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1CARE – FAQs



Q: What is 1Care for 1Malaysia? A: 1Care will merge private            Q: Do I still have to buy medical insurance? A: 1Care has
and public sectors into one system. Everyone pays private              very limited coverage, so you need insurance or lots of cash.
sector prices. There will be no more government healthcare for
the 75% of the rakyat who can't afford the private sector. It will     Q: Can I get my money back when I retire or if I never use
be a fully privatised, SHI-based system.                               the system? A: You will never get your money back.

Q: What is 1Care's Social Health Insurance (SHI)?                      Q:What if I am poor? A: If you are a family of four earning
A: An insurance scheme that every working adult must buy.              below RM500, the government pays the SHI for you.
This SHI pays for your healthcare. But international studies
show that SHI systems INCREASE costs and do NOTHING to                 Q: When will this scheme start? A: It already has. 1Care is
improve healthcare!                                                    currently in Phase 1 & 2 of a 4 phase implementation process.
                                                                       This is confirmed by the Health Ministry's Deputy Director-
Q: How much do I have to pay? A: The government                        General, Datuk Dr Noor Hisham Abdullah. The process is
estimates they need 9.5% of your income to maintain 1Care.             expected to be completed within the next 2 to 5 years.
They are also exploring sliding scale deductions, where the
poorer pay less and the richer pay more. So you could be               Q: Why do we need this 1Care reform?
paying much more than the 9.5%!                                        A: The government claims it can't afford to pay for healthcare.
                                                                       The Health Ministry's 2011-2015 Plan proposes cost-cutting
Q: Do employers still provide healthcare benefits?                     measures to make government hospitals "abandon acute
A: The 9.5% is supposed to be shared between employer,                 care" and "more strictly limit services" to the rakyat. But
employee and government. But it's actually ALL paid by you:            they willingly give out BILLION-RINGGIT contracts for services
                                                                       that don't improve healthcare!
(1) Your portion is deducted from your salary.
(2) Government's portion is paid with your tax money
(3) Employers will eventually pass the cost back to you                  THE RAKYAT DEMANDS OUR RIGHTS!
Q: What healthcare do I get in return? A: According to the               The UN Universal Declaration of Human Rights states:
1Care Concept Paper, your 10% will pay for about 6 clinic
visits or 1 specialist visit a year, or 1 hospital stay in 11 years.     "everyone has the right to a standard of living
And you will STILL need to pay when you see the doctor!                 adequate for the health and well-being of oneself
                                                                           and one's family, including medical care."
Q: What is a Primary Healthcare Providers (PHCP)?
A: PHCPs are 1Care-certified GPs. Everyone must register                   As a signatory to this declaration, the Malaysian
with a 1Care PHCP. If you don't like your PHCP, you can pay            government must uphold its dignity and not impose any
extra to see another one.                                              policy that restricts the rights of the people to affordable
                                                                       and quailty healthcare – either in public ot private sector.
Q:Why do I need to register with a PHCP?
                                                                          It is the government's responsibility provide enough
A: 1Care tracks your health records through the PHCP. If you
                                                                        quality and affordable healthcare for all the health needs
use “too much” of 1Care's healthcare budget, you may get
                                                                          of everyone in Malaysia, without any discrimination.
only limited or even no healthcare until a new budget is
approved. Unless you pay extra to get your own doctor.                  A moral and caring government will not force people to
                                                                             choose between disease or financial ruin.
Q: What is Gatekeeping? A: You can't go to any hospital or
specialist without your PHCP's referral. If you don't like the              A moral and caring government would not treat its
specialist or hospital he refers you to, 1Care gives you the           citizens' health as a commodity to be traded, manipulated
“choice” to pay extra to see your own.                                                   and negotiated for profit.
                                                                        The rakyat elects governments to protect our interests!
Q: How is the PHCP paid? A: 1Care pays PHCPs a flat rate
                                                                        Taxes must be used for the rakyat's benefit, including to
for every patient. There's no reward for better care, so doctors
                                                                        provide quality healthcare and other essential services.
have no incentive to improve. They also have a fixed budget. If
                                                                                 Therefore, the rakyat states clearly:
they see too many patients, they won't get paid. So your PHCP
may not see you if he's out of budget. You'll have to pay extra
to see another doctor.

Q: Can I change my doctor? A: Yes, You can apply to the
                                                                          TAK NAK 1CARE!
authorities, submit the paperwork, wait for approval, etc. If you                      Instead, the rakyat demands:
don't want the hassle or long waits, you can pay extra to see
your own doctor.                                                              1. DE-PRIVATISE PUBLIC HEALTHCARE
                                                                         2. STOP CORRUPTION, WASTAGES, LEAKAGES
Q: Do I have to pay for hospitalisation or surgery?                    3. INCREASE FUNDING FOR PUBLIC HEALTHCARE
A: 1Care will never fully reveal what they provide. But the
1Care Concept paper shows that if you get serious diseases              4. REGULATE PRIVATE HEALTHCARE CHARGES
like cancer, heart or kidney disease – you pay your own. Other             5. MAINTAIN THE PRESENT 2-TIER SYSTEM
needs are subject to 1Care's budget limitations.
1CARE – WHAT IT'S REALLY ABOUT


According the the Ministry of Health:                                      Clearly, the objectives of 1Care “reforms” are already being
                                                                           met by the healthcare system we have now. And many of the
                                                                           problems in our healthcare system can be easily solved
                                                                           without a total revamp. So why is government so very keen to
                                                                           implement 1Care “reforms”?

