marahfreedom

3 Articles on Malaysian health system and a slide into England’s NHS style failure – reposted by @AgreeToDisagree – 5th February 2012

In 1% tricks and traps, Abuse of Power, collusion, Education, Health, healthcare, unprofessional behaviour, vested interest on February 5, 2012 at 4:42 am

ARTICLE 1

What is happening to the medical profession — Concerned senior citizen – July 20, 2011

JULY 20 — As I write this I am saddled with a sadness wondering if the years of hard work and effort spent at the medical college by medical students before they can be certified as medical graduates is indeed worth all the labour and time.

I have spent more than 30 years serving the people but today I am at a crossroads wondering if I am witness to the beginning of the end of the glorious and noble profession that is the medical health sciences. Sadly there are growing signs that the sacrosanct ideals of the profession seem to be fading.

My close observation of the profession — and that includes all healing sciences be it medical, dental or any other as long as healing is involved — is that the number of doctors present in this country is ever increasing. The number of hospitals is equally impressive; both government and private.

The private establishments attempt to equip themselves with the most expensive facilities in terms of style, décor and sophistication in terms of equipment for diagnosis, treatment and of course patient recovery. This must also be accompanied by patient comfort. Having said this, my observation is that the cost of patient care has become inflated to an extent that it is hugely frightening for a citizen when he/she falls ill.

Is the medical cost in tandem with the citizens per capita income or within his/her means? If a patient is struck with an illness like stroke or cancer or organ failure then the fear of not being able to meet the cost is even more frightening. If this is really the case then are the doctors still holding on to the sacred belief that their duty is to heal the patient at all costs.

Now, the phrase at all costs may be contentious for a debate but not forgetting that it is the aim of every doctor to heal the sick. If a patient cannot be healed by a doctor then it defeats the purpose of that visit and it also defeats the purpose of the doctor meeting with the patient. What does a doctor do then? Has he a choice of doing anything else to achieve that goal. This is something that is left to the doctor himself/herself.

The point I am driving at is this. Being able to come to a correct diagnosis is good and this can be obtained with expensive technology.  But is this going to make it impossible for the patient to afford this service? If it is really the case then how does the doctor adapt himself to make it possible for him to do what he is supposed to do and that is to attend to the patient and achieve the healing.

Now the question: Is healing based on all the expensive machinery and the most expensive drugs available in the market? This is something doctors must most honestly search their minds and answer. Then again I have to ask. With all the expensive machinery and drugs available, why is it that many of the diseases are still left incurable. Is cough and cold curable? How then does it get cured? Is cancer curable? Is diabetes curable? Is eczema curable? When I say cure I mean that the disease becomes non-existent.

This is what I mean. If a patient has to be on a drug on a lifetime basis then it is not a cure. The disease is still inherent with the symptoms merely being blanketed by drugs till death takes over. The aim of a doctor is to heal the sick. If the healing has not been obtained then it is only logical that the treatment could have been either wrong or insufficient.

This unfortunately is the saddest part of being a doctor. Where then is the missing link? This is food for thought. Is it the training or the modus operandi of the system that has led to this sad state? Or is there a divine anomaly somewhere that doctors have lost sight of. The answers to healing is available in this universe. It is all left to the doctors to go and look for the answers.

There seems to be blatant disregard for ethics. Advertising seems to be rampant though however hidden it may appear. Lighted neon lights are being flashed around at the place of business. Many doctors are found to be rude, arrogant, and dishonest with their diagnoses. The dishonest diagnosis is meant to scare the patient into accepting the expensive treatment. This is not a myth or fault finding but is a real happening in the market.

Doctors’ behaviour towards patients can be a rude awakening for patients. They shout, scold and threaten as if the patient can be subject to bullying at his whims and fancies.

I have personally seen and witnessed doctors being rude, disrespectful and even threatening to patients in the presence of their spouses and children. This cannot and should not be condoned.

