COMMENT | As far as healthcare is concerned there are mandatory expenditures for the Health Ministry.
The budget which has been provided to the ministry will probably be able to cover, although not fully, the normal recurring requirements of the ministry in its attempt to provide healthcare to the 32 million Malaysians.
I would like to touch on some of the newer initiatives which were announced by the Finance Ministry in the recent budget.
One of the initiatives was to provide protection for those in the B40 category through a programme which has been spearheaded by a seed fund which has been provided by a private insurance company and is to be managed by Bank Negara.
From the information that we got from the budget, this health coverage will be for four critical illnesses and it will give a maximum of RM8,000 coverage and will cover 14 days of hospitalisation.
Although the motive seems to be noble, I have my doubts to whether this will actually achieve the intended objectives. Firstly, RM8,000 for hospitalisation benefits might create a situation where it might not be sufficient for members of this category if they were to admit themselves to a private hospital. The question will always arise what happens if the bill is above the RM8,000 .
Secondly, the management of critical illnesses involves providing long-term care. A lot of those in B40 have been going to the public sector for this protection, for example, if they have cancer.
In the absence of further details of this programme, we have to be concerned that there is a risk that people will be going into private sectors for health protection for these four critical illnesses but at the same time, may find that this coverage is inadequate.
This might subject them to further financial catastrophes which will eventually force them back to the public sector for the continuation of medical care. This is a real risk.
It would be more sensible if this RM8,000 instead of being given for hospitalisations, be given to the primary care providers, (that is the general practitioners in the private sector) for the management of non-communicable diseases in the B40 group.
RM8,000 a year will be sufficient to ensure that a person with illnesses like diabetes, hypertension, heart disease be managed in the private sector optimally.
The Health Ministry should activate the Protect Health Unit and monitor this effectively by establishing specific KPIs (key performance index) to be achieved by the private sector care providers to make sure that the treatment is optimal, the control of disease is optimal and lifestyle changes are achieved.
This will actually ensure that this money is well used and gives long-term benefits which will be much better than pumping it into hospitalisation.
Target patients' specific needs
The other initiative which was announced was the screening for those above 50 years of age, involving about 800,000 odd people.
According to most medical experts, medical screening in a blind fashion has not been proven to improve the quality of health and diagnosis. Medical screening has to be targeted and be guided by the age group and the patients' specific needs.
It may be better for the same amount of money to be pumped into the Enhanced Primary Care programme, the Kospen programme which is within the structures of the ministry, where these programmes are geared towards ensuring early detection of disease, optimal control and total holistic management with a coordinated multi-disciplinary team.
If this money was to be parked into our primary care clinics (Klinik Kesihatan, Klinik Desa, Klinik Satu Malaysia and the outpatient departments of the hospitals ) and the Kospen teams throughout the country, I think the objective of this health screening will be met in a better manner within a structure that is organised to identify and manage the particular group of diseases, particularly non communicable diseases in a more holistic fashion.
This will help us greatly in reducing the burden of the epidemic of non-communicable diseases facing the country.
The third point is on the tax which has been imposed on the sweetened beverages. There are a lot of countries which have implemented this, but the problem with implementing this sweet tax; sin tax, or soda tax as it's been called in different parts of the world is the fact that we do not know the trigger point which will cause behavioural change.
There have been very few studies which have been able to identify the trigger point. In the absence of the data, we are unsure whether this increase will actually lead to a reduction in consumption.
If it doesn’t do that, there may be the double whammy of increased inflation and non-reduction in the consumption of the sweetened beverage.
On the other hand, if this taxation was to have an effect on the industry and consequently the industry undergoes a cultural change in its manufacturing processes and they by their own accord reduce the content of sugar from 5g/100 ml to 3g or 2g or even 4g then there will be some achievement because there is already a net reduction of the sugar content in the drinks.
Even if a person were to consume it, its sugar content would have been much reduced. I hope that the effect of this taxation will not so much be aimed at reducing the consumption by the people but more to create a revolution in the industry, where they will look at methods to reduce the sugar content in sweetened beverages and liquid syrups.
How to reduce teh tarik consumption?
Moreover in Malaysia we also know that our sugar intake also comes from other sources rather than sweetened beverages; for example the teh tarik, the kopitiams and the cakes and the kuih which we consume regularly.
They all have very high sugar content. While we control one aspect and if we don’t control the other factors, I am not sure if the real objective of a society consuming less sugar can really be attained.
What is more important is to attack the other cultural components. How are we going to reduce teh tarik consumption, how we are going to reduce the sugar in teh tarik, how are we going to reduce the sugar in all the various forms of coffees which are available in the various kopitiams and coffee shops.
Unless and until we achieve that, I don’t think that this alone will be sufficient to actually cause a reduction. Although the objective is noble, I think there has to be a broader and more holistic approach to the problem in order to attain the intended intention. These are my views to the newer announcements which were made.
The RM29 billion will be just enough to cover the day to day running of the ministry, may not actually give much of a leeway to cover innovative newer packages.
In the Pakatan Harapan manifesto, they actually said they will provide 6-7 percent GDP towards healthcare. That will translate to about RM70-80 billion. Our current health expenditure is about RM52 billion (including private and public sectors). The public sector has to pump in another RM 20-30 billion to achieve the announced objectives.
My informed view is that in the Malaysian healthcare system, the bastion of healthcare is the public healthcare system.
We need to empower public healthcare, give it more resources, widen its capacity and improve its capacity to purchase services from the private sector.
If that can be done in an effective manner, I think we will have one of the best health systems in the world. Thank you.
Dr S Subramaniam is a former health minister.
The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.