                                                                           PRIVATISATION AND PROFITS
                                                                           These slides are from a January 2009 presentation by the
                                                                           Ministry of Health entitled: “FUTURE OF HEALTH CARE
                                                                           FINANCING IN MALAYSIA” by Dr Abd Rahim Mohamad,
                                                                           MOH Planning & Development Division.

                                                                           In the first 20 slides, Dr Abd Rahim lists the problems with
                                                                           Malaysia's healthcare system. Then he presents two reform
                                                                           options – introduce a NHI [2] and more privatisation, or
                                                                           improve the current system:


Slide 27 from presentation: “MALAYSIAN HEALTHCARE SYSTEM
TOWARDS ACHIEVING BETTER HEALTHCARE FOR MALAYSIA” by Dr.
Abd. Rahim bin Mohamad, MOH Planning and Development Division.
Briefing given in Putrajaya, 28 September 2010


BIG WORDS DISGUISE THE REAL INTENTIONS
The government uses nice-sounding words to give people a
positive impression of 1Care, but the meaning of the words
could be very different from what most people think.

Here are the real meanings of some words we need to
remember when discussing 1Care:

INTEGRATE:
1Care will merge private and public healthcare sectors to
create a single system. All government facilities will function
like independent “private entities” [1] and charge private sector          Slide 22: “FUTURE OF HEALTHCARE FINANCING IN MALAYSIA”
rates. 1Care will completely privatise healthcare.                         - Dr Abd Rahim bin Mohamad, 18 January 2009


UNIVERSAL COVERAGE:
The concept of EVERYBODY being able to get ALL the                         A right-thinking person would have chosen the second option.
healthcare they need. Malaysia already has universal                       It is more efficient and costs less for the rakyat. But in the next
coverage. The government uses taxes to provide all levels of               slide, Dr Abd Rahim proposes the FIRST option:
healthcare and has clinics and hospitals everywhere. Malaysia
also has a thriving private healthcare sector for people who
don't want to use government services.

SOLIDARITY AND EQUITY:
The concept where the richer pays to support the poorer to get
equal quality of healthcare. Malaysia already has equity
because 10% of the population pays taxes to make public
healthcare available for the other 90% who are too poor to pay
taxes. Most richer citizens also use private healthcare so that
the poorer can use public healthcare.

CHOICE OF QUALITY:
Malaysians already have choice – people can choose the
more expensive private sector with shorter waiting times and
better environment, or the cheaper public sector with better
expertise and facilities.                                                  Slide 23: “FUTURE OF HEALTHCARE FINANCING IN MALAYSIA”
                                                                           - Dr Abd Rahim bin Mohamad, 18 January 2009


[1] A Malaysian Pharmaceutical Society (MPS) report quotes a “Dr Nordin” from the MOH as saying “the current Govt Hospitals and Health
Clinics will be given autonomy and will operate like private entities”. This was during a briefing about 1Care to MPS by senior MOH officials
held on 15th Jan 2012. View the report here: http://on.fb.me/wD0utH
[2] NHI: National Health Insurance, another name for Social Healthcare Insurance (SHI), a compulsory nationwide medical insurance scheme
1CARE – PRIVATISATION IN DISGUISE


Behind all the big words and macro economic mumbo-jumbo,                   WHO BENEFITS MOST FROM 1CARE?
1Care is really just about money – a lot of money.                         The Economic Transformation Programme (ETP) report [4]
                                                                           enthusiastically promotes "health as an economic
The government has been trying to privatise healthcare ever                commodity". The report declares Malaysia should make:
since Dr Mahathir's time. In 1991, the Privatisation Master
                                                                                “ healthcare as an engine of
Plan officially listed healthcare to be privatised. In 1996,
the 7th Malaysia Plan stated “privatisation of health facilities
and services will also be an important aspect”. Since then,
many segments of public healthcare have been privatised.                             economic growth ”
Just a few examples of government privatisation:

1992:    Institut Jantung Negara corporatised (due to be
         privatised with impending Sime Darby buy over)

1994:    The Government Medical Store is privatised.
         Now, Pharmaniaga monopolises manufacturing,
         purchasing, storage and distribution of all drugs
         and medical products. Prices went up 3.3 times.

1996:    Hospital support services privatised to three UMNO-
         linked companies. Costs rose from RM143 mil in
         1996 to over RM1 bil in 2009

2011:    Radiology services in public hospitals privatised


FINISHING THE JOB
1Care will be the final piece in the process to completely
privatise Malaysia's public healthcare system. According to a
MOH briefing to the Malaysian Pharmaceutical Society, “Govt
Hospitals and Health Clinics will be given autonomy and
will operate like private entities” and “1 Care transformation             The ETP report calls for the government to “use its
proposals are now in the final stages.” [3]                                infrastructure capabilities, domestic consumption base
                                                                           and diverse population to create an economic growth
                                                                           agenda for healthcare.” (In other words, the government
                                                                           should use its facilities to make money from the rakyat.)

                                                                           The ETP report also identifies medical tourism as an “attractive
                                                                           sector” and explains that “with 1.9 beds per thousand and
                                                                           0.8 doctors per thousand as of 2008, Malaysia has a solid
                                                                           foundation to build on.” (pg 557)

                                                                           These numbers include both private and government
                                                                           doctors / hospitals! So with 1Care, the government is
                                                                           positioning themselves to reap huge profits from the health
                                                                           tourism boom, together with the private sector. Meanwhile, the
                                                                           rakyat is forced to subsidise the government's business
                                                                           through a compulsory SHI [5]!

