PSM is concerned about the many loopholes in the MySalam scheme.
For example, according to the MySalam website, severe Parkinsonism with permanent inability to perform activities of daily living (#30) is one of the 36 critical conditions for which the afflicted person can apply for the RM8,000 pay-out.
But the fact is, Parkinson’s disease generally affects people in their 70s and above. The MySalam only covers people between 18 and 55 years. So the vast majority of Parkinson’s patients are excluded because of their age.
Even if there is a person below 55 years who has Parkinson’s with severe disability, he would not be able to apply for he would have been diagnosed several years ago (Parkinson’s takes 10 to 25 years to result in severe disability). And MySalam excludes conditions that were diagnosed before 1/1/2019. Thus it is extremely unlikely that any person who develops Parkinsonism over the next five years will be able to benefit from the MySalam scheme because he would not meet the severity criteria.
Cancer and heart attack are mentioned as among the critical illnesses covered by the MySalam insurance, items 7 and 18 respectively. But the website states that these conditions must be “of a specified severity”. So, it is quite possible to be below 55 years old, suffer a heart attack between Jan 1, 2019 and Dec 31, 2019 but still not be eligible for any MySalam cover as the heart attack was not “severe” enough.
What are the criteria used to judge severity? Were these set by Great Eastern? Did the government have any input regarding these criteria? Was the health ministry consulted on this?
Bacterial meningitis (#3), encephalitis (#13) and head trauma (#24) are among the 36 critical illnesses mentioned in the MySalam website.
However, the website specifies that the person afflicted should be permanently unable to perform ADL (activities of daily living). How will “permanency” of the condition be assessed? Would the family of a person in a coma because of a head injury sustained in January 2019 be told to come back at least six months from the date of the head injury if he is still severely disabled?
Then the purpose of giving a cash handout at the time the family is in most need for it is thwarted. What happens to a person who sustains a head injury in November 2019? Will the claim on his behalf in May 2020 be rejected because it occurred prior to Jan 1, 2020? (Pre-existing condition?)
ADL include feeding oneself, walking about at home, bathing and dressing oneself. A person with severe brain damage due to meningitis, encephalitis or head trauma might be able to do some of these ADLs, but be totally unable to go out and rejoin the job market. According to the website criteria, such a person will be ineligible for the MySalam payment of RM8,000!
Did the finance ministry (MOF) go through the fine print of the MySalam plan to check the various exclusionary clauses for each of the 36 conditions listed? Did MOF commission an actuarial study based on these exclusionary clauses and the known incidence of these 36 conditions among those from 18 to 55 to assess about how much Great Eastern will pay out in a given year?
The government is spending RM400 million to purchase one year of MySalam cover for the B40 population. But if, because of all the exclusionary clauses, Great Eastern only has to pay out RM100 million each year, isn’t this a rip-off of the Malaysian public?
Wouldn’t the B40 get much more assistance if the RM2 billion from Great Eastern was used to pay for the plates, screws, lenses, stents and other equipment and appliances that patients in government hospitals are now required to buy?
And if the RM2 billion was parked in a designated fund under the government, the interest earned over the next few years would be quite substantial, and could also be channelled to help the B40.
As it stands now, the RM2 billion from Great Eastern is in the form of an IOU note that the government will draw upon for the purchase of MySalam insurance for the next four years.
The PSM, therefore, asks the Pakatan Harapan Cabinet to pause the MySalam scheme. Postpone its implementation for now. That is possible now as no payments have yet been made. This will give the government the time to do a proper actuarial study as to the actual quantum of payments that the Malaysian B40 will receive from this scheme, and please do not ask Great Eastern to do this actuarial assessment.
Also, please involve the health ministry as well as the civil society groups interested in healthcare delivery such as the Malaysian Medical Association, the Citizens Health Initiative and the Galen Centre in the process to ensure that the RM2 billion from Great Eastern is used optimally to benefit the B40.
Michael Jeyakumar is the former MP for Sungai Siput.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of Code Blue.
