The free market system cannot guarantee equitable access to health care services and it is the duty of the government to ensure that the people get access to services they deserve and need, writes masterwordsmith.
A forum on ‘What is wrong with our health care system?’ was held at Kompleks Penyayang on 20 March 2010. The speakers were Dr Jeyakumar Devaraj (MP for Sg. Siput, Parti Sosialis Malaysia), Dr T Jayabalan (Worker’s Health & Safety, Penang) and a guest speaker, Puan Rozita bt Ahmad. The forum was moderated by Dr Toh Kin Woon.
Toh began by reiterating health care as an important social service provided by the government to citizens which must be easily accessible, adequate in supply and affordable to the masses. He hopes to see health care being provided on the basis of need and not on the ability to pay. He highlighted two recent trends which go against such principles:
• In March this year, the Health Ministry introduced the Full-Paying Patients (FPP) scheme in four public hospitals in Malaysia including Hospital Sultan Bahiyah in Alor Setar, Hospital Serdang and Hospital Sg Buloh in Selangor, and Hospital Sultan Ismail in Johor. This scheme, which will be expanded to more hospitals soon, allows doctors in government service to charge full fees to those patients who can afford them. This may result in discrimination against those patients who cannot afford to pay.
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• Toh also highlighted the implications of the current emphasis on medical tourism as it would raise prices in private health care service as well as extract already scarce medical experts from public hospitals.
He pointed out that Parti Sosialis Malaysia has been the only group that has consistently campaigned against the privatisation of public health care service. With that, he introduced Dr T Jayabalan.
A fundamental shift
Dr. Jayabalan began his talk by presenting his slides entitled ‘Affordable Health Care’. He emphasised that even though health care is a basic and fundamental right of all citizens, our country does not have a national health policy to date.
He gave an account of the development of the public health care services. Initially, the health care system was a well-managed system that the British colonial administration handed down to the then Malayan government. Its main aim was to look after the health needs of British expatriates and local government officials. By the time we achieved independence, some basic services and private health care were in place in major cities. However rural health care was noticeably absent. During the earlier years after Independence, a rural health service was put in place.
By the 1980s, the country’s health care services saw a fundamental shift in financing. Tun Dr Mahathir was the main architect of such a change. The emphasis was that private funding was needed to pay for health care services. Soon after, we witnessed privatisation of different sectors of public hospital services such as pharmaceutical procurement, procurement of prosthesis and hospital equipment, laundry services, and biological waste management. By 1991, the privati-sation master plan was introduced and fully implemented. Private medical clinics were introduced in many teaching hospitals.
Of late, there was a suggestion to sell Institute Jantung Negara (IJN) to listed firm Sime Darby. This was met with much objection from the public. Some public teaching hospitals such as Universiti Kebangsaan Malaysia (UKM) and Universiti Hospital have private wings where full-fee paying patients do not have to wait as long a time as non-paying patients.
Dr Jayabalan further brought to attention the government’s recent drive to promote medical tourism, which he said is indirectly delaying local citizens access to medical services because private hospitals would be wooing more foreigners to seek medical treatment here. When private hospitals expand their services or when new private hospitals are built, they would be pinching experienced doctors, nurses and para-medical staff from government hospitals.
This will further aggravate the already severe shortage of personnel in government hospitals. It will also disrupt the mentoring and teaching of young doctors, newly qualified nurses and paramedical staff. The end result can only be a deteriorating standard of care in government hospitals.
The implications of privatisation
Dr Jayabalan further highlighted the following points:
The restructuring of health care can be seen in a few areas, namely:
• Privatisation of government hospitals as mentioned above. Such decisions were made by the Economic Planning Unit reporting to the Prime Minister’s Office rather than the Health Ministry, with the result that economic priorities over-rule the consideration to provide health services to all.
• Health tourism — The promotion of health tourism will further extract scarce and invaluable medical personnel from the government hospitals.