                                                                           As if this is not bad enough, the ETP further proposes that
Slide 48: “MALAYSIAN HEALTHCARE SYSTEM TOWARDS ACHIEVING                   Malaysia should be internationally promoted as a “R&D and
BETTER HEALTHCARE FOR MALAYSIA” - Dr Abd Rahim bin Mohamad                 clinical trial destination for the pharmaceutical and med
                                                                           tech industries” as our country has a “high incidence of
As this slide shows, the government wants to liberalise,                   lifestyle diseases”.
then capitalise on the lucrative healthcare industry. 1Care
“reforms” will make this possible. Merging the public and                  The government is not only forcing the rakyat to subsidise their
private sectors lets the government charge private sector fees.            healthcare business, they will also offer the rakyat up to be
1Care also guarantees the government a captive market of                   the world's lab rats!
full-paying patients, because the entire population must be
registered under 1Care.

[3] MPS report on MOH Seminar on 1Care Health Transformation held on 15th Jan 2012, http://on.fb.me/wD0utH
[4] You can view the ETP Healthcare Report (Chapter 16) from here: http://scr.bi/w2deN2 (the ETP has removed it from its own website)
[5] SHI: Social Health Insurance. 1Care forces everyone by law to pay up to 9.5% of their monthly income for a compulsory insurance
1CARE – HOW DOES IT WORK?


1. INTEGRATION:
1Care will merge the private and public healthcare sectors.
There will be no more government subsidised system. All
healthcare services will charge private sector prices. This
will leave the 75% of the rakyat who depend on public
healthcare with inadequate healthcare.




                                                                          Slide 33: “MALAYSIAN HEALTHCARE SYSTEM TOWARDS ACHIEVING
                                                                          BETTER HEALTHCARE FOR MALAYSIA” - Dr. Abd. Rahim bin Mohamad


                                                                          2. PHCPs – DOCTOR JAGA PINTU
                                                                          All GPs will have to register as 1Care Primary Healthcare
                                                                          Providers (PHCP). But their Medical Degrees won't be good
                                                                          enough. They must go for additional 1Care training. PHCPs
Slide 19 from presentation entitled “TOWARDS PUBLIC PRIVATE               will also not be allowed to dispense medicines. You will have to
INTEGRATION: ASPIRATION FOR 1CARE” by Dr. Azilina Abu Bakar, MOH          get it from a pharmacy after you see your doctor.
National Health Financing Planning and Development Division
                                                                          Some other important issues about PHCPs are:
To disguise the high costs of 1Care's privatised system, the
government will force everyone to buy a compulsory Social                 REGISTERING PATIENTS:
Health Insurance (SHI). The government says that you don't                Everybody must register with a 1Care PHCP. If you don't like
need to pay to see a doctor if you have this 1Care SHI.                   this doctor, you can pay extra to see another one. If you want a
                                                                          second opinion, you also pay extra. But your SHI premiums
This is a big lie because the rakyat are forced to pay up to              will not be reduced or refunded.
9.5% of their income every month for this SHI. And as this
MOH slide proves, 1Care's SHI only covers some services.                  Registration also lets 1Care track your health records. If you
Anything more, you pay out of your own pocket.                            use “too much” of their healthcare budget, you may be limited
                                                                          or denied healthcare in future. Unless you pay extra.

                                                                          GATEKEEPING:
                                                                          1Care PHCPs will act as Gatekeepers - no one goes to a
                                                                          hospital or a specialist without their PHCP's referral. For
                                                                          example, you cannot simply see your own gynae or
                                                                          pediatrician anymore. You must first see your PHCP. If he
                                                                          thinks you need a specialist, he will refer you to one that HE is
                                                                          registered with. If you don't like that specialist, you have a
                                                                          “choice” of paying extra to see your own.

                                                                          PREVENT DISEASE:
                                                                          1Care PHCPs have to ensure their patients stay healthy. This
                                                                          is because 1Care limits how many patients can be referred to
                                                                          specialists / hospitals. If too many patients are referred, 1Care
Slide 9: “1CARE FOR 1MALAYSIA: PRIMARY HEALTHCARE” by Dr Safurah
Jaafar, Director, Family Health Development Division, MOH.
                                                                          may penalise the PHCP. 1Care may also put you on a waiting
                                                                          list until its budget allows you to go to a specialist / hospital. If
                                                                          you can't wait, you can pay extra to get immediate service.
1Care also DOESN'T pay for cases where your disease is so
serious that you need very expensive long term treatment or               CLAIMS:
very expensive immediate treatment. 1Care expects you to                  PHCPs earn by claiming money from the SHI for patients they
have your own cash or insurance for that.                                 see. But they are given a fixed budget. So they can't see “too
                                                                          many” patients or they won't get paid. They may even be
But all the SHI premiums that you have paid in your entire                penalised. So your PHCP may not see you if he's out of
lifetime will NOT be refunded to you. Ever.                               budget. You'll have to pay extra to see another doctor.


NOTE: All these points are contained in the 1Care Concept Paper. You can read it at: http://taknak1care.weebly.com/1care-documents.html
1CARE – SOCIAL HEALTH INSURANCE (SHI)
                                                              HOW MUCH, WHO PAYS AND WHO DOESN'T? [6]



                                                                                            IS THE 10% PAY DEDUCTION TRUE?
                                                                                            The government strongly denies these figures are
                                                                                            real. They insist that they put some meaningless
                                                                                            numbers in their proposal to the Prime Minister. But
                                                                                            we can calculate how the Ministry got their figures,
                                                                                            based on official government statistics.

