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FEBRUARY 2 — Salam Datuk Seri Dzulkefly Ahmad and Lim Guan Eng,
Recently, the government announced two initiatives focused on the golden child, i.e. the B40 group. These are the Peka-B40 which focuses on a health screening programme for a target group of about 800,000 people, and MySalam, a critical illness programme that covers 36 illnesses that focuses on about four million members of the B40 segment.
The CI programme uses a standard Malaysian Insurance Industry definition. The two programmes appear to give primary focus on a political manifesto and political mileage rather than public healthcare.
The public healthcare is the secondary objective and it seems money is no object in achieving the political objective. This is shocking to read for a government that has declared they are very concerned that the country has a huge debt of RM1 trillion.
I am questioning the wisdom of the government. The Health Ministry (MOH) has the widest and deepest penetration in this country. It has the assets and people to reach any B40 group in this country. Simple logic will confirm that if MOH cannot reach them, no private GP will open a clinic in such a remote area.
So why doesn’t Peka B40 leverage on the government machinery and network? After all, MOH has all the data of the B40 and it can do all tests at 40 per cent of the cost that is being offered to the private doctor. The programme budget of RM100 million can be better utilised for the public healthcare network.
Protech Health can easily manage the administration of the services using MOH infrastructure. After all, MOH has been doing the health screening for free at its hospitals and ultimately, it has a proven track record and is responsible for managing the public health care services.
What is needed is rebranding, promotion, and improving the existing programme to achieve the necessary political mileage and ensure that as many target groups are met. There is no value of enriching private labs and GPs. Part of the funds can be used to enhance the efficiency of services that will eventually benefit all visitors to public health facilities.
The MySalam is leveraged on the RM2 billion donation received from a multinational insurance company in Malaysia. At this stage, it is unclear which insurance company will be appointed as the insurer of the programme. One thing for certain, this will have a negative political impact on Pakatan Harapan.
One needs to understand the term “Critical Illness”. The definition used by insurers is not the same as the public understanding of the terminology. What will happen is many claims among the B40 group would not be payable as the definition used by the insurer is not met.
Allow me to illustrate. What if a B40 member had paralysis of one leg. Would he get paid for CI under “Paralysis/Paraplegia” considering that the Insurance CI definition does not pay for such a claim?
How would the government react if the paraplegic B40 that cannot work and his claim was not paid and sought the help of opposition political parties and brings this matter to national media? This can easily be made a racial issue by the opposition.
Another example that can be illustrated is that the benefit that is defined as “Serious Coronary Artery Disease”. Under the insurance CI, one needs to have three vessel disease with a minimum blockage of 60 per cent for each blockage.
From the public perspective, if one has 80 per cent block and has symptoms, it is deemed serious enough and he would require the financial assistance to undergo the necessary procedure. The insurance company would not pay.
How would the government handle the political backlash considering this is a B40 and does not meet the insurance CI definition. I expect that there would be a lot of public backlash as a result of not being able to enjoy the financial assistance.
Political backlash aside, RM2 billion is a lot of money that can be used to support the B40 group under a National Health Insurance Programme (NHSP).
MOH has studied the NHSP for the last 30 years and last year, the government set up a company named Protect Health Sdn Bhd (PHSB). Unfortunately, this programme has been sidelined.
The NHSP brings better value for money for the B40 and this will be the nucleus for the further development of NHSP to cover the whole nation.
In fact, part of the RM2 billion can use to develop primary clinics under PHSB that should be open in semi-urban or rural areas with the aim of increasing penetration of service point.
And such development can be done on Private Public Partnership (PPP) where PHSB can help finance the clinics set up for new doctors to take ownership of the operations. MOH can direct its patients to these clinics.
The benefit is tremendous. It will address unemployment for the medical professionals, improve doctor-patient access, especially where there is little private practice access and the government facilities are overcrowded.
It will also be useful to ensure private healthcare cost remains affordable and stable. Currently, the private healthcare provider acts as a huge cartel when it comes to pricing and the anti-competition Act has not been able to touch them.
I am clear that political mileage is important. PH needs to show that it is doing something for the people but it must also show that it is smart and prudent.
It must also show that it has the vision to bring this nation to the next level. Having an NHSP is not only about political mileage or about healthcare. It has an impact on the economy as a catalyst and also could bring in the much needed FDI as foreigners see the value of an integrated and structured healthcare system.
This has been proven worldwide. One good example is the act of the Abu Dhabi government in managing NHS via its company named Daman.
At this juncture, I beg the government via MOH and MOF to revisit the financials and programmes planned for the B40 group.
We need to get the maximum bang for a buck. Money is a limited commodity and we must make full use of it.
Let MOH and PHSB manage the two programmes and integrate it in such a way that we can get maximum value. MOH is the expert and has the necessary resource and infrastructure and has the experience.
Perhaps the only thing needed is a bit of private sector culture infusion?
** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.