In the last few weeks there has been sporadic debate on the proposed national health scheme dubbed 1Care in both the internet and the mainstream media. A collective conclusion shared by both the public and the very professionals alike (who play a major role in the system) is the uncanny ability to fully comprehend the confusing entity which remains an uncertainty till today.
This commentary was written to achieve the following objectives:
1. To help the public understand why this system was proposed and what led to the genesis of this scheme
2. If possible, to pressure the government to be more transparent in providing information on the 1Care Scheme to allay fears among the general public
3. To help the layperson understand the un-addressed policy issues but highly crucial perspectives surrounding the 1Care Scheme
First, it would be wise to have a quick update on the prevailing Malaysian Health Care system so that it would help shine some light as to why there is a sudden accelerated interest to bring the 1Care Scheme into an imminent reality.
The Malaysian Health Care Scenario
The Malaysian Health Care System has often been hailed globally for its ability to endorse a sustainable health policy that reflects an outstanding and equitable health status at a relatively low economic burden. By allocating just 3 percent of its GDP to health care (majority of industrialized countries invest rough about 6 percent, with the exception of the United States which devotes 16 percent), data compiled by World Health Organization shows that the performance of the Malaysian health system is, in fact, highly efficient. This is evidenced by the “Health Adjusted Life Expectancy”(HALE) at birth indicator, which categorizes Malaysia as equal to most industrialized countries at 63 years.
However, the complexity of the system has also brought in much uncertainty that has not only slowed down service delivery, but has been closely related to the gradual increase in economic burden.
In an effort to make health care accessible (and most importantly equal) to all fabrics of the society, the concept of Universal Health Care was formulated and adopted by most countries around the world including Malaysia. The system attempts to finance the health benefits for all by a balance of tax revenues and medical insurance (mostly recommended by private health caregiver in Malaysia currently). This is imposed on employed, working class population. In Malaysia, much of the public medical fees are subsidized to a great extent from the much gained tax revenues.
It is important to note that the Malaysian Ministry Of Health only manages to recover 3 percent of its total operating cost through fees collected at health care premises. The amount is strikingly lower than most payments made in most European health system (which employs the co-payment system where funds are partly subsidized by the government and the insurance premium paid by the patient). The average consultation at a token rate of RM1 at any primary care centre barely covers 1 percent of the economic cost per visit.
The resulting non sustainable system calls for fiscal limitations and will eventually cause much financial loss due to
1. The spur of an unrealistic and unachievable demand for public health care
2. The operational costs to cover universal health care will surpass the government’s current fiscal capacity
By understanding this, it comes as no surprise that the proposed 1Care Scheme is a platform designed to re-coup the wastages from a bleeding pre-existing ( but noble and functional if properly handled) health care system that is sub-optimally managed. Like any other subsidized policies, the current health care system is resilient to any structural reform partly due to the lack of political will (where it is vital to appease voters by holding on to the unsustainable RM1 token fee and RM15-20 token fee paid at primary and specialist health clinics respectively) and the society itself whom have become so accustomed to enjoying cheap but scarce medical resources that has been perpetually vulnerable to potential abuse all these years.
The Single Most Important Question (Where Is The Information?)
Unlike most countries that have proposed and implemented such a scheme, information on the mechanics and the policies enshrined in the health care scheme is widely available for public scrutiny. One could easily access any updates and knowledge on the health care scheme through the Ministry Of Health website of the respective countries.
The same cannot be said for the 1Care system. The public, at large, have very patchy ideas on the health scheme without corroborative evidence from the Ministry Of Health. It would have been prudent, with all the disparate views available from all avenues of the mass media, to allay all concerns by allowing the public to peer into the workings of the proposed scheme or at least highlight the salient points that matters most to the average Malaysian. Efforts to make it an intellectual discourse by taking in question from the public would have been highly commendable.
Strangely, the documents or information regarding its modus operandi has remained elusive and is not available on the Ministry Of Health website (which is mandatory in most civil nations). The reason as to why this has been enshrouded in secrecy remains anyone’s best guess. However, one could only speculate that perhaps the precise knowledge of the system is within the confines of a privileged few elites who are still, themselves, grappling to reach a consensus on how to implement a scheme that is totally not viable given the current economic climate.
——-> Continued (Part 2: The Hypothetical Model)