Chalk up another victory for civil society groups.
The Health Ministry has terminated the services of Australian health care financing consultant Karl Karol, it was revealed on Sunday in Penang.
A senior Health Ministry official, Dr Lim Kuan Joo, told a ‘Malaysian Health Care Financing Scheme’ seminar organised by the Penang Medical Practitioners’ Society that Karol’s services were no longer needed because the Health Ministry felt that his proposals to fund health care were not appropriate for the country.
Karol had suggested a goods and services tax (GST) be imposed to raise money for health care. He was also proposing market-based incentives to contain costs and limit demand for health care. For instance, he proposed that private general practitioners could act as “gatekeepers” when referring patients to specialists and if they kept below the targeted number of referrals, the doctors would be given a bonus!
Karol’s health care financing study was funded by the UNDP. Now why would the UNDP want to fund someone who was going to come up with a regressive model of financing? Didn’t the UNDP or the Health Ministry know what kind of approach he would adopt?
Civil society groups, which got wind of his proposals, expressed alarm. A GST is considered to be a regressive tax because it is a tax on consumer spending, which means the poor will pay a disproportionately higher amount as a percentage of income compared to the rich. At present, the lower-income group fall below the income tax threshold and therefore do no pay any income tax.
The Health Ministry could have saved a lot of time had they listened to civil society groups in the Coalition Against Health Care Privatisation.
- Aussie consultant in health care spooks civil society
- Privatisation of health care feared
- Watch out for the Aussie consultant’s proposal
It’s not difficult to find out what ails the public health care system in Malaysia.
For one thing, Mahathir’s blessing for health care privatisation in the 1980s severely undermined the government hospitals as many overworked, unrecognised, and underpaid specialists left in droves for the private sector. Privatisation of essential services and drug procurement in general hospitals has also dramatically raised costs in the public sector.
The public health care system now is severely underfunded and understaffed, and many of the staff who remain there are doing an admirable job under difficult circumstances with limited resources. Instead of raising the miserable government spending on public health care, the Health Ministry is still toying with the idea of some form of social health insurance. But having learnt their Karol lesson, the Ministry is now dead against any form of regressive taxation, said Dr Lim.
But I don’t think the public, already reeling from higher fuel costs, will be thrilled if they were now asked to pay for social health insurance.
Why not just increase government spending on health care instead of sending angkasawans into space?! Too simple a solution?
Some key statistics will show us how badly under-resourced the public health care system is.
The government spends so little on health care (see below):
Total expenditure on health as percentage of gross domestic product
| Country |
Value |
Latest Year |
| Canada |
9.7 |
2005 |
| Cuba |
7.6 |
2005 |
| Malaysia |
4.2 |
2005 |
| Singapore |
3.5 |
2005 |
| Thailand |
3.5 |
2005 |
| United Kingdom |
8.2 |
2005 |
| United States of America |
15.2 |
2005 |
(Of this 4.2 per cent, the government spends just around 2 per cent; the remainder is private health care spending)
General government expenditure on health as percentage of total government expenditure
| Country |
Value |
Latest Year |
| Canada |
17.5 |
2005 |
| Cuba |
11.7 |
2005 |
| Malaysia |
7.0 |
2005 |
| Singapore |
5.6 |
2005 |
| Thailand |
11.3 |
2005 |
| United Kingdom |
16.2 |
2005 |
| United States of America |
21.8 |
2005 |
Per capita government expenditure on health (PPP int. $)
| Country |
Value |
Latest Year |
| Canada |
2402.0 |
2005 |
| Cuba |
302.0 |
2005 |
| Malaysia |
203.0 |
2005 |
| Singapore |
363.0 |
2005 |
| Thailand |
207.0 |
2005 |
| United Kingdom |
2261.0 |
2005 |
| United States of America |
2862.0 |
2005 |
With such low government spending on health care, no wonder we can’t keep our doctors in public health care… and no wonder, we have so few hospital beds. And no wonder we have a severe mismatch in resouces between the public and private sectors. The government hospitals have much fewer doctors and specialists than the private hospitals, but they treat the vast majority of patients. No wonder they are overworked and overstretched.
