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Health care at a cross-roads

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Civil society is mobilizing to protect the basic right to health care for all in the face of the government’s plan to make Malaysians pay national health insurance premiums.

The Coalition Against Health Care Privatization (the Coalition) and the University of Malaya’s General Staff Union organised a forum titled “Health Care System in Crisis: The People’s Proposal” on 11 December 2005.

More than 120 individuals from civil society groups, NGOs and unions participated actively in the forum. They were all given a booklet which contained ‘The People’s Proposal’, the Coalition’s correspondence with the Health Ministry and relevant press statements. The forum began with a video clip highlighting the crisis faced by our health care system.

Next, the former Director-General of Health, Tan Sri Dato’ Dr Abdul Khalid bin Sahan – who had rejected calls to privatize health services while he was in service – presented the keynote address. He gave an overview of our health care system, highlighting the development of the current two-tier system with all its problems. He stressed the need for a comprehensive national health policy, which covers funding for health care, delivery of health services, and the payment mechanism for such services. These three areas are all interrelated. He added that the formulation of this policy was best undertaken by an independent body – external to the Health Ministry. It should be a supra-ministerial body responsible to the Cabinet.

Dr Jeyakumar Devaraj, the Coalition’s secretary, then went through the Coalition’s efforts in the previous 13 months to communicate our concerns with the Ministry. He also highlighted some of the issues that were in the press lately. He was followed by Dr Subramaniam Pillay, the Coalition’s chairperson, who presented the People’s Proposal.

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The People’s Proposal, drafted by members of the Coalition, which is made up of 81 NGOs, argued that it is the Malaysian government’s responsibility to provide equitable and adequate health services to the rakyat. Other highlights of the proposal are:

    • the health budget be increased to 5 per cent of Gross Domestic Product or to RM15.9 billion. Other sources of revenue should come from taxes on alcohol and cigarettes and a portion of Petronas’ profits;
    • the need for the government to consult with civil society groups regarding the proposed national health financing scheme;
    • the proposed National Health Authority should be transparent and be established by an Act of Parliament. Accountability of the proposed authority must be ensured through the representation of civil society groups;
    • the government’s primary focus must be on strengthening the present public sector health care delivery system;
    • comprehensive health must be available for all irrespective of their ability to pay. The essential package must include all treatment options available in the present public health delivery system.

The floor participated actively with a wide range of comments. Among the issues raised were:

    • the need for the government to disclose the terms of reference for the foreign consultant who is going to be appointed to look into the proposed health care financing system;
    • coverage of health care for migrant workers needs to be considered. Employers need to pay for migrant workers’ medical care;
    • the need to control costs of health care by the government, especially with the entrance/existence of Health Maintenance Organisations (HMOs) and insurance companies;
    • health care services need to be reviewed – for example, the dispensing of drugs by private hospitals may lead to higher costs for patients;
    • maternity clinics need to be considered in the strategy;
    • the need for the government to play a bigger role in the training of more doctors to provide better services;
    • a need to create awareness of what is happening to our health care services by having road shows;
    • the need for a Royal Commission on Health to review health care reform; the public may benefit by gaining access to more information;
    • the need for the Coalition to have an action strategy so that it does not deal with matters on a piecemeal manner;
    • the need for the Coalition to be cautious in its engagement with the government so that it does not compromise on the principle of the right to health care for all, a a basic human right.

Suggestions for action:

    • (The Coalition will) write to the government (Economic Planning Unit) asking for the terms of reference for the foreign consultant to be released to the public. (This has since been done but the EPU replied that the terms of reference were ‘confidential’.)
    • (Each organisation needs to) spend the next two to three months discussing the Coalition’s People’s Proposal and to get back with their responses.
    • Mobilize by having talks on health care reform.
    • Get more endorsements for the People’s Proposal.
    • Present the revised and updated People’s Proposal to the Prime Minister at Putrajaya.

The meeting closed with a show of support by all participants that they will be part of a public display of action and endeavor to get endorsements from their organisations for the People’s Proposal.

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