Make Your Election Manifesto Matter By Addressing Cancer

Patient advocate Sew Boon Lui wants a Sarawak Cancer Centre. Oncologist Dr Ibrahim Abdul Wahid suggests subsidised private health insurance, where the government partially covers one’s premiums.

KUALA LUMPUR, Oct 16 — A cancer patients’ group and an oncologist have urged political parties to address the cost of cancer and the lack of accessible cancer treatments in their manifestos for the 15th general election.

When it comes to cancer in Malaysia, both Society for Cancer Advocacy and Awareness Kuching (SCAN) founding president and patient advocate Sew Boon Lui, as well as clinical oncologist Dr Mohamed Ibrahim Abdul Wahid, spoke at great lengths about the prohibitive cost of treatment.

They both advocated for a bigger public health budget, alluding to caretaker Health Minister Khairy Jamaluddin’s pledge to raise it to 5 per cent of the country’s gross domestic product (GDP) to ensure that cancer drugs are accessible to all patients, irrespective of income, and financial aid for the bottom 40 per cent of income earners (B40).

Cancer is a costly disease. In 2017, an average trip to the hospital cost a cancer patient RM7,087. To better understand the needs of people with this condition, CodeBlue interviewed Sew and Dr Ibrahim.

Sew is a breast cancer survivor who opted for early retirement to create the Society for Cancer Advocacy and Awareness Kuching (SCAN) that is rooted in her own personal journey with cancer. Sew was diagnosed with breast cancer in 2006, the most common cancer for Malaysian women.

Despite having received heavily subsidised treatment at the Sarawak General Hospital (SGH) in Kuching, Sarawak, Sew still found herself digging into her savings to pay for drugs that were not covered by the government and treatment at a private hospital in Kuching, which had the machine for PET/ CT scans.

She attributes her savings of over 25 years to her survival and is now a passionate advocate for the fundamental right to health care, irrespective of age, gender, race, ethnicity, locality, income, or any other factor.

Dr Ibrahim is medical director of Beacon Hospital in Petaling Jaya, Selangor, and a clinical oncologist who specialises in CyberKnife Radiosurgery and Stereotactic Body Radiation Therapy (SBRT), Intensity-Modulated Radiation Therapy (IMRT/IGRT), and also in lung, colorectal, breast, head and neck, and urology cancer. He is also the past vice president of the College of Radiology.

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Sew told political parties not to overlook health care needs in East Malaysia or the cancer community, pointing out that SGH is the only public hospital with a basic oncology or cancer care unit to cater for the entire Sarawak population of 2.56 million.

“A Sarawak Cancer Centre has been proposed by Deputy Premier Dr Sim Kui Hian since the Sarawak [state] election in December 2021. We hope necessary allocations have been made to make this cancer centre a reality – one that is fully equipped with the necessary infrastructure (rooms, wards, diagnostic and scanning tools), health care professional resources (oncologists, technicians, oncological nurses etc), as well as sufficient maintenance budget.”

Sew called for a revamp of public health care facilities to cater to ever increasing needs.

“The [SGH] building that houses the oncology unit is over 30 years old – bed shortage in existing wards, limited space in the chemotherapy room. Shortage of consultation rooms, where two patients are seen by two MOs (medical officers) in the same small room, is a common phenomenon. No privacy to protect patients’ confidential information.”

Sew Boon Lui, patient advocate and founding president of the Society for Cancer Advocacy and Awareness Kuching (SCAN)

Being all too familiar with the expenses that patients can incur, Sew advocates for financial aid for cancer patients from B40 groups and access to expensive drugs for advanced treatments for late-stage cancer patients.

Dr Ibrahim strongly recommended tax reliefs to encourage the populace to invest in private health insurance as a way to alleviate government spending on health care.

“Tax relief for when paying for essential medicines and hospital bills. The current tax rate is RM5,000 for your parents’ medical bills, but I think that can easily be extended to the rest of the family,” said the clinical oncologist.

“You might have children, wife, husband, you know, who’s not well and it can be a financial burden to pay for treatment, to pay for regular medications. You have to buy, you know, blood pressure tablets, you have to buy diabetic tablets and all that, and there’s no relief.

“And then you’re paying so much for hospitalisation. You’re paying so much if a person gets admitted with cancer, you’re paying so much for treatment and all that. Why don’t we encourage people to pick up insurance?”

Dr Ibrahim also advocated for policies to prevent insurance companies from unjustly terminating a policy.