                                                                                                RM44.23b (total health expenditure)
                                                                                            divide by 28.3m M'sians = RM1,562
                                                                                                RM972 (annual SHI per person) multiply 4.3
                                                                                            people per household = RM4181.50

                                                                                            We can also see that the Ministry's 9.5% estimate
                                                                                            is the average amount needed to sustain 1Care -
                                                                                            based on 2009 conditions. This will increase.
                                                                                            According to Dr Hsiao (Harvard economist and
                                                                                            1Care consultant), “In every country, health care
                                                                                            costs are increasing faster than wages. When
                                                                                            that happens, the premium has to go up.”

Table from the 2009 1Care Concept Paper [6] showing the Health Ministry's estimate of
                                                                                            The Ministry is also exploring sliding scale
how much the new 1Care system will cost the rakyat.                                         deductions, where the poorer pay less and the
                                                                                            richer pay more. So you could end up paying
                                                                                            much more than the proposed 9.5%!


WHO REALLY PAYS THE 10%?                                                        WHO DOES THE GOVERNMENT PAY FOR?
The government insists that the rakyat doesn't pay the whole
10%. It's supposed to be shared between the employee,
employer and government. They are only telling you half a lie.

The truth is that the 10% is ALL paid by you. How?

1. Your portion is deducted from your salary.
2. Government's portion is paid with your tax money
3. Employers pay their portion, but will eventually pass
   the cost back to you quietly

This last point is confirmed by Dr William Hsiao, who is helping
the MOH develop the 1Care implementation plan.



                                                                                2009 1Care Concept Paper shows those who don't need to pay for the SHI.

                               “ the burden of (SHI) on                         The government says they will take care of the poor by paying
                               employers was actually                           for their SHI. Who are these “poor” people? The PM says
                                                                                families that earn RM3000 a month find it hard to make ends
                                borne by employees ”                            meet. This is about 60-70% of the population (about 17-20
                                                                                million people).

                                                                                But this table shows the government pays for only 187,172
Dr William Hsiao                                                                poor people (0.7% of the population). These are only the
                                                                                hardcore poor – defined as a family of four who earns less
In one of his consultant reports, Dr Hsiao explained that,                      than RM500 a month! [8] So if a family of four earns only
“(SHI payments) imposed on employers were passed back                           RM501/month, they have to to pay the 10%!
to employees over time in the form of lower wages or
lower pensions and other fringe benefits.” Hsiao says, “In                      This table also shows that the largest group that the
other words, the burden of payroll tax on employers was                         government pays for are not poor or needy cases at all!
actually borne by employees.” [7]

[6] All these points are contained in the 1Care Concept Paper. You can read it at: http://taknak1care.weebly.com/1care-documents.html
[7] You can read the interview with Dr Hsiao here: http://bit.ly/ze89ea
[8] For statistics on Malaysia's poverty levels, visit these sites: http://bit.ly/wahNEk, http://bit.ly/k4Y3S,
1CARE – SOCIAL HEALTH INSURANCE (SHI)
                                                           PAYING MORE BUT GETTING LESS HEALTHCARE!



SHI SYSTEMS PROVEN: THEY DON'T WORK!                                       CASE MIX / CASE BASED:
The government says our world-renowned health system is                    A very complex method to budget for the number of patients
unsustainable. They claim 1Care's SHI will make healthcare                 needing different types of care. For example, Hospital A has a
cheaper and better. But international studies show that SHI                budget for 3 heart attacks, 7 broken arms, and 5 fevers a
systems don't work! TWO World Bank studies conclude:                       week. If more cases come in, the SHI won't pay for them.

 “ There is no evidence that SHI countries enjoy                           CO-PAYMENT:
                                                                           Even after paying 10% a month for 1Care's SHI, you STILL
better quality health care than countries with tax-                        need to pay when you see the doctor!
           financed health systems ” [9]
                                                                           BENEFITS PACKAGE:
“ SHI systems...more expensive than tax-financed                           A list of what the SHI pays for [12]. No one knows exactly what
                                                                           1Care's package is. But the Ministry's 1Care Concept Paper
  systems, do no better in terms of most health
                                                                           estimates that your 10% deduction is only enough to pay for
          outcomes...may do worse ” [10]                                   about 6 clinic visits a year, or 1 specialist visit a year, or 1
                                                                           hospital stay in 11 years. [12]
It doesn't work because a SHI system is only concerned with
money, not people's lives! This creates many problems.
                                                                           The SHI won't cover the most serious and expensive
                                                                           healthcare needs such as cancer, kidney disease, heart
                                                                           disease and AIDS. [12] You have to pay on your own if you
                                                                           have these diseases. And treatment for any one of these could
                                                                           easily cost well over RM200,000!

                                                                           This is unacceptable, because the government knows:
                                                                           - 25% of the population gets cancer by age 75,
                                                                           - 10% suffer from kidney disease, and
                                                                           - the No.1 Killer in Malaysia is heart disease

                                                                           1Care makes you pay so much yet gives so little in return and
                                                                           abandons you when you need it the most. And the government
                                                                           is doing this on purpose!

