DECEMBER 7 — With due respect to the Health DG, his press statement has not really addressed the issue raised by the article published in the Malay Mail Online on December 5, 2016.

It is an incontrovertible fact, supported by research evidence which were cited in the Malay Mail Online article, that cancer patients in Malaysia are getting a bad deal.

Coverage for treatments of solid cancers especially for life-saving targeted therapies are relatively low. As a consequence, many patients die prematurely (for breast cancer, about half the deaths each year were avoidable) and probably many more were financially distressed in paying out-of-pocket (OOP) for the treatments to save their lives (Credit Counselling & Debt Management Agency (AKPK) has data on credit card debts due to healthcare). 

Treatment coverage is fundamentally driven by healthcare financing. Our policy has clearly failed cancer patients, and hepatitis, epilepsy and other under-funded therapy areas.

In sharp contrast, it has worked reasonably well for patients with kidney failure, heart disease, cataract, blood cancers etc as cited in the Malay Mail Online article, who enjoy high treatment coverage.

To make sense of this inequitable contrast requires a basic understanding of our health system, and therein the solution to address the issue.

Ours is not a single-payer dominant provider system such as the UK NHS or the Australian and Scandinavian public health services. We have a fragmented multi-payers, multi-tiered system catering to different segments of our population, much like the US or Swiss system.

In our system, MOH’s tax-funded public services are intended to provide safety net healthcare to the poor; MOH is too cash-strapped to be able to provide for all who cannot afford OOP self-financing.

The number cited by the Health DG is telling, I quote: “In 2015, MOH spent RM240 million just on cancer therapy”. Taking out financing for drugs for blood cancers (Imatinib, Rituximab etc), that leaves only about RM170 million for all drugs for all solid cancers (breast, lung, colon etc).

Compare this with the RM110 million we spend a year on epoetin merely to correct anaemia (which is not even life-saving) in patients with kidney failure, the financing shortfall for treatment of solid cancers is clearly stupendous.

And I don’t blame the MOH for failing to close the funding gap; MOH simply isn’t meant to be the main payer and provider of cancer care in our system, just as it isn’t for well covered therapies like kidney failure, heart disease etc.

Other payers in the system must owe up to their healthcare financing responsibilities to their beneficiaries; JPA for state employees and pensioners, SOCSO (which is financed through a mandatory 2.75 per cent payroll tax) for low income employees, voluntary private health insurance or employer sponsored plan for the middle classes, and charities for the indigents who somehow fell through the MOH safety net.

And this is precisely how some therapies have secured such high coverage. Again take kidney failure as an example. Of the RM1.2 billion we spent a year on the 35,000 patients on dialysis (yes, billion, far larger than the few hundred millions we spent a year on the 70,000 cancer patients who need care in a year), MOH only accounted for 32 per cent of the financing, JPA 11 per cent, SOCSO 13 per cent, Private 30 per cent and the rest charities.

Our health policy is due for a correction.

* Dr Lim Teck Onn is vice chairman of the Together Against Cancer group.

** This is the personal opinion of the writer and does not necessarily represent the views of Malay Mail Online.