• Proliferation of Health Maintenance Organisations (HMOs) and private insurance schemes. Such commercial organisations will further promote private health care services on a for-profit basis.
He also pointed out the implications: private wings in public hospitals would lead to:
• Human resources shortage – the already existing manpower shortage will be further exacerbated.
• Inadequate infrastructure – existing wards in government hospitals would have to be converted to private wings to accommodate full-paying paying patients. This would lead to further shortages of beds for non-paying patients.
• The costs of upgrading hospitals to have private wings would be borne by public funds while only a few who can afford to pay for them would enjoy the benefit.
• Discrimination by hospital staff against non-paying patients would arise.
With the on-going trend of privatisation of health care services, equity, accountability and accessibility to health care services will be jeopardised. Dr. Jayabalan highlighted a few problems we are already facing:
• Burgeoning private insurance costs;
• Rising health care costs;
• Access to services restricted in some cases where patients cannot afford to pay;
• Expensive medication;
• Shortage of staff and work overload at government hospitals.
Certainly, there are many problems besetting the health care system in our country. He concluded by citing a few main points:
• The provision of health care and costing via market mechanisms is contradictory to the provision of health coverage for all and equal access;
• Private insurance is incompatible with public social insurance as private insurance is geared to attain profit and would cover only those who can afford to pay while leaving out those who are poor or are considered to be at high risk.. The old and the sick, who need health services most, are thus left out of private insurance schemes.
• There must be provision of essential health care services regardless of social classes and geographical areas;
Dr Jayabalan concluded by emphasising that the Health Ministry should not implement privatisation of public health care services by stealth and underhand measures. Furthermore, such decision-making process must be transparent to include all stakeholders such as the medical and allied professions, the trade unions and the public at large.
Dr Toh commented that Dr. Jayabalan had given a comprehensive presentation of health care with particular attention paid to the negative implications of recent trends. He introduced the next speaker, MP Dr Jeyakumar.
Undermining public hospitals
Dr Jeyakumar began his presentation by stating that only one third of the country’s medical doctors are serving in government hospitals and they have to serve three quarters of the population. As such, they are overwhelmed by the ever-increasing work load. Patients seeking treatment at public hospitals have to endure long queues and a deteriorating standard of service. Any further moves to privatise the public hospitals will further add to the woes already faced by these patients.
He also pointed out that Parti Sosialis Malaysia is the only political party that has been actively campaigning against the privatisation of public health care. He explained that the main motivating factor in promoting privatisation is to seek more profit. He highlighted some controversial statements made by government leaders which confirmed such an intention.
He informed the audience that in April 2008, the Health Ministry had given licenses to build 45 new private hospitals. He asked, where would so many new hospitals look to in order to recruit new medical and nursing staff? These new hospitals would not be not teaching hospitals where they would be committed to educate medical and nursing students and produce more doctors and nurses for the country. Their sole aim would be to provide services for profit. As such, they would most likely recruit their staff from government hospitals. It is estimated that for each private hospital established, about 10 senior medical experts would be poached from a government hospital in the same vicinity. This would severely affect the standard of service provision at the government hospitals at a time when there is already a severe shortage of doctors in the public sector. It would be a waste of public funds for the government to train these doctors only to have them pinched by the private sector.
The departure of senior medical consultants from public hospitals would also result in shifting the already heavy work load to medical staff who choose to remain behind. Many less experienced doctors would be called upon to perform surgeries and duties which are beyond their capabilities.
Similar situations would result in the further shortage of nurses, para-medical staff, laboratory technicians and engineering staff in the public hospitals.
Jeyakumar reiterated that government hospitals are important institutions for training medical students, young doctors and para-medical staff. They are the centres for passing on skills and experience to the next generations of health care providers.
All these factors will cause a deterioration of services provided at the public hospitals.
Jeyakumar then discussed issues related to the privatisation of Pharmaceutical and Prosthetics Supply to the public hospitals. Recently their contract has been renewed for another ten years. Many sectors of the public hospitals have also been privatised. These include the laundry services, the biological waste disposal services and the engineering services.