I have seen doctors even quoting their fees to patients based on whether he/she wants a second-hand Proton or a Mercedes Benz. I have seen doctors who despise other doctors with no care for their reputation or welfare. Everyone else is wrong except himself.

The extent to which professional jealousy exists is frightening. If one doctor begins to do well in practice out of sheer dedication and hard work, then the others in the same profession would do everything to cause him/her harm. This indeed is despicable.

Are doctors waiting for the day when patients will begin to lose their patience and bring in gangsters into clinics and beat up doctors before the other patients. Please do not wait till that sad day.

Remember, the people are becoming wiser and more knowledgeable day by day due to technology. Or are they lost in their own time wrap? Time to wake up.

These days it is common for one doctor to derecognise another doctor when he/she comes for treatment. They charge fees as they like. Of course there is nothing wrong with charging a decent fee to cover costs, no sane person would deny a doctor this.

But it is the blatant mercenary attitude that I condemn. There have even been instances when a colleague has been “detained” in the clinic/hospital till the full fees have been brought by family members. How low and despicable is this.

Today, private hospitals have become a business enterprise and that is why so many businessmen have started investing in them. It costs almost half a million ringgit to become a doctor today and there one must make his or her first million in the first year of work. This seems to be the prime motivation of every medical graduate. This is shameful.

My honest suggestion is that every doctor should open their doors to cater to patients at least once a week and start healing the sick at no cost. If you can do this for the rest of your life then and only then will you realise what healing the sick really means and then you will begin to value the great and sacred virtues of the profession. Till then I offer my prayers for each one of you.

* This is the personal opinion of the writer or publication. The Malaysian Insider does not endorse the view unless specified.

ARTICLE 2
Double taxing the public via 1 Care — Yow Hong Chieh February 05, 2012

JAN 5 — A tax by any other name is still a tax. And that’s exactly what the 1 Care healthcare proposal is, if reports about the scheme are true.

Central to 1 Care is the National Health Financing Scheme (NHFS), a government insurance fund that both employees and businesses will have to pay 10 per cent of their monthly income to, similar to our Employees’ Provident Fund (EPF).

But unlike the EPF, it’s very likely we will not get our money back. So it’s basically a tax, plain and simple, however you try to dress it up.

I have no issues with progressive taxes, which is what the NHSF appears to be; those who can afford it will subsidise healthcare costs for those who can’t.

Given that only 10 per cent of the work force, or about one million, now pay for public goods enjoyed by all 28 million Malaysians via income tax, that seems par for the course.

But we already pay taxes, not only in the form of income tax but sin tax on booze and tobacco products, among others, to the government as payment for all public goods, including healthcare. Where’s the money going?

I don’t deny that healthcare costs may be spiralling upwards but it seems rich to propose a new levy on Malaysians when the government does not seem all that keen on tackling the leakages and illicit outflows, which are at an all-time high, by all independent accounts.

At the same time, Putrajaya seems bent on encouraging the poor dietary habits of the general population by increasing its sugar subsidy, which would only add to the burden on the healthcare system in years to come.

Malaysians already consume an average of 26 spoons of sugar daily and, as the Consumer Association of Penang (CAP) has pointed out, excessive consumption of the sweet stuff has been linked to over 60 diseases, from cancer, diabetes, obesity, heart problems, osteoporosis and kidney problems to asthma and allergies.

The prevalence of diabetes in Malaysia alone has jumped from below two per cent in 1960 to 14.9 per cent in 2006, or about 4.2 million patients. That’s 15 per cent of the total population, or almost one in seven persons.

CAP also pointed out that the federal government would save some RM567 million if it sells sugar at market price, due to lower healthcare costs in the long run, and I don’t doubt that they’re right in this case.

So if the government is sincere about preserving the health of Malaysians, it should get rid of the sugar subsidy, nix the 1 Care insurance scheme and find more efficient ways to employ the tax ringgit we have handed over to provide for fundamental public goods.

The very last thing it should be doing is double-taxing Malaysians just because it has failed to do its job properly.