                                                                           WILL 1CARE REALLY RATION HEALTHCARE?
                                                                           Yes! Like all insurance, 1Care's main focus is to pay out as
                                                                           little as possible so that money stays in the fund. And 1Care
                                                                           needs a lot of cash to maintain its many, many NEW support
Slide 14: “TOWARDS PUBLIC PRIVATE INTEGRATION: ASPIRATION FOR              organisations and their activities. [12]
1CARE” by Dr. Azilina Abu Bakar, MOH

                                                                           The rakyat will never fully know how much they are being
IT'S ALL ABOUT THE MONEY                                                   denied healthcare. But Dr Rozita Halina Tun Hussein, Deputy
With 1Care, the rakyat pays the SHI. The SHI then pays the                 DG of the Health Ministry, confirms that there will be rationing:
doctors and hospitals when we use their services. The
government says this way, we all get healthcare but don't have
to worry about paying the expensive bills. [11] Not true.

Again, we have to re-look at some of the big words in the slide
above to understand what they really mean.

GLOBAL BUDGET :
It simply means “fixed budget”. Doctors / hospitals are given a
fixed amount, and they can only use that much and no more.
This ALWAYS leads to “rationing” - healthcare providers will
try to give as little service, materials, drugs, etc as possible so
that they won't run out of money.

CAPITATION:
A fixed fee. 1Care pays PHCPs a flat rate for every patient, no
matter what service they give There's no reward for better care            Slide from: “IMPLICIT & EXPLICIT BENEFIT PACKAGE: PROS & CONS”
                                                                           presented by Dr Rozita at the Prince Mahidol Award Conference, Thailand,
or penalty for poor service. So doctors have no incentive to               January 2012. ('Implicit' - only top officials know which services 1Care
improve their care towards their patients.                                 excludes. 'Explicit' - PHCPs know too. But patients won't ever know.)

[9] “SOCIAL HEALTH INSURANCE REEXAMINED” by Adam Wagstaff, Development Research Group, World Bank. http://bit.ly/w8aMoo
[10] “SHI VS. TAX-FINANCED HEALTH SYSTEMS-EVIDENCE FROM THE OECD” by Adam Wagstaff http://bit.ly/wuaQnl
[11] “Better healthcare for all” - 7th para, The Star, 3 DECEMBER 2011 http://bit.ly/wJYVsE
[12] Point No 46 & 55, Annex 6: 1Care Concept Paper, http://taknak1care.weebly.com/1care-documents.html
1CARE – IS IT CONFIRMED OR NOT?



FACTS SPEAK FOR THEMSELVES
This is Dr Rozita's profile printed in the
Prince Mahidol Award Conference 2012
programme book. It clearly states that:

    “ 1Care for 1Malaysia
  has been accepted by the
  Government of Malaysia ”

This is an international conference,
jointly organised by the WHO and World
Bank. It was attended by over seven
hundred senior healthcare policymakers
from around the world.

The government tells the rakyat that
“nothing has been decided” and they
are still “looking at which concept to
adopt.” But they told the whole world
that 1Care has been accepted and
they are working to implement it!

Can we trust ANYTHING they tell us
about 1Care if they can lie to its
citizens so shamelessly like this?

The government thinks we are all
fools who will believe anything!



  HOW CLOSE ARE WE TO COMPLETE PRIVATISATION?
             Policy:                         Privatised:                     Facilitating:                    Facilitating:                  Facilitating:
     The 1991 Privatisation          Selected healthcare services.     Hospital Information System,       Patient’s purchase of        Mandatory private health
                                      Private practitioners allowed     Teleprimary Care and Oral        implants and prosthesis     insurance for foreign workers
      Master Plan officially
                                     to practise in public hospitals    Health Information System       - have shops in hospitals
     listed healthcare to be                                                                          - public providers introduce
                                                                                                          patients to sales reps            Integration:
                                            Outsourced:                      Integration:                                               Locum arrangements -
    1992 - Corporatised:
                                      ICT systems development              Training schools –                                          public doctors in private
    Institut Jantung Negara                                                                                Outsourced:
     (to be privatised with           and support – HMIS, THIS         John Hopkins with Perdana
                                                                                                          Catering services
                                                                                                                                            Facilitating:
                                            Acquisition:                                                                                FOMEMA - mandatory
      1994 - Privatised:
                                      Buying private hospitals –             Outsourced:                                               medical check ups for all
    Government Medical Store.
                                        Sabah and Sarawak                 radiotherapy, urology,
     Pharmaniaga monopolises
                                                                            dialysis, radiology
      manufacture, purchase,




                                                                                         1CARE
   storage and distribution of all                                                                                                             INFO SOURCES:
    drugs and medical products              Outsourced:                                                                               “PUBLIC-PRIVATE INTEGRATION
                                      Transgenic mosquitoes for                                                                         IN HEALTHCARE DELIVERY -
                                           Dengue control                                                                                   PAST AND PRESENT”
                Policy:
                                                                                                                                      Dr Rozita Halina Tun Hussein, MOH
   In 1996, the 7th Malaysia Plan
    stated that “corporatisation                                                                                                       “REVISITING PRIVATISATION IN
     and privatisation of health            Concession:                  Methadone programme
                                       Private build & maintain.                                                                      MALAYSIA: THE IMPORTANCE OF
     facilities and services will                                        - Authorise GPs and later                                       INSTITUTIONAL PROCESS”
                                        MOH rent then transfer           community pharmacists.
                                      ownership to government –                                                                       by Shankaran Nambiar, Malaysian
                                                                       - Govt gives methadone FOC                                       Institute of Economic Research
     1996 - Outsourced:               Women and Child Hospital
                                                                             - patients pay GPs             Integration:
                                                                                                          Training schools –                   http://bit.ly/w54z2A
          clinical waste
          management,                                                                                 John Hopkins with Perdana       “OWNERSHIP AND HEALTHCARE
     facility maintenance,                  Land Swap:                    Semi-privatised:                                                 SERVICES IN MALAYSIA:
        laundry services,             MOH institutions on prized           UMMC, HUKM,                                                       CRITICAL ISSUES”
                                       commercial land, private                                              Privatised:
   biomedical maintenance,                                                Hospital Selayang,                                            by Raja Rasiah, Makmor Tumin,
                                          sector to build new                                          Monitoring of privatised
       janitorial services                                                Hospital Putrajaya                                           Nik Rosnah Abdullah, Uni. Malaya
                                     complexes on private or MOH                                      services and consultancy
                                                                                                                                              http://bit.ly/ydynRC
                                         land – 1NIH research                                            contracted to SIHAT
                                                                                                                                       And various other news sources
1CARE – WHAT WILL HAPPEN WHEN IT STARTS?

