Saturday, May 22, 2010

National Health Care

From Malaysiakini:

Nation's healthcare system ill, needs attention

It is frequently said that a true measure of society is how it treats its weak and poor. To this we would like to add that the true measure of a civilisation is how it cares for its sick and dying.

Recently a friend's mother was diagnosed with advanced bowel cancer. In her mid-50s, with two children of college age, she was obviously desperate to put up a brave fight for as long as possible.

Six months and RM 400,000 worth of treatment later she sadly lost her battle with the Big C, leaving a grief stricken family that had re-mortgaged the family home and were waist deep in debt. Although she had healthcare insurance, the insurance firm would only cover 70 percent of the costs, hence the need to dig deep into savings and release property equity to raise the additional funds, at considerable cost to her loved ones.

Cardiovascular disease, diabetes and stroke are already among the leading causes of mortality in Malaysia, in line with that of the rest of the developed world. Cancer diagnosis is on the rise and over the next 20 years it is projected that 1 in 3 to 1 in 4 of us will develop cancer.

Many of these diseases don't discriminate - at some point in the future either we ourselves or someone close to us will suffer from a potentially serious healthcare condition. How much will this cost us and how many of us will be unable to afford the treatment we need?

In recent years, Malaysia has witnessed the growth of the private sector share in our healthcare system. Whilst many private hospitals provide good standards of care, some are more concerned with profit margins.

Many of us will be familiar with stories of private hospitals performing unnecessary tests and additional treatments as a means of income generation. A friend's uncle tells the hilarious story of climbing a rambutan tree a few years back and falling off a branch, sustaining a mild concussion.

With a bit of a sore head he thought he'd better go and get checked out. Despite little in the way of additional signs and symptoms he was subjected to a MRI scan at a popular private hospital and an IV drip overnight although he was perfectly capable of eating and drinking.

The outcome? He was discharged the next day with a bill for RM5,000. On relaying his story to a doctor friend later on he was berated for having been taken for a ride, when a couple of Panadols and close observation would probably have sufficed.

Profiting from pain

When a close friend was recently accepted into an oncology training programme overseas, her father's friend, a respected surgeon, noted what a good career move she'd made. He congratulated her father on the fact that when she returned to Malaysia she could hope to make up to RM 70,000 a month as an oncologist in the private sector.

She was stunned and clearly dismayed by this proposition -in her mind, no one or no institution should ever be able to profit out of the pain and suffering of others. There is something fundamentally wrong with a system that puts profit and material gain before human life.

Some will argue that a private healthcare system should be allowed to develop and those that can afford it continue to pay, whilst those that can't can fall back on the government system.

We would argue that promoting a two tier healthcare system is dangerous both in terms of ensuring equitable access, maintaining healthcare standards, promoting research and development as well as the inevitable brain and talent drain that follows -as clinicians are drawn away from the government system towards the private sector.

Currently the private sector accounts for 23 percent of the country's hospital beds (12,000 beds per year). Around 40 percent of the country's doctors are employed within the private sector (9,000 doctors) with a doctor to patient ratio of 1 to 1.3. This is compared to a doctor to patient ratio of 1 to 3 in the public sector.

However with the move towards semi-privatisation and lack of a coherent social welfare system, even healthcare provisions within the government sector are not completely 'free'.

Neither are these provisions always affordable. A friend recalls undergoing cancer treatment at University Malaya Medical Centre (formerly known as University Hospital).

She was charged RM30 for her first round of chemotherapy. At the same time in the chemotherapy suite was another woman who was bemoaning the fact that she couldn't afford to have further treatment.

She unfortunately was now onto her second course of chemotherapy for cancer recurrence and this time round had to pay around RM3,000. Apparently this was part of the additional charges for successive chemotherapy sessions.

Ethical dilemmas

Also, doctors in the government sector often face tough ethical dilemmas. One senior doctor was seriously disillusioned by the fact that difficult cost-benefit calculations have to sometimes be made on behalf of patients. Some patients may be faced with the prospect of treatment that may buy them a further 18 months of life but leave their family with RM 20,000 worth of debt.

For many of us, ANY additional time spent with a loved one would be considered immeasurably precious. However for a family existing on RM1,000 a month this could spell financial ruin. In many instances, doctors in the government service heroically choose to turn a blind eye and continue to treat patients regardless of their ability to pay. Many of them however find themselves on the sharp end of rebukes from finance departments and hospital managers.

So what is it that Malaysians need and what is it that they deserve?

We would argue that instead of wasting taxpayers money through superfluous vanity projects and outrageous spending, (the purported RM77 million splurged on the US-based Apco Worldwide consulting firm just to revamp the new Prime Minister's image being a prime example), the Malaysian government should in fact be focusing on providing a world class healthcare system that is free to all at the point of delivery.

And by that, we don't simply mean a few token clinics hastily scrambled together devoid of properly qualified medical officers.

Malaysians are more than capable of leading cutting edge research and providing world class healthcare services that saves lives -the fact that there are many Malaysians in top consultant/research/public health posts abroad in the UK, US, Singapore, Canada and Australia is testimony to that.

Comprehensive plan required

We need to come up with a plan for comprehensive healthcare coverage that ensures we get the treatment we need when we need it, regardless of our ability to pay. We need a comprehensive overhaul of our public health policies that make diabetes, heart disease, stroke and cancer diagnosis and treatment top on our list of priorities.

We need to guarantee that the next time a minister's wife develops breast cancer she is able to access the best up to date treatment on her doorstep without having to fly halfway round the world. Along with our mothers, sisters, wives and daughters.

Breast cancer is, after all, hardly a rare disease. We need to pay our doctors a fair wage and reward initiative, innovation and hard work, so that we retain the talent we need to build a world-class health system within the public sector.

We need to invest more money in healthcare- last year the government spent only three percent of our gross domestic product (GDP) on healthcare (and only half of this-1.5 percent was spent in the public sector).

During the recent economic downturn, public healthcare expenditure was among the first to be slashed by a staggering 30 percent.

It is bad enough that existing levels of expenditure for healthcare fall short of the World Health Organisation recommended level of five percent and that of China and India who over the last seven years have consistently spent over five percent of their GDP on healthcare.

Most importantly we need to remind ourselves that many illnesses, including cancer, do not discriminate, and when you're ill and vulnerable all the money and material wealth in world may fail to make things better.

More than skyscrapers, shopping malls and multi-million dollar vanity projects we need a robust healthcare system that serves the people and can be trusted and relied upon to care for us when we are at our most vulnerable.

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