Such privatised sectors are examples of the crony capitalist system with contracts awarded to government-linked corporations run by political supporters. The lack of competition and accountability has resulted in inefficiency, inflated prices and leakages.
He stressed that the government, as the custodian of the public health care system, must develop, maintain and strengthen the public health care system instead of undermining it. He was particularly concerned as recent policies implemented by the Director General of Health, the Health Minister and even the Prime Minister continue to undermine the public health care system.
Jeyakumar reminded the audience of Aneurin Bevin’s statement in 1952. Bevin was a member of the Labour Party of the United Kingdom who was the main architect in establishing the National Health Service in Britain. He said, “No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”
Jeyakumar stressed that the free market system cannot guarantee equitable access to health care services and it is the duty of the government to ensure that the people get access to services they deserve and need.
He brought to light certain changes which indicate a shift from the social democratic system to a neo-liberal economic system. For instance, whereas in the past, health care services were provided by the government, we now have a free market system taking over the provision of health care services. The government has gradually abandoned its social responsibility towards the rakyat and let the little regulated market forces take over the provision of health care. The result is that health care has now become a commodity to be sold and purchased. Those who can ill afford to pay for it, and they now comprise the majority of the population, will be left to fend for themselves.
He viewed the privatisation of public health care system as an example of the continuing dismantling of the social safety net. This is the direct consequence of the Barisan Nasional pursuing neo-liberal economic policies.
Malaysia is not facing this assault alone. In fact, the capitalist ruling classes in many nations have imposed neo-liberal policies to maximise the profits of private corporations while at the same time dismantling the social services previously won by the masses. This attack has gained momentum after the end of the Cold War as the ruling capitalist class no longer fear the threat of revolts by the working class.
Toh noted that Jeyakumar had offered a refreshing look at the problems besetting our health care system. The cause lies in the deliberate shift from social democracy to neo-liberalism. He cited the Goods and Services Tax (GST), a regressive tax, as another example of a neo-liberal policy introduced to further beggar the rakyat.
Puan Rozita then gave a first-hand witness account of how she lost her husband, Encik Ahmad Nazri Ibrahim, as a result of the privatisation of the Prosthesis Procurement Services of the public hospitals and the bureaucratic procedures involved.
Her husband Encik Ahmad Nazri Ibrahim, 48, suffered from shortness of breath one day and was rushed to a public hospital, where he was informed that he needed to have three stents inserted in his heart vessels to relieve the blockages. The cost: RM19,000, to be paid in cash or by a bank draft.
The family did not have ready cash but had funds in the EPF. The EPF, however, refused to issue a letter of guarantee, citing the reason that this was not the usual procedure. The family then appealed to the DAP to solicit for donations from the public.
However, the funds came in too late as during the waiting period her husband suffered a massive heart attack, lapsed into a coma and succumbed to heart failure.
This is a tragic example of how the pay-first policy as a result of the privatisation of the prosthesis procurement department of the public hospital led to a delay in the treatment of a patient, resulting in his untimely death.
Following this, there was a lively discussion with more questions raised by the audience including Darshan Singh, Mr Lim Kean Chye (founder member of the Malayan Democratic Union), Datuk Seri Dr T Devaraj, Mr. Lee and others. The meeting ended with a round of applause to the speakers and the chair.
I left the forum with a heavy heart and wondered why PSM is the only party that is concerned about the health care system. Many other points were raised and it is just impractical to list them all. Suffice to say that there are many issues in this area which must be tackled to improve the quality of health care for our citizens. This will bring untold benefits both in the short and the long term. I earnestly hope that there will be other leaders like Dr Jeyakumar and Dr Jayabalan who truly have the welfare of citizens at heart.
This article was written by blogger Masterwordsmith and originally appeared on http://masterwordsmith-unplugged.blogspot.com/ with the title The Changing Landscape of Health Care. The version published here has been edited by the Sembang-sembang Forum and further edited by Aliran.