By Dr Helmy Haja Mydin, First published in The Sun Daily, 17 February 2012

THE United Kingdom’s publicly-funded National Health Service (NHS) was established in 1948. It provides free primary, secondary and tertiary services at the point of delivery for all UK residents, including those of foreign nationality. The system has evolved over the past decades and despite being far from perfect, it is the envy of many countries given its history of continuing development and innovation.

Understandably, the UK electorate takes great pride in the NHS. Any proposed changes to its framework are always contentious. Politicians tend to tread carefully when dealing with the NHS, especially when the electoral cycle is drawing close. Even Margaret Thatcher was reluctant to touch it in her heyday, despite being able to de-nationalise many other industries.

The current UK government is attempting to push ahead with a health and social care bill in Parliament. Without going into too much detail, it is attracting a vast amount of criticism due to the manner in which it is being pushed through i.e. without proper consultation with all stakeholders. Voices leading the outcry include not only those from the opposition party, but from the ruling coalition and the House of Lords (roughly similar to our Dewan Negara), as well as those of medical doctors, nurses and even physiotherapists. At the time of writing, the government has had to make almost 2,000 amendments as concessions prior to the next tabling of the bill.

Irrespective of motive and outcome, the mistake that the UK government made was to unilaterally drive through reform of the healthcare system without sufficiently engaging the stakeholders. This is a mistake that Malaysia’s Health Ministry can (and should) learn from.

According to WHO data from 2007, Malaysia spent a mere 4.4% of GDP on healthcare. The private sector contributes 55.5% of total expenditure on health i.e. higher than the government’s 44.5%. More worryingly, only 14.4% of patients who utilise private healthcare have private insurance, while 73.2% do so out of their own pocket. In other words, the majority of patients attending private hospitals have to burn through their bank accounts in order to afford the care they desire. This raises a number of issues e.g. how sustainable is this and why the preference for private healthcare?

The Malaysian government is in the process of drawing up the 1Care healthcare scheme, a reform of our healthcare system that is meant to lead to a more equitable and economically sustainable service. It is meant to be based on the NHS, but details are sketchy. Details bandied about over the internet include the alleged creation of a new financing authority to impose limits of healthcare usage and tax of up to 10% of monthly income to contribute to a new 1Care fund (which might or might not exclude civil servants, depending on where you get your information from).

Is it not unfortunate though that we have to resort to these Chinese whispers for something as fundamental as the way in which hospitals will treat us when we are at our most vulnerable? It is in the interest of all stakeholders that any significant move to improve our healthcare service is done in an inclusive and comprehensive manner. Dynamic Search in Malaysia, on behalf of the International Research Institutes (a global market research organisation), recently published results of a global healthcare survey conducted last year. This survey harnessed opinions on a range of issues, including the reasons for problems within healthcare systems – 43% of Malaysian respondents attributed this to poor management and 42% to lack of funding.

This translates to a perception that the current service can be provided in a more efficient manner and a viewpoint that the current budget for healthcare is insufficient. The government would do well to increase the level of public engagement prior to instituting wholesale changes to the manner in which we receive our healthcare. Many would agree that increased taxation should not be the first approach towards raising funds – this should only follow the trimming of bureaucratic excess, a decrease in unwarranted subsidies (e.g. subsiding the cost of sugar in the midst of a diabetes epidemic), and most importantly, be preceded by corresponding improvement in budgetary transparency and good governance.

Many governments have introduced policy changes and taxes with the best of intentions, but fail due to a lack of transparency in decision-making processes and lack of engagement with the public. As rumours of an upcoming general election begin to circulate over the internet and in coffee shops, it is my fervent hope that the rakyat and NGOs will use the opportunity to pressure both the ruling and opposition coalitions to engage the public in their plans for healthcare reform. It is time we moved electoral debates away from personality cults and ethnic divisions and debate the issues that actually matter.

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Dr Helmy Haja Mydin is a fellow at the Institute for Democracy and Economic Affairs (Ideas).
Image Credit: MalaysiaKini

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