Physicians density (per 10 000 population)
| Country |
Value |
Latest Year |
| Canada |
19.00 |
2006 |
| Cuba |
59.00 |
2002 |
| Malaysia |
7.00 |
2002 |
| Singapore |
15.00 |
2003 |
| Thailand |
4.00 |
2000 |
| United Kingdom |
23.00 |
1997 |
| United States of America |
26.00 |
2000 |
|
Hospital beds (per 10 000 population) |
|||
| Country |
Value |
Latest Year |
|
| Canada |
34.0 |
2005 |
|
| Cuba |
49.0 |
2006 |
|
| Malaysia |
19.0 |
2006 |
|
| Singapore |
32.0 |
2006 |
|
| United Kingdom |
39.0 |
2004 |
|
| United States of America |
32.0 |
2005 |
|
I was also surprised to learn that even private hospital doctors are worried about the health insurance industry, which they feel is getting even more powerful and influential. One senior private hospital doctor told me, “We have to fill page after page of health insurance forms before we can treat patients.” He also complained that certain insurance firms were resorting to unethical practices such as asking private hospitals and their doctors to reduce their fees in return for more patients being channelled to them.
Apart from this, doctors also have to contend with the rising threat of litigation.
Another doctor said that many private hospital doctors were increasingly unhappy with the profession and he felt that in a few years, many wouldn’t want their children to take up medicine as a profession.
Dr Jeyakumar Devaraj, one of the speakers at the forum, stressed that health care was an essential service that could not be left to market forces.
He also warned that the trend towards health or medical tourism would further undermine the public health care system, as it would create more demand for doctors and other resouces in the private sector, aggravating the braindrain from the public sector. Pakatan Rakyat governments, please take note!
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GPs as gatekeepers actually ensure that patients get to see the right specialist instead of having people self refer to the wrong one. This also ensures that as an orthopaedic surgeon for example, your waiting room is full of orthopaedic problems and not medical, neurosurgical or rheumatological patients who add to the waiting time of patients in your speciality. Some GPs may be skilled enough to deal with problems so that you don’t actually need to see a specialist hence saving the patient money.
Everything else this consultant said is not appropriate for Malaysia.
it’s true….health care cant left to market forces. health care is not all about money.
now i can see why ppl worshipping money more than worshipping god.
sometimes dr has to choose between ethical and management-pressure. to treat or not to treat. must treat, bcoz it’s his job, not to treat, bcoz the patient has no money and not deserved to be treated.
DOCTOR DILEMMA
http://www.delhihomeo.com/paperberlin.html
Ganesh, according to one English tuition teacher, you may substitute the word city with the Big Apple. I don’t think Parisians or Londoners would be too happy that their cities may be referred to as that.
I took Economics as one of my A level subjects. At the beginning of the Mahathir era, I was convinced I’d been wasting my time. Thatcherism was de rigueur. I still remember the accolades heaped on both Mahathir and Anwar by Thatcher during her visit to Malaysia, when the BBC was quick to point out that Thatcher’s husband’s name was spelt incorrectly during an official dinner function ( Denise as opposed to Dennis). There’s one for you, Ganesh. Thatcherism might have been the best medicine to wake up the Brits from their colonial dreams that the world still owed them… Read more »
Andrew, the teacher in the school itself cannot speak proper English, so what do you expect of the standard of English of the students?
And the best part, the teacher that cannot speak good English, what does he or she teach? Shockingly, and its not a joke, the teacher teaches the English subject!