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1Care Info Pack

  • 1. 1CARE – FAQs Q: What is 1Care for 1Malaysia? A: 1Care will merge private Q: Do I still have to buy medical insurance? A: 1Care has and public sectors into one system. Everyone pays private very limited coverage, so you need insurance or lots of cash. sector prices. There will be no more government healthcare for the 75% of the rakyat who can't afford the private sector. It will Q: Can I get my money back when I retire or if I never use be a fully privatised, SHI-based system. the system? A: You will never get your money back. Q: What is 1Care's Social Health Insurance (SHI)? Q:What if I am poor? A: If you are a family of four earning A: An insurance scheme that every working adult must buy. below RM500, the government pays the SHI for you. This SHI pays for your healthcare. But international studies show that SHI systems INCREASE costs and do NOTHING to Q: When will this scheme start? A: It already has. 1Care is improve healthcare! currently in Phase 1 & 2 of a 4 phase implementation process. This is confirmed by the Health Ministry's Deputy Director- Q: How much do I have to pay? A: The government General, Datuk Dr Noor Hisham Abdullah. The process is estimates they need 9.5% of your income to maintain 1Care. expected to be completed within the next 2 to 5 years. They are also exploring sliding scale deductions, where the poorer pay less and the richer pay more. So you could be Q: Why do we need this 1Care reform? paying much more than the 9.5%! A: The government claims it can't afford to pay for healthcare. The Health Ministry's 2011-2015 Plan proposes cost-cutting Q: Do employers still provide healthcare benefits? measures to make government hospitals "abandon acute A: The 9.5% is supposed to be shared between employer, care" and "more strictly limit services" to the rakyat. But employee and government. But it's actually ALL paid by you: they willingly give out BILLION-RINGGIT contracts for services that don't improve healthcare! (1) Your portion is deducted from your salary. (2) Government's portion is paid with your tax money (3) Employers will eventually pass the cost back to you THE RAKYAT DEMANDS OUR RIGHTS! Q: What healthcare do I get in return? A: According to the The UN Universal Declaration of Human Rights states: 1Care Concept Paper, your 10% will pay for about 6 clinic visits or 1 specialist visit a year, or 1 hospital stay in 11 years. "everyone has the right to a standard of living And you will STILL need to pay when you see the doctor! adequate for the health and well-being of oneself and one's family, including medical care." Q: What is a Primary Healthcare Providers (PHCP)? A: PHCPs are 1Care-certified GPs. Everyone must register As a signatory to this declaration, the Malaysian with a 1Care PHCP. If you don't like your PHCP, you can pay government must uphold its dignity and not impose any extra to see another one. policy that restricts the rights of the people to affordable and quailty healthcare – either in public ot private sector. Q:Why do I need to register with a PHCP? It is the government's responsibility provide enough A: 1Care tracks your health records through the PHCP. If you quality and affordable healthcare for all the health needs use “too much” of 1Care's healthcare budget, you may get of everyone in Malaysia, without any discrimination. only limited or even no healthcare until a new budget is approved. Unless you pay extra to get your own doctor. A moral and caring government will not force people to choose between disease or financial ruin. Q: What is Gatekeeping? A: You can't go to any hospital or specialist without your PHCP's referral. If you don't like the A moral and caring government would not treat its specialist or hospital he refers you to, 1Care gives you the citizens' health as a commodity to be traded, manipulated “choice” to pay extra to see your own. and negotiated for profit. The rakyat elects governments to protect our interests! Q: How is the PHCP paid? A: 1Care pays PHCPs a flat rate Taxes must be used for the rakyat's benefit, including to for every patient. There's no reward for better care, so doctors provide quality healthcare and other essential services. have no incentive to improve. They also have a fixed budget. If Therefore, the rakyat states clearly: they see too many patients, they won't get paid. So your PHCP may not see you if he's out of budget. You'll have to pay extra to see another doctor. Q: Can I change my doctor? A: Yes, You can apply to the TAK NAK 1CARE! authorities, submit the paperwork, wait for approval, etc. If you Instead, the rakyat demands: don't want the hassle or long waits, you can pay extra to see your own doctor. 1. DE-PRIVATISE PUBLIC HEALTHCARE 2. STOP CORRUPTION, WASTAGES, LEAKAGES Q: Do I have to pay for hospitalisation or surgery? 3. INCREASE FUNDING FOR PUBLIC HEALTHCARE A: 1Care will never fully reveal what they provide. But the 1Care Concept paper shows that if you get serious diseases 4. REGULATE PRIVATE HEALTHCARE CHARGES like cancer, heart or kidney disease – you pay your own. Other 5. MAINTAIN THE PRESENT 2-TIER SYSTEM needs are subject to 1Care's budget limitations.