* Yow Hong Chieh is a journalist with The Malaysian Insider

ARTICLE 3

Dissent grows over rumoured healthcare tax under ‘1 Care’ scheme
By Clara Chooi
February 01, 2012

KUALA LUMPUR, Feb 1 — Public outrage is growing over a proposed “1 Care” scheme to restructure the country’s healthcare system that critics claim would force employees and businesses to contribute 10 per cent of their monthly income to a government-run insurance fund.

Although details of the scheme are still vague and Health Ministry officials have insisted it is still “too early” to sound warning bells, medical practitioners and consumer associations have banded together since last December to kick off the “Tak Nak 1 Care” campaign, hoping to shelve Putrajaya’s plans before they come into force.

Critics claim the scheme would force employees and businesses to contribute 10 per cent of their monthly income to a government-run insurance fund. — Reuters file pic
Calling themselves the “Citizens’ Healthcare Coalition” (CHC), the group have taken their cause online, using social media tools like Facebook, Twitter, blogs and YouTube to spread information about the scheme and gain wider public support.

Among others, the group have started a “#TakNak1Care” Facebook community page, a Twitter account using the handle @taknak1care and uploaded on YouTube, several video clips urging Malaysians to reject the scheme.

Their efforts appear to be gaining traction among netizens and have even caught the attention of Health deputy director-general (Medical) Datuk Dr Noor Hisham Abdullah, who has been personally involved in lengthy discussions with the group via their Facebook page.

The Malaysian Insider understands that “1 Care” is modelled in its entirety after the United Kingdom’s National Healthcare Service (NHS), a publicly-funded healthcare system, and was mooted in the 10th Malaysia Plan for the Health Ministry’s 2011-2015 strategic plan.

It is believed that the five-phase scheme has already entered its third phase, and the full initiative, post engagement with doctors and pharmacists nationwide, is due to be presented to the Cabinet by March.

According to one CHC member, “1 Care” will replace Malaysia’s current two-tier (public and private) healthcare system by integrating both private and government hospitals, in hopes of ensuring more “equitable” healthcare for Malaysians across all socio-economic statuses.

Under the present two-tier system, Malaysians can choose to either seek treatment at private clinics or hospitals and pay out of their own pocket or via health insurance claims, or opt for treatment at government clinics or hospitals and pay only a nominal fee for basic, government-subsidised healthcare.

With “1 Care”, CHC said it would be made compulsory for all wage earners, excluding government servants and pensioners, and businesses to contribute 10 per cent of their monthly income to a government-run Social Healthcare Insurance (SHI).

“So those who can pay, will pay, while those exempted from paying, such as the poor and so on, would still qualify for free basic medical benefits offered under the scheme … Basically, those who can afford it will pay for those who can’t,” the member said, speaking on condition of anonymity.

But, apart from the “fee-before-service” system under “1 Care”, CHC is also griping over the limited healthcare benefits offered under the scheme such as: a patient is assigned to a specific general practitioner (GP); visits are limited to six times per year; visits are limited to one ailment per visit and GPs or primary healthcare providers (PHCPs) are given Key Performance Indicators (KPIs) to meet and would be subjected to penalties.

“Under this system, PHCPs only profit by billing the SHI for their services. Like all insurance, the SHI won’t approve too many claims to minimise cost. PHCPs may be penalised for giving too much service … or referring too many patients to hospitals or specialists.

“1 Care” is believed to be modelled after the UK’s National Healthcare Service (NHS). — Reuters file pic
“Doctors may have to provide less healthcare to avoid penalty… but you don’t stop paying or pay any less to SHI,” the group claimed in one YouTube video.

The CHC member explained to The Malaysian Insider that “1 Care” budgets a maximum claim of RM360 per patient for each GP from the SHI, which amounts to only six consultations a year at RM60 each.

“And with the KPI quotas to meet, GPs would try to delay referring too many patients to hospital. Those who need to seek treatment urgently would then have to go to the hospital on their own and pay out of their own pocket,” the member complained.

