Time for health insurance

WITH all eyes focused on the tabling of the 2018 Budget tomorrow, the Health Ministry in particular would be crossing their fingers in hopes of getting a bigger share of the pie.

With RM25bil originally allocated in 2017, representing close to 10% of the overall budget, healthcare is a major appreciating cost.

Incidence of non-communicable diseases (NCDs) such as hypertension, heart disease and diabetes has been on the rise. These diseases currently account for threequarters of all deaths in Malaysia.

Gains in life expectancy also translate to increased health burden as the population both grows and ages (15% of Malaysians will be over the age of 60 by 2030).

There have been many recommendations which the Government can implement as cost-costing measures to better manage spending and to get the national deficit under control. Reducing the size of the public service and placing more emphasis on increasing efficiency through increased computerisation are examples which easily come to mind. It has been estimated that over 40% of government revenue will need to be used to support the public sector emoluments alone.

However, reducing the allocation for healthcare cannot be one of those options to consider for cost-cutting. Provide less in 2018 than what was allocated in 2017 and there would be severe consequences, including shortage of essential drugs needed to treat NCDs particularly for senior citi- zens and those from the lower income bracket; disruption of public health programmes such as dengue prevention and control; loss of skilled and trained personnel to the private sector; and, most worrying of all, increased out-of-pocket expenditure by patients and their families.

But I think health will get a boost this time around. It won’t be as much as the Health Ministry would like but certainly more than what they received this year.

However, a more sustainable solution to financing the national healthcare system must be found. We cannot depend on maintaining what we have today based on a “living from national budget to national budget” mindset, facing almost existential questions each time September and October approach.

We are fortunate that the Government is steadfast in its commitment to ensuring that Malaysians have access to high quality healthcare. When we look at the battles being waged in the United States and Britain over this issue, we can count ourselves fortunate.

But that day is soon coming. Back in May, Health Minister Datuk Seri Dr S. Subramaniam boldly announced that the Government would introduce a voluntary national health insurance system in 2018. That took guts. The unpleasant experience with 1Care has demonstrated how finding a publicly and politically acceptable approach can be incredibly difficult and tricky, particular- ly when it involves the public purse. Ensuring and maintaining high quality healthcare is neither free nor cheap, regardless of whether it is in the public or private sector. How we pay for it has been the question that planners and boffins of the Health Ministry have struggled to answer for the past 15 years.

The fact is that with the constraints and ever-increasing demands made on the Government, the national budget allocation can never really commensurate with the medical cost, hence the need for a separate financing mechanism specifically for healthcare and to complement the existing framework.

So what would this national health insurance look like if implemented next year? How much do we have to pay and who needs to be enrolled? We don’t know yet. All we have been told so far is that it would be voluntary and not profit-driven, and that it would be managed by non-profit organisations under the Health Ministry. Members of the national insurance scheme might also have access to private healthcare.

I believe that similar to the system in Germany and Australia, people should be able to opt out if they wish to retain their own private insurance or pay for their own private healthcare.

A national health insurance could save the public healthcare system as we know it today, and enable Malaysians to have access and maintain coverage for better care and treatment. It would also act as a social safety net, particularly in ensuring quality medical treatment for the elderly and those with lower incomes.

A national health insurance scheme could be a game changer to catapult the Malaysian healthcare system into the 21st century.

Selling the idea of a national health insurance scheme to the Malaysian public is going to be tough and unpopular even if it is voluntary. But it must be done and cannot be delayed any longer.

Budget 2018 will give us a clue of where the Government wants to go with this. What I do know is that the commitment to implement it must be announced with a definitive timetable of implementation. The details must be shared with the public as soon as possible for us to better understand and support it.

It will be a bitter pill to swallow, especially with the GST, reduction of various subsidies and a trust deficit in the background. But there will never be a right moment or perfect conditions to introduce such an initiative.

Consider the fact that Britain’s National Health Service was founded in 1948 shortly after the end of the Second World War. This was the worse condition possible and yet it was done and exists to this day. The NHS’ founding principles are very like our own: the provision of healthcare services that are comprehensive, universal and free at the point of delivery. AZRUL MOHD KHALIB Kuala Lumpur