KUALA LUMPUR, August 1 — Former Health director-general Tan Sri Dr Mohd Ismail Merican proposed today a compulsory health insurance system to cover rising health care costs.

Dr Ismail said at a talk organised by the Galen Centre for Health and Social Policy that he has advocated for a national health care financing system since 1998 and presented it to three prime ministers.

"You want to have insurance, don’t make it voluntary. Just grit your teeth,” Dr Ismail told reporters after the talk.

"The rate must be minimum and affordable,” he said, when asked what was his suggested insurance premium rate.

Dr Ismail, who was Health DG from 2005 to 2011, said that after a national health financing system is introduced, the Health Ministry could be decentralised by creating "area health authorities” to oversee health matters in their own zones.

These six area health authorities — which could be set up in the north, south, east, west, Sabah and Sarawak — would have more autonomy in running health care services and receive funding from an authority under the federal ministry based on a certain formula.

"It’s up to them to manage these funds responsibly without compromising or shortchanging the needs of the people they’re responsible for,” Dr Ismail said at his talk.

"It’s up to you. Money not enough, your business, how you collect money, your business, you make profit, your business. But certain hospitals or certain regions may need more.”

The Health Ministry, he said, would have a smaller role and focus on oversight and issues like policy, standards, regulation and enforcement, public health, research, training, and health care financing.

Dr Ismail explained that area health authorities would manage residents in their own zones so that they wouldn’t have to seek services in other areas.

"If a guy gets a heart attack in Penang, you don’t come to IJN (National Heart Institute). You go to Penang Hospital or any hospital that has cardiac facilities. Why should you come to IJN?

"Unless they cannot do the procedures that are required, then they go to IJN. Otherwise, they can be managed at the cardiac centres within the authority,” he said.

He also said these area health authorities had to raise their own funds instead of asking for more money from the Health Ministry.

"If the area health authority finds you’re not performing, then they’ll change the CEO.”

"So that way, you’re able to manage the people better in that particular region and there will be better utilisation of resources, both in public and private sector in that region,” he said.

Dr Ismail said Malaysia currently only spends 4.2 per cent of the GDP on health care, below the 7 per cent recommendation by the World Health Organisation.

The previous Barisan Nasional government once proposed a national health insurance scheme called 1Care in 2011, purportedly based on the UK’s National Health Service (NHS), but it was scrapped after public outcry.

Health Minister Dzulkefly Ahmad under the new Pakatan Harapan government reportedly said last May that his ministry would request for more allocations.