“Now, there’s discrimination against people. People who are sick – they end your cover, you know? I think that should not be the case. Once they take somebody on, they should honour that.

“They should honour the continuation of the policy. The moment they (patients) reach the thing or whatever, that’s it. They (the insurance company) terminate the policy. ‘You got cancer? I don’t want to cover you anymore at all’. That is a problem. I think that’s not fair. I mean, in America, you’re not allowed to do that.”

Dr Mohamed Ibrahim Abdul Wahid, clinical oncologist and medical director of Beacon Hospital

“Once you take on insurance, you take that person on for life,” said Dr Ibrahim.

He urged the government to negotiate with insurance companies for better coverage of their clients and to ensure continuity of health insurance policies.

Dr Ibrahim also recommended government-subsidised insurance to encourage more patients to take up health insurance.

“So instead of paying the cost of treatment, the government pays to reduce their premium as the insurance in the long term will pay for treatment – potential savings for the government.”

The oncologist also called for tax relief for private hospitals offering subsidised or free treatment for underprivileged or B40 patients.

What health issues do you think the next government should address in the next term?

“The alarmingly huge gap in access to advanced drugs, which are known to be exorbitant. For example, targeted therapy drugs can cost between RM4,000 a month to RM15,000 or more every three weeks, depending on cancer type or subtype,” Sew said.

“Even M40 (middle 40 per cent) groups will not be able to afford it. That means 80 per cent of Malaysian patients risk not getting the drugs to treat or prolong their lifespan once diagnosed to be in advanced stage cancers.”

Sew also highlighted low cancer awareness, leading to a high percentage of cancer cases presenting at the late stage.

“Can have more cross-disciplinary effort within different sectors of the Ministry of Health (MOH) working closely with relevant non-governmental organisations (NGOs) in launching campaigns, as a healthy lifestyle and healthy diet helps to prevent many other diseases, for example diabetes, high blood pressure, heart problems etc.

“Drive implementation of pap smears and mammogram checks via the National Population and Family Development Board Malaysia (LPPKN) more aggressively.”

Similarly, Dr Ibrahim believes there should be a “better or compulsory screening programme for breast cervical cancers (and) priority [should be given] to patients with cancer to get early appointments in government hospitals and not endure long waiting lists to get treatment.”

Sew outlined the issue of distance in obtaining health care, such as for Sarawakian cancer patients who live outside or far away from Kuching but need treatment in SGH in the state capital.

“Distance can become a barrier due to an additional cost to bear, especially for those from B40 groups, besides having to look for lodging.

“The MOH should work with the Welfare Department to provide travel and lodging subsidies for needy patients and families, and provide grants to NGOs who provide lodging or a halfway house to needy patients.”

Sew Boon Lui, patient advocate and founding president of the Society for Cancer Advocacy and Awareness Kuching (SCAN)

Dr Ibrahim recommended that the government address the increasing cost of health care in Malaysia and to curb “excessive profits”.

“Private hospitals should focus on the need to address health issues for the country, not putting profits as priority.”

In addition to curbing the profit-driven private sector, Dr Ibrahim also urged the government to open negotiations with pharmaceutical companies to get better drug prices for Malaysia.

“Many countries do this at the registration stage and they have cheaper costs compared to Malaysia. For example, hormonal treatment for the treatment of breast cancer is twice the cost here compared to Europe,” he said.

How can cancer treatment and care be made more affordable in Malaysia? What financing mechanisms can be proposed?

Sew recommended a national health insurance scheme, citing examples in Taiwan and SIngapore.

She added that Malaysia should establish a Cancer Drug Fund, where the government can provide tax exemptions to contributors from the top 20 per cent (T20) of income earners, as well as tax cuts for cancer patients who paid annual taxes in the past.

When it comes to out-of-pocket payments, Dr Ibrahim suggested that the private sector create affordable health care packages, as well as public-private partnerships between public and private hospitals, where the government covers the cost of certain patients treated in private facilities.

“Those who cannot pay will come to the government. And if necessary, the government can offload these patients to you (the private sector) and we (the government) pay for the patient. So it has got to be a give-and-take.”

Dr Mohamed Ibrahim Abdul Wahid, clinical oncologist and medical director of Beacon Hospital

He proposed that the government negotiate with various private hospitals, so that should one hospital be unable to meet the prices set by the government, the government will still have options they may be able to pursue.

“So, if one party (hospital) says, ‘Oh, you know, I cannot afford to charge [the amount] you are giving me,’ then just move on and talk to other hospitals who are willing. There are hospitals who are willing to bring down their charges.”

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