The Health Ministry has come up with a proposal to revamp the health care system. We look at the salient features of what they have in mind.
The government’s proposed new scheme has seven main components. These are:
1. The National Health Fund
They promise that this fund will not be privatised but run by the government. The Fund will pay for the treatment of all the conditions / illnesses that are specified in the “Essential Health Benefit Package” (see no. 3).
Payments will be made to both the Ministry’s hospitals and clinics as well as to the private hospitals and general practitioner (GP) clinics.
2. Mandatory monthly contributions
Every wage earner will be required to pay towards this fund. The amount payable has not yet been specified. The government will make payments for government staff, pensioners, the poor as well as the disabled.
3. Essential health benefit packages
The package of health benefits deemed “essential” has not yet been defined. For example, Ministry officials were not able to answer definitively when we asked them whether the treatment of a heart attack would be part of the essential package.
Apparently, the consultant will help the government decide what benefits will be included.
4. Restructured government hospitals and clinics
We were not told how hospitals and clinics would be restructured in order to improve efficiency, affordability and accessibility. One idea that has been floating in the Ministry for more than a decade now is that these institutions should be corporatised to improve efficiency and to enable them to implement improved pay schemes for their staff (and thus halt the brain drain).
5. The private sector
The National Health Fund will also make payments for visits to GPs. The Ministry, however, has not yet decided whether payments will be on a fee-for service basis or on a capitation basis.(where the doctor will be paid fixed amount per patient per year based on the number of patients registered with the GP). The former system leads to over-treatment, neglect of preventive aspects and skyrocketing costs. The latter may lead to under-treatment. The National Health Fund will also cover a portion of the costs for the treatment of conditions listed under the “Essential Packages” even in private hospitals.
6. Private insurance for extra coverage
More affluent families will be able to purchaset additional private insurance packages to top up for the payment of conditions for which the National Health Fund will pay only a portion of the costs that the private hospitals charge. The private insurance packages will also cover conditions not specified in the essential package underwritten by the National Health Scheme.
7. The National Health Financing Authority
This authority is envisaged as a new body responsible for overseeing overall administration and evaluation of the new health care system. Ministry officials, however, were not able to say how this authority would be constituted.