Citizens' Health Initiative — Aliran Media Statement
The Continuing Crisis in Malaysian Health Care:
Commission of Enquiry, or People's Tribunal on Health Care?
In our society, some aspects of life are off-limits to commerce. We prohibit the selling of children and the buying of wives, juries, and kidneys. Tainted blood is an inevitable consequence of paying blood donors; even sophisticated laboratory tests cannot supplant the gift-giving relationship as a safeguard of the purity of blood. Like blood, health care is too precious, intimate, and corruptible to entrust to the market.
Steffie Woolhandler, MD, David Himmelstein, MD
New England Journal of Medicine, August 5, 1999
CUEPACS President N. Siva Subramaniam insinuates at a foreign hand behind the citizens' campaign for healthcare reforms (Star, August 14, 1999). Could it be the World Health Organisation he suspects, whose weighty opinion allegedly moved the Cabinet to suspend (temporarily?) the policy of corporatising and privatising government healthcare? If that is the case, Citizens' Health Initiative is encouraged to bring to the attention of the Minister of Health additional advice from an oracle of modern medicine, the New England Journal of Medicine.
In an August 5, 1999 editorial, Dr Steffie Woolhandler and Dr David Himmelstein of Harvard Medical School provide a trenchant review of the extensive evidence documenting the human costs and institutional and systemic wastefulness and inefficiencies of investor-led, market-driven medicine in the U.S.
The evidence has long been clear to all but the most obtuse and dogmatic of pro-market fundamentalists. The US health care system consumes 14% of GDP (double the Western European/Japanese average), and yet leaves 43 million residents without health insurance cover, including 10 million uninsured children (one out of every seven). Many more have inadequate cover for catastrophic illness. The US has state-of-the-art medical technology, but among the twenty-two OECD countries, its infant mortality rate is exceeded only by Portugal.
CHI cannot be but alarmed at the multitude of US-based healthcare consultants purveying their wares in Malaysia, eagerly anticipating (joint-venture?) opportunities from a privatised "sunrise" service industry with enticing growth potential. Indeed, one of the few lessons we can learn from that archetype of market-driven medicine is how NOT to organise the provision and financing of healthcare.
The Malaysian healthcare system is far from perfect. Much improvement is possible and necessary in the both the public and private sectors. In aggregate terms however, the geographical dispersal and generally rational deployment of primary health care resources has been a major factor contributing to our enviable health statistics, despite our very modest government health expenditures. This system, which has delivered good value for money until recently, is now threatened by the disastrous privatisation of components of government healthcare. Despite the official secrecy, there is enough evidence to indicate that dramatic increases in costs for privatised medical supplies and pharmaceuticals, and for privatised hospital support services (laundry, hospital equipment and facilities maintenance, cleaning services, and clinical waste disposal), increases as much as 4- to 5-fold, are grossly incommensurate with gains in quality of service.
There is a dark side to our modest public expenditures on health care: our public sector health care personnel deserve better remuneration and terms of service, but even more importantly they are entitled to consultative, accountable and competent staff management without which severe demoralisation and erosion of work motivation would add further to the perennial exodus of senior, experienced staff from the public sector.
In view of these continuing, urgent problems of public sector healthcare, CHI urges the government of the day, now and in the future to:
- immediately convene an independent Commission of Enquiry, with the full participation of credible lay representatives, to investigate into and report on the comprehensive reforms necessary to the organisation, staffing and financing of public sector healthcare (including education, research and training requirements) to ensure the continuance of publicly-funded and publicly-provided equitable, accessible, and sustainable healthcare of quality;
- allow for a comprehensive, impartial review of existing corporatised and privatised health services with a view towards rational, accountable and sustainable use of public resources;
- demonstrate its commitment to accountable and responsive healthcare governance by establishing a permanent National Health Council with clearcut advisory and policy-setting powers in which the lay public through their civic representatives are effectively, adequately, and credibly represented.
The Citizens' Health Initiative is prepared to work with the government and other interested parties in convening such a Commission of Enquiry. It is also prepared, if necessary, to convene a People's Tribunal on the future of healthcare in Malaysia.
August 15, 1999
Citizens' Health Initiative — Aliran
THE CITIZENS' HEALTH CAMPAIGN CONTINUES!
Citizens' Health Initiative c/o Aliran Kesedaran Negara 103 Medan Penaga 11600 P. Pinang
fax: ++ 60-4-6585197 email: [email protected]
(please reply or communicate with a cc to <[email protected])
website: http://www.malaysia.net/aliran