  • 2. 1CARE – WHAT IT'S REALLY ABOUT According the the Ministry of Health: Clearly, the objectives of 1Care “reforms” are already being met by the healthcare system we have now. And many of the problems in our healthcare system can be easily solved without a total revamp. So why is government so very keen to implement 1Care “reforms”? PRIVATISATION AND PROFITS These slides are from a January 2009 presentation by the Ministry of Health entitled: “FUTURE OF HEALTH CARE FINANCING IN MALAYSIA” by Dr Abd Rahim Mohamad, MOH Planning & Development Division. In the first 20 slides, Dr Abd Rahim lists the problems with Malaysia's healthcare system. Then he presents two reform options – introduce a NHI [2] and more privatisation, or improve the current system: Slide 27 from presentation: “MALAYSIAN HEALTHCARE SYSTEM TOWARDS ACHIEVING BETTER HEALTHCARE FOR MALAYSIA” by Dr. Abd. Rahim bin Mohamad, MOH Planning and Development Division. Briefing given in Putrajaya, 28 September 2010 BIG WORDS DISGUISE THE REAL INTENTIONS The government uses nice-sounding words to give people a positive impression of 1Care, but the meaning of the words could be very different from what most people think. Here are the real meanings of some words we need to remember when discussing 1Care: INTEGRATE: 1Care will merge private and public healthcare sectors to create a single system. All government facilities will function like independent “private entities” [1] and charge private sector Slide 22: “FUTURE OF HEALTHCARE FINANCING IN MALAYSIA” rates. 1Care will completely privatise healthcare. - Dr Abd Rahim bin Mohamad, 18 January 2009 UNIVERSAL COVERAGE: The concept of EVERYBODY being able to get ALL the A right-thinking person would have chosen the second option. healthcare they need. Malaysia already has universal It is more efficient and costs less for the rakyat. But in the next coverage. The government uses taxes to provide all levels of slide, Dr Abd Rahim proposes the FIRST option: healthcare and has clinics and hospitals everywhere. Malaysia also has a thriving private healthcare sector for people who don't want to use government services. SOLIDARITY AND EQUITY: The concept where the richer pays to support the poorer to get equal quality of healthcare. Malaysia already has equity because 10% of the population pays taxes to make public healthcare available for the other 90% who are too poor to pay taxes. Most richer citizens also use private healthcare so that the poorer can use public healthcare. CHOICE OF QUALITY: Malaysians already have choice – people can choose the more expensive private sector with shorter waiting times and better environment, or the cheaper public sector with better expertise and facilities. Slide 23: “FUTURE OF HEALTHCARE FINANCING IN MALAYSIA” - Dr Abd Rahim bin Mohamad, 18 January 2009 [1] A Malaysian Pharmaceutical Society (MPS) report quotes a “Dr Nordin” from the MOH as saying “the current Govt Hospitals and Health Clinics will be given autonomy and will operate like private entities”. This was during a briefing about 1Care to MPS by senior MOH officials held on 15th Jan 2012. View the report here: http://on.fb.me/wD0utH [2] NHI: National Health Insurance, another name for Social Healthcare Insurance (SHI), a compulsory nationwide medical insurance scheme
  • 3. 1CARE – PRIVATISATION IN DISGUISE Behind all the big words and macro economic mumbo-jumbo, WHO BENEFITS MOST FROM 1CARE? 1Care is really just about money – a lot of money. The Economic Transformation Programme (ETP) report [4] enthusiastically promotes "health as an economic The government has been trying to privatise healthcare ever commodity". The report declares Malaysia should make: since Dr Mahathir's time. In 1991, the Privatisation Master “ healthcare as an engine of Plan officially listed healthcare to be privatised. In 1996, the 7th Malaysia Plan stated “privatisation of health facilities and services will also be an important aspect”. Since then, many segments of public healthcare have been privatised. economic growth ” Just a few examples of government privatisation: 1992: Institut Jantung Negara corporatised (due to be privatised with impending Sime Darby buy over) 1994: The Government Medical Store is privatised. Now, Pharmaniaga monopolises manufacturing, purchasing, storage and distribution of all drugs and medical products. Prices went up 3.3 times. 1996: Hospital support services privatised to three UMNO- linked companies. Costs rose from RM143 mil in 1996 to over RM1 bil in 2009 2011: Radiology services in public hospitals privatised FINISHING THE JOB 1Care will be the final piece in the process to completely privatise Malaysia's public healthcare system. According to a MOH briefing to the Malaysian Pharmaceutical Society, “Govt Hospitals and Health Clinics will be given autonomy and will operate like private entities” and “1 Care transformation The ETP report calls for the government to “use its proposals are now in the final stages.” [3] infrastructure capabilities, domestic consumption base and diverse population to create an economic growth agenda for healthcare.” (In other words, the government should use its facilities to make money from the rakyat.) The ETP report also identifies medical tourism as an “attractive sector” and explains that “with 1.9 beds per thousand and 0.8 doctors per thousand as of 2008, Malaysia has a solid foundation to build on.” (pg 557) These numbers include both private and government doctors / hospitals! So with 1Care, the government is positioning themselves to reap huge profits from the health tourism boom, together with the private sector. Meanwhile, the rakyat is forced to subsidise the government's business through a compulsory SHI [5]! As if this is not bad enough, the ETP further proposes that Slide 48: “MALAYSIAN HEALTHCARE SYSTEM TOWARDS ACHIEVING Malaysia should be internationally promoted as a “R&D and BETTER HEALTHCARE FOR MALAYSIA” - Dr Abd Rahim bin Mohamad clinical trial destination for the pharmaceutical and med tech industries” as our country has a “high incidence of As this slide shows, the government wants to liberalise, lifestyle diseases”. then capitalise on the lucrative healthcare industry. 