Is this truly universal healthcare?

THE Health Ministry claims it is committed to universal health coverage. According to the World Health Organisation, universal health coverage means the government provides healthcare and financial protection for ALL Malaysians. Further, it means that all citizens can access the health services they need, when they need them and where they need them without financial hardship.

The mySalam scheme aims to provide “protection for individuals in the B40 (lower) income group via the mySalam Trust Fund”. However, the scheme has two serious exclusions.

Firstly, to qualify for the scheme, the B40 consumer cannot have been diagnosed with a disease before Jan 1, 2019. Thus if he has been suffering for many years, he will be excluded. Only those diagnosed after Jan 1 this year can benefit from the scheme.

Secondly, the scheme covers only those between 18 and 55 years old. Thus, if the B40 consumer is above 55, he will be excluded.

In summary, for a person from the B40 group to qualify for the scheme, he or she must have been diagnosed only after Jan 1, 2019; existing diseases are excluded; and the person must be less than 55 years old.

This is typical of what is offered by insurance companies, where there is a critical consideration of the individual’s “risk”. Those who already have medical conditions are excluded. Those considered “high” risk either because of age or other factors pay higher premiums or are excluded completely. Thus insurance companies provide coverage for those who are “low risk”. This way, the company can minimise paying for claims and maximise shareholder value. This is the natural modus operandi of insurance companies whose primary objectives are profits and maximising shareholder value.

The government does not act to maximise profits, rather it acts to maximise services and the rakyat’s well-being. Or, at least, that is what it should be doing.

Unfortunately, the government seems to be acting as an insurance company here by excluding those who need help the most and those who are aged. This is certainly not universal health coverage.

The mySalam website indicates that the scheme is managed by an insurance company. Thus it is certainly not surprising that the typical exclusion policies of an insurance company are being implemented in this scheme even though the scheme is supposed to help the poor.

To ensure true universal health coverage, healthcare must be managed by the government. The focus then would be on service for all and not on excluding “risky” consumers.

Contributions by insurance companies or any private company should certainly be encouraged. However, if they are genuine, their contribution should focus on increasing public health expenditure. The current public healthcare expenditure of about 2% of GDP is too low. This low expenditure is resulting in overcrowded government hospitals, long waits to see specialists, shortages of beds and, sometimes, a lack of medicines.

With the much talked-about increase in non-communicable diseases, the government certainly could use funds from the private sector to provide better healthcare for all, but especially the poor.

Receiving funds to serve the rakyat is certainly welcome. However, the government must manage these resources and keep to its commitment of universal health coverage. If private companies are allowed to manage healthcare, they will take into account people’s “risks” and we may end up with a system that will not allow chronically sick, aged or vulnerable people to seek treatment at public hospitals.

MySalam is a classic example of what happens when you allow a private company to run a healthcare programme. Instead of the government making the company provide healthcare for all (an inclusive policy), the private company instead has succeeded in making the government provide healthcare only to those they deem are worth the risk (an exclusive policy). It appears that insurance company policies have prevailed over the role of government.