I refer to the article ‘ Engage public in changes to health care system ’ by G Thomas which is a query on details in ‘ With 1Care, the choice will not be there ’ by Stephen KW Chow. It is useful to clarify some the processes the government is undertaking in developing the 1Care for 1Malaysia plan.
The Ministry of Health (MOH) is committed to open discussion and sharing of information. In fact, for a number of years now, MOH has been having many sessions to engage key stakeholders whether they are community representatives and parliamentarians, professional bodies including the Federation of Private Medical Practitioners’ Associations Malaysia, and health providers, industry and others, both at national and state level. The MOH has already planned to step up these discussions to another level of engagement next year.
Many stakeholders are also members of technical working groups which are just now working to clarify details of the concept in order to better inform the public and their constituents, as well as ensure that their concerns are addressed. These members who represent agencies are asked to revert to their constituents to get further feedback.
The whole concept of 1Care is to improve the quality and delivery of health services for the rakyat, provide more choice to patients and preserve the strengths in our current health system, which of course for the public sector is founded historically on the NHS.
The NHS has since undergone many reforms to improve service delivery and yet in the 54 years since Independence, our health system has not undergone fundamental changes where necessary. At the same time, the government does not look only at 1 or 2 countries, as no health system is perfect and it is impossible to simply transpose other health systems, as we have our own existing system, values and culture, history, capacity, socio-economic development, policies etc. which also shapes the planning and outcomes.
Therefore, the MOH looks critically at various countries throughout the world, understand the elements and context of their system and evaluates to see what good components may be adapted, given our environment. So it is incorrect to assume that we will apply the NHS, rather look at successful elements within it as with other health systems too.
Within the concept of 1Care, the major role of financing will be strengthened and be managed by a government not-for-profit entity. It should be realised that currently in Malaysia, the public sector manages only a bit more than half (only about 55%) of the financing for health.
About 36% comes from private out-of-pocket spending of individuals, while the balance is paid by private companies, through private health insurance and other private modalities.
So, rather than the government abdicating its responsibilities for health, 1Care is intended to provide the government stronger stewardship and regulatory as well as financing roles. Thus, policies for good health care and concerns raised by the rakyat such as the rising cost of health care services can be addressed more effectively, not just through coercive means such as regulation and enforcement but also employing other means that invite more collaborative efforts in a win-win partnerships between the government, the rakyat, the economy and all health providers. How best to achieve this is currently being studied.
Dr Hasan Abdul Rahman is director general of Health Malaysia, Ministry of Health
