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Pendapat / Opinion

What’s up 1Care?

It is hard not to mention President Barack Obama when it comes to politics and healthcare policy. Having retained the West Wing for the second term, one of Obama’s landmark legislative achievements is the 2010 health law reform that aims to expand health coverage and contain the cost.

Malaysia is at the crossroad, aiming to be a developed nation by 2020 with expected citizens of 34 billion, not helped by uncertain economic performance around the corner, the biggest challenge is to expand healthcare coverage, in term of quality and capacity, and at the same time inhibit the cost from going exorbitant.

Our current health care system presents a unique challenge to the public health physicians, economist and policy makers alike. With too much political interference, heavy subsidies, poor integration between primary care and hospitals; and between public service and private practice, 1Care has been proposed.

Yet, so far public has been kept at bay when it comes to what actually 1Care is? Public forums being done throughout the nation has not been fruitful in terms of providing tangible essence of the newly proposed healthcare reform. With orchestrated presentation and Q&A sessions, the panellists keep on beating around the bush, not to mention the so called academician moderators are too reassuring rather than inspiring real debate.

As PM Najib is seeking to renew people mandate on the longest serving political entity in modern democracy, there has been too much rebranding of government services to include the word ‘one’.

Nowadays, it is hard to get through a single day without having to do something for the word ‘one’. Truth be told, substance matters most. PM Najib can rebrand everything all he wants but what the people really want is a sincere top down reform from Barisan Nasional in governing this country.

It begins with Barisan National stopping from using government machinery for their political survival and mileage. Example, Klinik 1 Malaysia, a big mess. Primary care system in Malaysia is already intricate, in public sector there are already 2854 Klinik Kesihatan dan Klinik Desa and 6589 private clinic.

And then, because PM Najib wants them, there are 115 Klinik 1 Malaysia which is not community clinic as such but not yet health clinic. Those Klinik 1 Malaysia is targeted in the urban area with high population density, where the health clinics already doing extra hours and most of the residence can actually afford to go to plenty of private practices available.

All these redundancies just to show that PM Najib is doing something that has the word one in it. So far, analysis has shown that attendance at Klinik 1 Malaysia has not been cost effective. Efforts have been made to promote the existence of the clinic. Mainstream media has, without failed, tried to highlight services that can be done at Klinik 1 Malaysia, whereas the increasing workload will strain more resources from established healthcare facilities.

Health clinic doctors are scheduled to go to Klinik 1 Malaysia leaving their own clinic unmanned. Health clinic staffs are being rotated at Klinik 1 Malaysia because there is actually no new post created by the government, neither proper planning what more risk benefit study done to show the actual needs of Klinik 1 Malaysia other than for the next PRU. Seriously, even the budget to set up Klinik 1 Malaysia is channelled through BarisanNational branches rather than directly from the Ministry of Health. Top government officials in the MOH will testify to this.

Hence, political sentiments put aside, what we really need now is a health care system reform that is honest in the sense that it must not aim to gain popularity for the governing party, but it is a structured and well organized health care system that is proactive, responsive, inclusive and prudent in addressing current as well as future needs.

Primary health care should be at forefront, the very foundation for health care system that should place strong emphasise on preventive medicine, early intervention and special focus on promoting wellness. There is a real need to get government primary care service providers and private practice at a round table in order to strengthen integrated personalised care approach.

Most private practices are not essentially trained general practitioner or family medicine specialist, so they have to be regulated regularly to increase adherence towards clinical practice guidelines by ensuring their participation in continuous professional development.  Also, they have to be made legally answerable, responsible and accountable of the patients’ management by proper record keeping, strict recruitment of staff and locum doctors.

With increasing awareness towards health issues, various supplements and alternative therapies are entering the market, there is a need for a law to govern and protect medical practitioner from conflicting clinical and business interest.

Primary care and hospital care at the moment is very alien to each other, like two different planets apart with a moon, the university hospitals. Communication is barely viable with no effective sharing of healthcare information. They do not know what each other is doing and they both think that they are much more important than each other. Bureaucracy is a must and abundant, the barrier is like the Berlin wall before 1989. The victim is the patient.

No proper continuation of care, what more holistic multi-disciplinary individualized care. Alas, when patient missed an appointment, the patient will be lost because the system is so disintegrated. The health care system need to learn the art of doing simple thing, put aside unnecessary boundaries and encourage effective communication to culminate responsive and inclusive healthcare system.

The biggest challenge of all is to be judicious in spending. With 40 million already gone to Umno Sabah, it is hard to spend wisely these days. Needless to mention, healthcare service is costly, the staff, staff development, medical equipment, logistic and advancement, all entail prudent spending and planning. One of Barisan Nasional’s instrument to keep bribing Malaysians is subsidies. Fifty-five years after independence, this government has miserably failed to cultivate the citizens to become independent.

As a result, heavy reliance on subsidies is hindering progress. Patient took medical care for granted because the consultation and medication is free; they just pay RM 1 for registration fee. As a result, after a while, they will end up in and out of the hospital because of end organ failure since angiogram, dialysis, surgical intervention or transplantation is limited, if not expensive. To save guard BN supremacy, the government of today has failed to educate the citizens to be responsible for their health.

As reality takes its course, the government could not subsidize medical care forever. In 2012, 4.96% of GDP is being spent on health, to achieve developed country standard, the benchmark is at 7%. Logically, 1Care has mooted the idea of sharing the burden with the taxpayers via obligatory contribution towards a scheme to finance the healthcare system. Consequently, the ministry had to do damage control by denouncing it as premature. Up until now, the financial aspect of 1Care is a taboo.

Thus, with election looming, it remains to be seen whether the governing party has the gut to put the harsh truth to the people face. Malaysians need a viable proactive, responsive, inclusive and prudent masterplan to achieve the aim of expanding healthcare yet maintaining the cost. People should judge BN performance after all these years, are they up for it?

With leakages everywhere, millions of illicit outflows and flourishing corruptcy, it is almost impossible to expect sincere transformation from BN. Of all, government servant should give them a wakeup call. BN has tarnished professionalism and integrity of civil servant to the fullest, beyond repair. Facts and evidence does not matter anymore, as long as it is being done in line with effort to uphold BN longevity, then it is a done deal.
Let’s put an end to that.-fmt

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