For Our Cititzen Patients, Not for
Profits
By: Choo Sing
Chye
The study to
privatise public heath care services and hospitals by the
government began in the late 80s and it came into
the open when the 7th Malaysia plan was unveiled. There
were 12 major entities/projects earmarked for
privatisation and 8 for corporatisation. One of the eight
were Hospitals.
Apparently
the government had studied many health care systems in
the world but could not find any system that fit what the
government is looking for until today. This is because no
where in the world that we can find a system that
completely divorce the government from the responsibility
to provide health care coverage to all its citizens.
Even in
Britain where privatisation was the main political trust
during the heydays of Margaret Thatchers
administration, health care surprisingly still remains
within the realm of socialised medicine. Many hospitals
are still own and operated by the government.
In Canada,
although most of the hospitals are private own,
provincial governments get block grants from the federal
government to cover every patient with the same package
of benefits to ensure universal and comprehensive
coverage. Thus what Canada is practising is socialised
insurance and Britain, socialised medicine. 1
After all the
studies made by the government in the 80s to
privatise hospitals, the only solution that it is able to
come out is, instead of privatisation, it opts for
corporatisation. Even then, the issue of corporatisation
is yet to be debated and many still do not know its form
and function let alone answer the nagging question
whether sufficient long term safeguards to protect the
poor are built into it.
The haste to
corporatise stands as a hallmark of the government to
renegade from the responsibility to provide universal
health care for the people. The crux of the question is
not whether corporatisation in its initial form has
sufficient safeguards, but will these safeguards be
sustained indefinitely without falling prey to the
slippery slope principle which would begin to
operate when cost escalates.
According to
this principle, the involvement of the government in the
corporatised health care system would surely and slowly
shrink and in the end slips into a state where the
government is totally divorced from it. Inevitably
corporatised health care would transformed into
privatised entities. This had unshamefully happened to
INSTITUT JANTUNG NEGARA
Sad to say,
the slippery slope principle has already begun even
before corporatisation. According to the then
Director-General of Health Tan Sri Dr Abu Bakar Suleiman,
the cost of health services would inevitably rise once
government hospitals were corporatised and the government
which spent RM4 billion a year on health care could
"not afford to subsidise fees as is being practised
now." 2
We do not
need to corporatise or privatise our hospitals on the
account that it is too expensive to maintain. The policy
makers must be enlightened to the fact that Malaysia is
not burdened with the kind of social security (e.g.,
unemployment security, old age pension and etc) or with a
comprehensive health care safety net that we see exist in
Western Countries.
Western
Countries spent around 10 percent of their GDP for their
health care services, Malaysia only spent 2.30 percent of
its GDP on health care services. According to Dr. Chan
Chee Khoon, "the health care expenditures has been
declining, from 3.53 percent of GDP in 1980 to 2.30
percent in 1995, well below the WHO recommended norm of 5
percent." 3
The policy
makers are fond of arguing, in fact, too liberally that
the government had allocated too large a sum on health
care services and could not continue doing so. To
dominate societal thinking with this argument is morally
wrong. Must we devalue public health care on the account
of this or let ringgit and sen to dictate the
accessibility to health care?
Conspicuously
if one supports the issue of privatisation of government
hospitals in Malaysia, one must be prepared to face the
immoral issue of having thousands of poor common people
excluded from proper medical care. Needless to say that
it is like withholding medicine to those who cannot
afford and it is likened to the practise of Passive
Euthanasia.
The
government had privatised a few of its services namely,
hospital equipment and facilities maintenance, laundry
and clinical waste disposal but instead of decreasing
operational cost, it increases to five times as much.
(Sun 20-6-1999)
The American
example offers the best indicator of a privatised health
care merits and demerits.
