Understanding the 1Care proposal
The UMNO/BN government plans to introduce a new healthcare system called 1-Care.It includes an insurance system to fund for healthcare. The National Healthcare Financing Authority (NHFA) will be in charge of1Care – and it is likely to be turned into a GLC. Based on the current performance of the GLCs, it is going to be a disaster.
Based on available information, every household will be made to pay up to 9.4% of gross household income for social health insurance. The payers will be the individual, the employer and the government via taxes, exact proportion still being worked out.
There shall be no choice. Everyone has to pay. There is no opting out. We have to pay upfront. It will no longer be fee-for-service; it is fee-before- service. There has been no information on exactly how this payment will have to be made or how the government will collect from self-employed people.
The government will be expected to contribute to the insurance premiums of government pensioners, civil servants and five dependents. But the problem is: 1Care does not cover all your medical expenses. It covers only for a prescribed basic list of what “you can have” healthcare items. Anything more than basic you will have to pay your own.
The medical practitioners have to comply too
Your long-serving independent family doctor or General Practitioner (GP) will have to join the system or will not be allowed to see you under the 1Care scheme. The robust, cost- effective independent clinics serving the country will be replaced by 1Care clinics. You cannot pick your own doctor; 1Care will allocate a doctor to you. If you want to see a doctor of your choice, you’ll need to pay for that from your own pocket. Your allocated doctor will decide when and which specialist you can see if the need arises (a process called gate-keeping).
The NHFA will pay GPs RM60 (present proposal) for each patient as consultation fees. It does not include medicine. Compare this with presently, for cough and cold visit, the GP would charge RM20-RM30 for consultation and medicine. With 1Care: consultation for GP visit is RM60 and this does not include medicine.
You cannot see your doctor as and when you feel the need arises. There will be a rationing system in place as well. There will also be rationing for specialist care with the GP as the gate-keeper. Likewise if you wish to see the specialist of your choice or go to a hospital of your choice, unless referred by your allocated doctor, you will also have to pay out of your pocket.
You will have to pay more for poor service and cheap medicine
Even if you only see the doctor once in a year, you will not get a refund from 1Care. Your medical costs are prepaid in advance irrespective of whether you become sick or not. You are also expected to make an additional co-payment for your visit. This is to discourage you from seeing doctors too often.
You will be prescribed only medicines from a standardised list of not-the- original medicines in keeping with WHO List of essential Medications. This will save cost for 1Care and maximise profit for the insurance companies. Insurance companies will have major say in the price and the range of this standardise medicine list. It will likely to be the cheapest medicine.
The doctor will only give you injections. You’ll need to get all other medicines from a pharmacist, even if it means hauling three sick children with high fever along a hot, dusty busy street looking for the nearest pharmacy. If you do not like what is given to you, you can get alternative care by paying out of your own pocket.
What is the outcome of this money-making scheme?
Each year, we all pay a total of RM44.24 billion a year for healthcare – now called National Healthcare Hospitals and Clinics ( an integration of public hospitals and clinics, private hospitals and private GPs. which in essence is a privatisation of public and nationalisation of private healthcare facilities).All this will now go under 1Care. This means 1Care will get almost RM45 billion a year. The administrative cost is likely to be 10% or about RM 4.5 billion.
The poor will be the marginalised population. When the private and public are healthcare corporatized and turned into independent commercial entities each competing with the other for business and profits.
Public hospitals and clinics are service-driven will become corporatize/privatise and have to be profit-driven. So who will serve the people in remote places? Who will serve the very poor people?
What happens when the government introduces 1Care?The whole system of independent one-stop GPs will be restructured and converted into 1Care clinics like the UK NHS general practitioner system.
Let us look at three simple scenarios
Case 1.Before: Ali has always having skin rashes for many years. He has to see his doctor once a month to get treatment. That would mean he will have to see his doctor 12 times a year just for this illness. What if he has other illnesses?
Now: But now, Ali’s doctor has allocated only a budget equivalent to six visits a year. Regardless of how many time Ali would need for his yearly treatment. What happens then? A rationing system will kick in. If the doctor sees Ali too many time, his “P4P” (Pay for Performance) profile will be poor and he will be paid less. To start with, Ali will probably cannot just walk in and expect to be treated. He will have to make an appointment. There will be a long waiting list. What if Ali needs to be treated for fever or some painful joints? He will also have to wait for his appointment. If he cannot wait and wants immediate treatment from another doctor he will have to pay on his own. This is what the NHS UK system is offering its patients.
Case 2.Lim has an appointment to see his doctor over a knee ache. Just before his appointment, he has an ingrown toe nail that has become painful. At the clinic, after his doctor treats him for his knee ache, he asks his doctor if he could look into his ingrown nail. His doctor says “No, the system does not allow me to do that. You must make another appointment. This visit I can only treat and bill for your knee ache. 1Care will accuse me of over-servicing my patients. I have no discretion here, all is by SOPs” This is what the NHS UK system is like today.
Case 3.Mutu lives in a remote rubber estate. One day he had chest pain and went to the nearby 1Care clinic. He has blood pressure problems since young and has had fits. A hospital assistant saw him. Because of a change of his medications to the cheapest not-the-original medications, his blood pressure went out of control and his seizures returned. He developed a fatal stroke and died. This is what is happening when essential original medications are replaced with the cheapest .The cheapest medication is not necessarily the best for the patient and certainly not the safest.
What if you never go to the hospital or clinic?
Every salary man must get a 5-9% deduction from his salary to fund this scheme. This money is taken and gone for good even if you don’t see a doctor.
An e-mail from Dr Ng Swee Choon, Medical Affairs Committee Member Federation of Private Medical Practitioners’ Associations Malaysia.