When attempting to allay fears over “1 Care” recently, Dr Noor Hisham explained that the proposed scheme was merely at “conceptual stage” and that reconstruction of the country’s healthcare system was badly needed.

“Now in the public sector we spend RM16 billion and only recoup two per cent. On the other hand, we wouldn’t want to burden the rakyat so we are currently looking into various options and models.

“At this point of time nothing has been agreed upon. Until everything has been agreed to by the public and such, we need to study the cost analysis. However, there are already lots of assumptions and speculation and bad branding of the system like this ‘Tak Nak’.

“I wonder where they pluck the figures from without substantive data to support,” he wrote in one response.

But the CHC claims a new “1 Care Act” is due to be tabled in Parliament imminently, possible as early as the next sitting in March.

The CHC will brief reporters on the issue tomorrow in the build-up to the Selangor/Kuala Lumpur Healthcare Public Forum on February 12. The Malaysian Insider understands the forum will be opened by Selangor Mentri Besar Tan Sri Khalid Ibrahim and attended by Health Ministry officials.

[[[ *** RESPONSE *** ]]]

Medicine should be a tenure reward based profession so that professionals do not spend their time thinking about money and healing instead (i.e. free education, free housing, free food stamps etc..), and prices controlled by government so that doctors do not focus on becoming multimillionaires, though prices of education need to be lowered and spaces in the medical institution need to be increased. As of now medicine and education for is too expensive, too much hazing and abuse occurs in housemanship also government,  and this contributes to the ‘payback’ mentality which is too prevalent.

To study medicine in dignity, people need to spend astronomical amounts overseas often at extreme cost to unhappy parents that may need to sell off family properties and pressure the student and young person needlessly, resukting in later bad behaviour from the now graduated doctor or if in the psychiatric or pharma establishment, intentional unecessary profiteering by prescribing expensive and unecessaery medications and treatments.

The local universities are abusive, the professors arrogant – even the receptionists and security guards snarky and status conscious due to the behaviour of their superiors (it trickles down), trainee doctors driven through entire periods of borderline insanity on the extreme hours in houseman shifts intentionally by the establishment WHILE bombarded by well rested political administrators/inculpators of certain mindsets that support the establishment thinking and sense of collusion – a corrupt culture if the government of the day is corrupt.

This is how a respectable institution like medicine becomes a tool of abuse and profiteering, and how the medical workers and doctors are wont to extract a pound of flesh at every turn, their rise to status of professional comes at tremendous personal psychological cost compounded by pressure by vicious bouts of housmanship, government harrassment and in some cases a general dislike for closeness to people but a desire to get the ‘Dr.’ in front of their name.

Most doctors (actually even other degree disciplines) are not interested in their field (this is intentional IMHO, people slated for exceptional careers must be interested in their field and this is ONLY afforded by selective political or in power persons children being placed there who do have interest while everyone else gets a seat for a degree they have no interest in to make their career mediocre, the politically unaffiliated or non-earmarked are only able to earn a living, not excel and compete on an even playing field, those who can afford to go overseas to take a degree they want may face the problem of selective offers in jobs vacancies and hiring in collusion with industry people . . . again reserved for certain cliques etc. so do not spend on education as if it will change anything in your child’s life . . .

If you are not politically favoured locally especially in the 3rd world, preserve those properties and focus on other debt free earning methods . . . ) or even emotionally suitable to dispense healing, the typical ‘doctors’ are into prestige and greed egged on by family pressure, in some cases brand obsessed wives and education of children in ever increasingly expensive schools and university funds (education should be free, as medicine should be free)- and this is reflected in unhappiness, manipulative behaviour and collusion with government described the above articles. When you step into a medical institution run by or staffed in the above described cases, you are walking into a pit of vipers, not a place of healing. Don’t get ill or try to recover on your own by keeping healthy eating well (again careful of WHERE you eat or go, collusion between unhealthy eateries/franchises and medical establishment is not impossible or unknown, the conscience and ethics upon the heads of the service providers derermined by the economy . . . ), exercising and keeping away from negative people . . .

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