In the first
instance, private health care in the United States is
more expensive to maintain then that of the government,
for an example:
Americans
paid the 1.500 private insurance companies $241.5 billion
for premiums during 1991. Those companies paid out $209.2
billion in benefits. The remaining $32.3 billion, more
than 13 percent of every premium dollar, went for
overhead - claims processing, marketing, building and
furnishing insurance company offices, executives
salaries, and, of course, perks and profits. In contrast,
Medicare spent about 2 percent on administration , and
Canadas public insurance system pays less than 1
cent of each premium dollar to insurance overhead. 4
Furthermore,
according to the Rand study which concluded that
"free care would avert 106,00 deaths per year."
5 In 1987, the National Medical Expenditure Survey found
"that a million Americans who needed emergency
attention never got it." 6 An increasing proportion
of Americans are "avoiding care because of cost - up
from 27 percent in 1981 to 36 percent in 1987." 7
According to
the National Health Interview Survey, about one-third of
all Americans are either uninsured or underinsured.
"Many of them face grave difficulties getting needed
care, and they are sicker and die younger because of this
poor access." 8
In his paper,
Privatisation and the heath care sector - Re-negotiating
the Social Contract, Dr. Chan Chee Koon, brought the
question of inaccessibility of the poor to reasonable
good health care: one is reminded that the Longwood
Medical Area in Boston, home to some of the most
sophisticated medical technologies at the Harvard Medical
school and its affiliated hospitals, exists cheek by jowl
with the Roxbury neighbourhood, a deplorable urban ghetto
reputedly having one of the highest infant mortality
rates in the North Eastern United States.
During the
early 70s when the American health care policy
shifted to cutting costs:
private
insurers raised deductibles and co-payments, expanded
exclusions from coverage (e.g., refusing to pay for
"pre-existing" conditions), and intensified
efforts to avoid insuring people with high risk of
illness. State governments threw people off Medicaid
rolls and reduced coverage.
While these
policies have not contained costs, their toll has been
high in terms of restrictions on care and inequalities in
health. Decades of improvement in health standards have
been halted, and in many instances, reversed. 9
Thus when the
government dabbles with the idea of privatising or
corporatising public hospitals, it must first prepare to
discard the very universal principle which is part and
parcel of our moral values that if a person should die
from an illness, it is because there is no cure rather
than the fact that he or she has no money.
If somehow
this universal principle applies, then privatisation and
corporatisation of health care services and public
hospitals should not have any place in our society.
Morally the
government had spent an enormous sum of public fund
through the years to build these hospitals and health
facilities. How can the government now, without
consulting the people, contemplate in corporatising all
these health facilities?
The Ministry
of Health or the Cabinet should not have the final say on
the issue of corporatisation. What should rightly happen
now is to have a referendum so that the people can have a
direct say on whether they want corporatisation or not.
We must
remind the government that the institutions of health
care must rest on the foundation of a caring society and
not in the clutches of the profit driven companies.
The whole
idea of the need to have a caring non-profit health care
can be summed up eloquently by the Massachusetts
physicians and nurses.
We are
Massachusetts physicians and nurses from across the
spectrum of our professions. We serve patients rich and
poor
Mounting shadows darken our calling and
threaten to transform healing from a covenant into a
business contract. Canons of commerce are displacing
dictates of healing, trampling our professions most
sacred values. Market medicine treats patients as profit
center.
Public resources of enormous worth -
non-profit hospitals, visiting nurse agencies, even
hospices - built over decades by taxes, charity, and
devoted volunteers are being taken over by companies
responsive to Wall Street
10
1. John
Canham-Clyne. "A Rational Option"
2. Utusan
Melayu. "Government To Ensure Healthcare Remains
Affordable." (July 4 1999 Press Report)
3. Chan Chee
Khoon. "Rrivatisation and the Healthcare
Sector." (Sept 1996)
4. John
Canham-Clyne. "A Rational Option"
5. ibid.
6. ibid.
7. ibid.
8. ibid.
9. ibid.
10. "For
Our Patients, Not for Profits." Dec 1997 (Internet)
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