I believe in free trade, and I do believe that freeing up the market does bring reduced cost and higher quality…unfortunately this is not implementable due to huge government intervention all around the world (even the proponents) as each country wants to benefit from the growth and yet shield themselves when it doesn’t suits them. The problem with true free trade is that no one accepts the damages caused by wrong investments. The so-called ‘privatized’ companies in Malaysia took over critical utilities as a monopoly; most of the management had political connections; they had a race quota; there was an… Read more »
Yes, Anil, Malaysian civil society should continue to be vigilant on this very important issue and make the case as Dr Jeyakumar has been making: health care is and should always be an essential or basic service for everyone, not just the rich. This message cannot be promoted enough in the light of the dominance of neo-liberal economics with their mantra of privatisation and commoditisation of everything under the sun. This is the economics that comes with the capitalist (as opposed to people-oriented) ideology that market forces will deliver efficient, affordable services to all. But it has shown to be… Read more »
Thank you for the financial info, Ganesh. Absolutely, we want education and health. What use will these corridors be when the people do not have the knowledge and well being to utilise them? The standard of education today is deplorable. We have sales people who need to use calculators for the most basic sums, grammatical errors strewn all over speech and written communications and a population with little general knowledge. We have the nouveau riche who visit other parts of the world, not to learn anything from their travel experiences, but so that they can brag to others about it.… Read more »
A doctor friend told me once never show them the money because they[umno] will swoop in like vultures
http://www.jerrymohan.blogspot.com While it is true that we may have to rely on drug therapy and hi-tech in acute life-threatening emergencies and trauma, as far as the management of chronic diseases are concerned, we should look to evidenced based, safe and Natural alternatives such as Acupuncture and Homeopathy which are by far cheaper and safer than drugs produced by western countries. Countries like India, Pakistan and Bangladesh which uses Homeopathy widely and China which uses Acupuncture are reducing their healthcare costs by leaps and bounds. Many countries in Latin america and Africa (e.g. South Africa) are also following this trend. It… Read more »
I know insurance is a bad word in most languages, but as we are not civil servants, how else do we afford going to a private hospital? And please don’t tell me to go to KLH, I’ve knocked years off my life ‘waiting-and-waiting-and-waiting’ with my dad in the years before he died. No complaints about the care, though, they were caring and careful in KLH’s cancer wing. But for me and mine, we are stuck with medical insurance. I am in my fifties and imagine that I will be spending more time in and around, than ‘out’ of hospitals. What… Read more »
It is vital for a government to give free Education and free Health, not just increase spending on health care. This is a basic necessity. The UK government, with only 60 million people, can give free Health, why can’t we? After all, our government gets a lot of revenue from sources that other social state countries like the UK don’t ie like high taxes from cars etc. Some writer in Malaysia Today did some calculations and estimated that since the inception of high car taxes, the taxes collected from cars alone would be some RM180 billion to date. http://www.malaysia-today.net/2008/content/view/8763/84/ Malaysia… Read more »
Vote in the BN clowns! The aussie will tell you, “She’ll be right, mate.”
Dear Anil A good article overall. But I would like to comment on some points you raised: 1. “For instance, he proposed that private general practitioners could act as “gatekeepers” when referring patients to specialists and if they kept below the targeted number of referrals, the doctors would be given a bonus!” Having GPs serve as gatekeepers is actually a good thing. This is carried out in the British NHS. The real problem with his proposal is the part about the bonus. Bonus schemes for doctors are a disaster for patients in US “managed care” insurance schemes. 2. Having a… Read more »
All the complaints and ‘suggestions’ – why dont we ask ourselves, do we (or MOH) actually know whether the money for healthcare is being spent prudently? Rather than spending more money on grand schemes, why dont start investing a little amount on gathering and analysing the data and processes to determine how to prioritise the use of the money. With the current way of operating the service, even a major increase in funding will not be sufficient as there will always be leakages and inefficiencies. Solve the real problems of cost management, resource sharing and optimisation (including between public and… Read more »
anil,
a bit drowsy with all this doctors actually
1.some goodsoul doctor told me once dont use company doctor if you want a good medicine because the company contract out to them with very minimum fees.(so he have to give basic panadol)
2.Insurance – money making devil from everyone.
3.consultant and politician – still blur what they trying to do for medical needs of the poor.
rajraman-I HAVE A DREAM-can u please ask haris ibrahim
Not only do we have to compete with nepotism and cronyism, we also have to contend with foreign ‘experts’ who should try harder to sell their ideas in their own countries, rather than come over here and try to rake more than a few bucks off us.
Western governments know what kind of public reaction to expect with policies that have the slightest hint of regressive taxation.
Thought we didn’t know that, did you?
The problem is not the consultants Karl Karol..but the dungus who hired them. The MOH is just filled with substandard people who cannot think for themselves nor can they fathom what the public or health professionals want. This country with its vagaries from Bangsar right till Bekalanag in Sarawak has different needs….the only people who are going to be able to tackle the various issues is not a health consultant from Siberia but Malaysians themselves. Lim Kuan Joo, a Chua appointee, should just leave. And take with him his moronic DG Merican. The current MCA minister appears to mean well…and… Read more »
How many more of such IMF-types ‘consultants’, whose sole purpose is to recommend schemes or plans that will impoverish the populace and later seize control of the country’s resources and wealth when the nation gets into trouble, that have penetrated deep into key industries and doing their dirty work?
Congratulations to Penang for sniffing this one out and sending the operative home packing. Comb the various departments and key industries that more can be flushed out before the damage is done.
Selamat pejuang, Pakatan Rakyat. Syabas!