The Ministry of Health claims it is committed to universal health coverage. According to the World Health Organisation, universal health coverage means the role of the government to provide health care and financial protection for ALL Malaysians.
Further it means that all people have access to quality health services they need, when they need and where they need without financial hardship. Universal Health Care encompasses access of healthcare for all Malaysians.
Yet, the mySalam scheme which aims to “provide national health protection for B40 individuals under the Bantuan Sara Hidup (BSH) has two serious exclusions. This scheme is for the B40 that means, the bottom 40 yet two significant groups of people who are under this group do not qualify for the benefits of the Scheme.
Firstly, the B40 consumer should not be diagnosed for the disease before 1 January 2019. Thus if he has been suffering for many years, he will be excluded. Only those who are diagnosed after 1st January 2019 are allowed to benefit from the scheme.
Secondly, the scheme is only for those between 18 to 55. Thus, if the B40 consumer is above the age of 55, he would be excluded. It cannot be denied that the older we get, the more we are prone to various diseases and health problems. Yet, the sick who are also poor, over the age of 55 are excluded.
In summary, the person to qualify for the scheme must be diagnosed after 1st January 2019. Previous diseases are excluded. The person must be less than 55 years. Older patients are excluded.
This would typically be a scheme run by insurance companies, where there is a critical consideration of the “risk” of the individual. Those who already have pre-conditions are excluded. Those considered “high” risk either because of age or other factors pay higher premiums or are excluded completely.
Thus the insurance provides coverage for those of “low risk”. High risk consumers are penalised or excluded. This way the company can minimise paying for claims and maximise shareholder value. This is the modus operandi for a company whose primary objectives are profits and maximising shareholder value.
The government does not act in a manner to maximise profits, rather it acts to maximise services and well-being of the rakyat. Or at the very least, that is what it should be doing.
Unfortunately, the government is acting as an insurance company – excluding those who need help the most and those who are aged. The Ministry of Health is certainly not practising Universal Health Coverage.
The mySalam website indicates that the scheme is managed by an insurance company. Thus it is certainly not surprising that their typical exclusion policies of an insurance company are being implemented in this scheme, although the scheme is targeted to help the poor.
Health care programmes must be managed by the government. This will ensure true Universal Health Coverage. The focus then would be service for all and not excluding “risky” consumers.
Contributions by insurance companies or any other private company should certainly be encouraged. However, if they are genuine, their contribution should be towards increasing public health expenditure. The current public healthcare expenditure of about 2 per cent of GDP is certainly too low.
This low expenditure is resulting in overcrowding in government hospitals, long waits to meet the specialists, shortage of beds and sometimes lack of medicines. With the increase in non-communicable diseases, the government certainly could use the 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 their commitment of universal health coverage.
The danger is if you allow private companies to manage health care, they will take into account the “risk” of consumers, and we may end up hospitals which will not allow sick, aged or vulnerable people to seek treatment at the public hospitals.
mySalam is a classic example of what happens when you allow a private company to run a health care program. It is indeed shocking; instead of the government forcing the company to provide health care for all (an inclusive policy), the private company instead has succeeded in forcing the government to provide healthcare only for those they deemed worth the risk (exclusive policy).
It appears that insurance company policies have prevailed over the role of government.
Paul Selva Raj is the Federation of Malaysian Consumers Associations (FOMCA) CEO.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.