KUALA LUMPUR, August 28 — Galen Centre for Health and Social Policy chief executive officer Azrul Mohd Khalib has raised concerns about the adequacy of funding for the Madani Medical Scheme.
In an interview on BFM’s Top Story podcast aired last Tuesday, Azrul questioned whether the federal government’s allocation of RM100 million is sufficient to support the Skim Perubatan Madani’s (SPM) target of benefitting 700,000 households.
Azrul pointed out that the Selangor state government’s Skim Peduli Sihat (SPS), the model for SPM, initially received a larger allocation during its launch compared to the federal government’s allocation for SPM — a nationwide medical scheme.
“The Malaysian Medical Association (MMA) themselves have reservations concerning the Madani Medical Scheme. They are concerned because, at the end of the day, you look at the intended beneficiaries. I think it was announced that this should benefit around 700,000 households with an allocation of RM100 million.
“So the question is, is that sufficient? It sounds like a lot, right? But this Madani Medical Scheme is actually an extension of what was introduced in Selangor, which a lot of people have already forgotten. In 2016, the Selangor government introduced something called Skim Peduli Sihat, and this is essentially the same programme but extended at the national level.
“The reason why they’re doing this is because it was quite successful in Selangor in getting the kind of results that they are hoping to get through the Madani Medical Scheme. But when you look at it, they intended that programme, the Skim Peduli Sihat for 250,000 families or around a million Selangor residents, also lower-income (B40), involving around 1,000 GP clinics.
“But get this, their allocation for that scheme when it was first introduced was RM125 million. The Selangor government, at that point in time, when they were introducing SPS, actually allocated more money for that SPS programme than the federal government right now introducing the Madani Medical Scheme for the entire country,” Azrul said.
The SPS programme, designed for lower-income (B40) families, initially received RM125 million under the state’s 2017 budget and an additional RM20 million a year later. By March 2018, around 1.2 million beneficiaries were registered, with approximately 320,000 Peduli Sihat cards distributed and 983 clinics across Selangor registered.
In fact, the Selangor state government’s SPS programme provides a higher amount and wider range of benefits than the federal government’s SPM.
Under SPS, the annual limit for basic health treatment for households is RM500 (which is 100 per cent higher than SPM’s RM250). For individuals, the annual limit for basic health treatment is RM200 (which is 167 per cent higher than SPM’s RM75).
Unlike the federal programme that only covers treatment for acute cases, the Selangor state programme does not impose any limit on the type of basic treatment or medication for coverage.
SPS, launched in December 2016 by Selangor Menteri Besar Mohamed Azmin Ali, was expanded by his successor, Amirudin Shari, in 2020 with an additional allocation of RM42.5 million. More benefits were added to the scheme under Amirudin’s administration, such as vaccination under the basic health treatment benefit, plus RM5,000 payment for critical illness or for death or disability caused by accidents, RM2,000 payment for life assurance or total permanent disability, and RM1,000 for burial expenses.
What Happens Once Benefits Are Maxed Out?
The matter of cost also extends to the allocated funds for beneficiaries and the subsequent steps when their subsidised coverage is depleted, Azrul said.
ProtectHealth Corporation Sdn Bhd, a Ministry of Health (MOH) entity overseeing the scheme, is in charge of paying the private GPs for treatment expenses. However, the official website does not detail the procedure for cases exceeding the beneficiary’s limit. It merely states that additional charges by GPs are prohibited.
Azrul highlighted the necessity to address these issues regarding limits and payment. He referred to negotiations undertaken for the B40 scheme and emphasised that remuneration for participating GPs was a major challenge for the PekaB40 initiative.
As SPM offers various services that range from the treatment of cough and cold to family planning, determining payment amounts for these services is notably intricate.
“The question that really comes to mind is, you know, if you’re using insurance, these limits can go very, very quickly and whether or not this is sufficient. What happens when it exceeds or is maxed out, in terms of the allocation provided? Because this is intended for a whole year.
“There has been no real answer as to what happens, except that probably once you’ve maxed out, you have to go back to the government hospital, just in case you need care.”
Azrul said there are ongoing negotiations between ProtectHealth and various GP clinics when it comes to treatment costs for different ailments.
Under SPM, family households registered with the Inland Revenue Board (LHDN) receive a maximum of RM250, senior citizens aged 60 and above without spouses get up to RM125, while singles aged between 21 and 59 years old, and persons with disabilities (PWD) singles aged between 19 and 59 years old are entitled to a maximum of RM75. These benefits are valid for beneficiaries until December 31, 2023.
Decongestion Of Public Hospitals, Clinics In Question
Azrul’s projection of patients returning to government hospitals and clinics seems counterproductive to SPM’s purpose.
According to KKMNow statistics, non-critical care and intensive care unit (ICU) bed utilisation remains high across the country.
Health Minister Dr Zaliha Mustafa recently touted SPM as a successful hospital decongestion method. She held that 70 per cent of the patients who frequent hospital emergency departments are members of the B40 community and those who come after office hours for simple ailments. SPM was introduced by the coalition government to alleviate the congestion in hospitals by redirecting traffic to private GPs.
However, with the return of SPM beneficiaries to hospitals once the limit is reached, the scheme appears to merely delay congestion rather than solve it.
Adding to the uncertainty in terms of cost as well is ProtectHealth’s involvement. According to Azrul, as ProtectHealth is the third-party administrator (TPA) that is running SPM, they will take a cut of the payment, but the exact amount they will be taking is undisclosed.
While this method of decongestion may work in suburban and urban areas with ready access to private GP clinics, Azrul suggested that extending SPM to rural regions, including those in East Malaysia, seems unlikely.
“This initiative really is dependent on the availability of private GP clinics. So, it will likely involve mostly cities and towns. The rural areas will still depend on the government’s network of clinics and regional hospitals. So, it’s not likely that those rural areas in the peninsular and Sabah and Sarawak will be involved in this initiative.”
Phase Two Premature Without Learning From Phase One Results
Azrul said that it is too early to tell if the scheme has been a success and thinks the launch of the second phase of SPM is premature.
“It’s a bit too early to know at the moment. It’s early days for the programme to know whether the programme has actually eased the burden of public hospitals, basically reducing the volume of patients filling up emergency departments and waiting areas of outpatient care.
“If we were to just look at some of the areas where the programme is currently progressing, we still see a lot of patients in public hospitals with still a lot of congestion. And just bear in mind, it just started back in June.
“So it is really still too early to tell, but I can tell you that, based on its potential alone, it’s going to be something very interesting for us to see and measure perhaps at the end of the year.
“I think it is premature though to initiate Phase Two of the programme without seeing the results of Phase One first, and this is something that, I think, they’re in too much of a hurry.
“It is going to be important to learn from the pitfalls and the gaps in terms of coverage and effectiveness of outreach because, at the end of the day, success is really going to be measured based on how crowded your hospitals and clinics are with patients who should really be seen by GPs.”
The second phase of SPM that covered 11 new districts — Kota Setar and Kuala Muda in Kedah; Kuala Terengganu and Kuala Nerus in Terengganu; Kota Bharu and Pasir Mas in Kelantan; Kuantan, Pahang; Melaka Tengah, Melaka; Seberang Perai Tengah, Penang; Seremban, Negeri Sembilan and Perlis — was launched on August 8, less than two months since the launch of the programme on June 15. ProtectHealth said the Madani Medical Scheme would be expanded nationwide next month.
Phase Two of Selangor’s SPS, on the other hand, was launched more than three years, in April 2020, after the launch of the programme in December 2016.
