system is good but we certainly feel the State is rationing healthcare on the basis of need, and less of demand.

      And of course a government who does not know how to spend wisely will screw up everything no matter how beneficial the scheme is.

  5. simple says:

    Medical card for all workers (private & government servants).

    Flat rate of 1% of monthly income of the worker like the Socso scheme. Salary RM1,000 per month, pay only RM10 per month only.

    If salary low, like salary RM500 per month, they have to pay RM5 per month. That is 1%. Make it compulsory for all workers for a start.

    Introduce this first, it can be a good start. The medical insurance can collect billions of ringgit per month. Later, widen it to the rest, like business [people], the self employed, etc.

    The worker can choose to seek free treatment in private clinics and hospitals, and government hospital and all covered by the medical insurance.

    Then government clinic and hospital will be almost empty and private clinic and hospital will be full of patients…
    At least the government hospital will not be over crowded…..

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