Iltizam Selangor Sihat: Up To RM70 Coverage For GP Visits In Selangor

Iltizam Selangor Sihat (ISS) provides up to RM70 co-payment coverage for GP visits, while patients cover the balance. But only 7% of ISS beneficiaries utilise its benefits, which include outpatient treatment, wound care, and vaccinations.

KUALA LUMPUR, Oct 26 – Iltizam Selangor Sihat (ISS), formerly known as the Skim Peduli Sihat, provides subsidies for patient visits to private general practitioner (GP) clinics, offering up to RM70 per visit, according to Selangor Public Health and Environment state executive councillor (Exco) Jamaliah Jamaluddin. 

Jamaliah described the RM70 per visit cap for ISS beneficiaries more as a subsidy rather than an absolute limit that GPs cannot exceed when providing treatment and prescribing medication.

“Under this ISS, of course, we want to help our Selangorians as best as we can, but it also [does] not mean that we can cover all the costs. It’s meant to help them lessen their burden – meaning to say, let’s say that if they visit the clinic, if they have to pay RM90, we subsidise RM70, they still only need to pay RM20 compared to without having the card,” said Jamaliah during an interview with CodeBlue at her Damansara Utama office last October 11. 

The DAP lawmaker said that the RM70 figure was determined after evaluating the average treatment cost in Selangor, found to be RM58 per visit, and considering the financial context of the ISS scheme.

So far, Jamaliah said there have been no complaints from private GPs regarding the reimbursement rates set by SelCare, the third-party administrator overseeing the ISS programme.

“Under Schedule 7 [of the Private Healthcare Facilities and Services Act (PHFSA) 1998], private GPs are regulated [and required] to cap it (consultation fees) at RM10 to RM35 for consultation. 

“We sort of budget it based on the most realistic and practical amount that we can have, and it is actually very subjective, if we were going to separate the amount based on constituency, or based on city or rural areas. Then you will have very subjective and complicated opinions about it. 

“What we try to do is we keep it all at the same level throughout the Selangor state government because it’s very difficult for you to tell because within the city there are also a lot of GPs having different standards because it’s a free market after all,” Jamaliah said.

Last year, Selangor Menteri Besar Amirudin Shari announced an allocation of RM45 million to benefit approximately 100,000 ISS beneficiaries and around 150,000 family members registered under the scheme.

The scheme’s criteria stipulates that primary breadwinners with an income of up to RM3,000, with a family and dependents aged 21 and below, can apply for the scheme. Individuals who want to apply, must be earning RM2,000 or below, hold a people with disabilities card, or be 65 years and older. Additionally, applicants must have resided in Selangor for over a decade.

Under the ISS scheme, families receive an annual allocation of RM500, and individuals receive RM250. Beneficiaries are issued a card to present to panel GP clinics registered under SelCare.

While the scheme covers outpatient treatment, wound care, and vaccinations, it does not specify the exact treatments. Basic treatments include infectious conditions (respiratory, urinary, and skin), trauma care (wound care), and routine health check-ups, including urine and blood tests.

The scheme also covers vaccinations such as Pneumococcal (RM180), Meningococcal (RM180), Typhoid (RM80), Influenza (RM80), and Hepatitis B (RM55), according to the ISS website. If the vaccine cost exceeds RM70 per visit, patients are responsible for the balance.

The Selangor state government’s ISS programme operates as a shared cost model, with the state government and patients splitting the treatment expenses. 

Despite its feasibility at the state level, Jamaliah expressed concerns about adopting a co-payment model with the federal government, fearing that it might lead to departmental budget cuts due to state funding. She is also concerned about potential complexities arising from misalignment between federal and state governments.

“When it comes to this, it’s very complicated, very complex, and you need time for us to digest and to go through the pros and cons because once you make such a huge decision, you cannot say that this year I decide to do that and next year I want to u-turn because it’s not really working.

“There are considerations such as if you have two-tiered system, it’s very complicated in a way that you cannot actually decide who is responsible for what, which asset belongs to whom, and then you will also have a situation, like what if the federal government decides to not support a certain budget because they feel that I can now let go and just put the burden on the state government.

“And does that also mean that a better, financially supported state will have a better health care system? How about those states that go without an additional budget for their health care? Does that mean that they deserve to be neglected? There are a lot of other considerations as well. 

“And also, what if political decisions kick in, like, for example, if the federal government is not aligned with [the] state government? Will that also cause another issue for our civil servants serving in the health care system? Will there be any difficulties for them [about] who to follow because they are actually receiving a budget from both sides?”

Only 7% Of Eligible Recipients Tap Into ISS Benefits

As of October 2023, only seven per cent of ISS beneficiaries have utilised their benefits, despite having 98,142 total beneficiaries. The maximum number of beneficiaries for the ISS programme is 100,000. 

This low utilisation may be due to a lack of awareness of the additional benefits added over the years, Jamaliah said.

Jamaliah and her team plan to promote the programme and preventive measures in the coming year, focusing on increasing awareness and participation among Selangor residents.

“It is also our intention to actually promote it next year when we have finalised our budget for 2024. We are going to run more campaigns, not only for the ISS programme, but health programmes [under] the Selangor state government and other prevention campaigns.

“We want to promote to Selangorians that they can use this card, not only to access health care – to get their medicine if they are sick or anything – but they can actually also use it for check-ups, use it for vaccination. 

“So, probably, that is what we are going to do next year. We’re going to have more publicity, and then we are going to have more awareness. And we’re going to ensure that people not only sign up for this card, but they also remember what kind of benefits we have.”

Jamaliah is currently focused on raising awareness for the program through grassroots connections, including state assembly persons, counsellors, village heads, and civil servants. She said the lack of mainstream advertising is due to insufficient funds for media advertisements.

Despite the programme’s popularity, the low utilisation by beneficiaries could lead to a budget cut in 2024. Jamaliah believes such a cut would be logical, as the funds could then be redirected to finance other programs under the Selangor state government.

“We will ensure that the estimated amount is still enough to cover the 100,000 people registered under the ISS.”

You may also like