KUALA LUMPUR, Sept 30 — Peka B40, touted as a comprehensive medical screening and aid package for low-income Malaysians, has only captured some 11 per cent of this year’s target.
With only three months until the year expires, the Ministry of Health (MOH) scheme has only recorded 87,449 people who underwent the Peka B40 health screening as at September 23.
This is an unenthusiastic response as it was targeted to have benefitted 800,000 from the bottom 40 per cent (B40) of income earners by year-end, after the programme was launched in mid-April this year.
Out of RM100 million allocation for the pilot project, Peka B40 has so far spent only about RM14 million on payments to general practitioners (GPs) and diagnostic labs for health screenings, free medical devices for beneficiaries, cash aid for cancer patients, and cash incentive for transport to hospitals.
Speaking to Deputy Health Minister Dr Lee Boon Chye, CodeBlue learned that out of the 87,449 beneficiaries, 64,972 have done their second screening.
The Peka B40 scheme is inclusive of four benefits: health assessment, health aid, completing cancer treatment incentive (CCTI), and transport incentive.
The free health assessment, or screening, can be done at participating private GP clinics. The health aid provides a lifetime limit of RM20,000 worth of medical devices. CCTI gives RM1,000 cash to cancer patients at MOH hospitals, while the transport incentive comprises RM500 and RM1,000 cash for travel to MOH hospitals in the peninsula and East Malaysia (Sabah, Sarawak, Labuan) respectively.
Dr Lee said there is no target number of beneficiaries per benefit for the health aid, CCTI, or transport incentive, but the numbers show that take-ups are on the slow side.
As at September 17, 896 beneficiaries were approved and paid for the health aid, 305 for CCTI, and 1,010 for the transport incentive.
With a payment rate of RM40 for the first screening and RM20 for the second screening per patient, the government has paid GPs RM848,240 so far, as at September 17.
The government has so far disbursed RM154,241 for the health aid, RM91,500 for CCTI, and RM98,791 for the transport incentive.
Peka B40 also includes disbursements to labs that do the screening analyses and tests for potential beneficiaries.
“The lab tests include Full Blood Count, Renal Profile with estimated glomerular filtration rate (eGFR), HbA1c (not blood sugar), Random Lipid Profile, and Urine Biochemistry tests,” Dr Lee explained.
(HbA1c test is a type of blood test that gives an indication of how well the patient’s diabetes is being controlled.)
Each of these tests costs RM30. This would mean that the lab would receive RM150 per patient for five tests; and for 87,449 people, approximately RM13.12 million have been disbursed to these labs.
Adding GP reimbursements, plus payments for the health aid, CCTI and the transport incentive, this totals to just over RM14.31 million.
Taking into account that this amount does not include other expenses like manpower, as well as the spending for the set-up of the Benefits Management System (BMS), an IT system used to keep track of Peka B40 beneficiaries and the status of their applications, RM14.31 million is a meagre amount compared to the project’s worth of RM100 million.
With the clock ticking, the question lingers: will the government meet its target for the pilot project by the end of the year?
“We expect the number to pick up as time passes by, even though at the rate of increase, we are still short of target.”
Deputy Health Minister Dr Lee Boon Chye
“We should reach about 100,000 people by end of Sept 2019 and every week, more than 2,000 are added for first screening. As I said, the number will continue to increase,” Dr Lee told CodeBlue.
“We hope to reach at least 5,000 per week on average.”
However, he acknowledged that more needs to be done in order to ensure a better success rate for the programme.
“Need more promotion and probably make more people eligible by lowering the eligible age from the current 50 years to 40 (as suggested by Minister),” he said, referring to Health Minister Dzulkefly Ahmad’s recent announcement on expanding Peka B40 to those aged 40 and above.
The programme has been riddled with disgruntlement from the doctors’ community and from the public as well.
Discrepancies And Uncertainties In Peka B40 Manual
CodeBlue has gathered that there are discrepancies and uncertainties, according to the Peka B40 Manual for MOH Hospital itself, that may be causing deterrence against the take-up of the programme.
For example, Section 3.2.2 of the manual sighted by CodeBlue says that a beneficiary who is diagnosed with recurrent or metastatic cancer, whom CCTI has been given upon his/her primary diagnosis, is not eligible for a second application.
This fails to explain the eligibility of a patient who comes in for the first time during the late stage of the illness. With breast cancer, for example, the most common cancer in Malaysia, 20 per cent of female patients were diagnosed at stage 4, according to the Malaysian National Cancer Registry Report 2007-2011.
According to Section 3.6.1 of the Peka B40 manual, CCTI beneficiaries only get the second payment of RM700 after nine months of treatment. The first payment of RM300 is given upon successful application for the incentive.
But according to MOH’s Malaysian Study On Cancer Survival 2018 report, patients suffering from cancer of the lung, trachea and bronchus have a median survival time of 6.8 months.
Would this mean that these cancer patients are not eligible for the second payment? Section 3.6.2 states that the second payment won’t be made if the beneficiary dies.
Another prominent point of the manual is that the transport incentive is only eligible for patients who have been cleared for the health aid or CCTI. This would mean that patients who have to go to the hospital regularly, besides Klinik Kesihatan, to collect medications for chronic conditions, like diabetes and hypertension (high blood pressure), are not eligible for the transport aid.
But this is in contrast with the rising concern on the increasing rate of these diseases among Malaysians in recent days.
Dzulkefly said in July that the rates of non-communicable diseases (NCDs) like diabetes, as well as hypertension that raises the risk of heart disease and stroke, are now at a worrying stage in Malaysia.
He said based on the National Health and Morbidity Survey conducted by MOH once every five years, the percentage of adults suffering from diabetes had risen from 8.3 per cent in 1996 to 17.5 per cent in 2015, and the percentage of adults suffering from hypertension remained around 30 per cent during the same period.
CodeBlue is waiting for a response from ProtectHealth Corporation, a wholly-owned company by MOH that administers Peka B40, for its comments at the time of writing.