1Care “reforms” will make this possible. Merging the public and The government is not only forcing the rakyat to subsidise their private sectors lets the government charge private sector fees. healthcare business, they will also offer the rakyat up to be 1Care also guarantees the government a captive market of the world's lab rats! full-paying patients, because the entire population must be registered under 1Care. [3] MPS report on MOH Seminar on 1Care Health Transformation held on 15th Jan 2012, http://on.fb.me/wD0utH [4] You can view the ETP Healthcare Report (Chapter 16) from here: http://scr.bi/w2deN2 (the ETP has removed it from its own website) [5] SHI: Social Health Insurance. 1Care forces everyone by law to pay up to 9.5% of their monthly income for a compulsory insurance
  • 4. 1CARE – HOW DOES IT WORK? 1. INTEGRATION: 1Care will merge the private and public healthcare sectors. There will be no more government subsidised system. All healthcare services will charge private sector prices. This will leave the 75% of the rakyat who depend on public healthcare with inadequate healthcare. Slide 33: “MALAYSIAN HEALTHCARE SYSTEM TOWARDS ACHIEVING BETTER HEALTHCARE FOR MALAYSIA” - Dr. Abd. Rahim bin Mohamad 2. PHCPs – DOCTOR JAGA PINTU All GPs will have to register as 1Care Primary Healthcare Providers (PHCP). But their Medical Degrees won't be good enough. They must go for additional 1Care training. PHCPs Slide 19 from presentation entitled “TOWARDS PUBLIC PRIVATE will also not be allowed to dispense medicines. You will have to INTEGRATION: ASPIRATION FOR 1CARE” by Dr. Azilina Abu Bakar, MOH get it from a pharmacy after you see your doctor. National Health Financing Planning and Development Division Some other important issues about PHCPs are: To disguise the high costs of 1Care's privatised system, the government will force everyone to buy a compulsory Social REGISTERING PATIENTS: Health Insurance (SHI). The government says that you don't Everybody must register with a 1Care PHCP. If you don't like need to pay to see a doctor if you have this 1Care SHI. this doctor, you can pay extra to see another one. If you want a second opinion, you also pay extra. But your SHI premiums This is a big lie because the rakyat are forced to pay up to will not be reduced or refunded. 9.5% of their income every month for this SHI. And as this MOH slide proves, 1Care's SHI only covers some services. Registration also lets 1Care track your health records. If you Anything more, you pay out of your own pocket. use “too much” of their healthcare budget, you may be limited or denied healthcare in future. Unless you pay extra. GATEKEEPING: 1Care PHCPs will act as Gatekeepers - no one goes to a hospital or a specialist without their PHCP's referral. For example, you cannot simply see your own gynae or pediatrician anymore. You must first see your PHCP. If he thinks you need a specialist, he will refer you to one that HE is registered with. If you don't like that specialist, you have a “choice” of paying extra to see your own. PREVENT DISEASE: 1Care PHCPs have to ensure their patients stay healthy. This is because 1Care limits how many patients can be referred to specialists / hospitals. If too many patients are referred, 1Care Slide 9: “1CARE FOR 1MALAYSIA: PRIMARY HEALTHCARE” by Dr Safurah Jaafar, Director, Family Health Development Division, MOH. may penalise the PHCP. 1Care may also put you on a waiting list until its budget allows you to go to a specialist / hospital. If you can't wait, you can pay extra to get immediate service. 1Care also DOESN'T pay for cases where your disease is so serious that you need very expensive long term treatment or CLAIMS: very expensive immediate treatment. 1Care expects you to PHCPs earn by claiming money from the SHI for patients they have your own cash or insurance for that. see. But they are given a fixed budget. So they can't see “too many” patients or they won't get paid. They may even be But all the SHI premiums that you have paid in your entire penalised. So your PHCP may not see you if he's out of lifetime will NOT be refunded to you. Ever. budget. You'll have to pay extra to see another doctor. NOTE: All these points are contained in the 1Care Concept Paper. You can read it at: http://taknak1care.weebly.com/1care-documents.html
  • 5. 1CARE – SOCIAL HEALTH INSURANCE (SHI) HOW MUCH, WHO PAYS AND WHO DOESN'T? [6] IS THE 10% PAY DEDUCTION TRUE? The government strongly denies these figures are real. They insist that they put some meaningless numbers in their proposal to the Prime Minister. But we can calculate how the Ministry got their figures, based on official government statistics. RM44.23b (total health expenditure) divide by 28.3m M'sians = RM1,562 RM972 (annual SHI per person) multiply 4.3 people per household = RM4181.50 We can also see that the Ministry's 9.5% estimate is the average amount needed to sustain 1Care - based on 2009 conditions. This will increase. According to Dr Hsiao (Harvard economist and 1Care consultant), “In every country, health care costs are increasing faster than wages. When that happens, the premium has to go up.” Table from the 2009 1Care Concept Paper [6] showing the Health Ministry's estimate of The Ministry is also exploring sliding scale how much the new 1Care system will cost the rakyat. deductions, where the poorer pay less and the richer pay more. So you could end up paying much more than the proposed 9.5%! WHO REALLY PAYS THE 10%? WHO DOES THE GOVERNMENT PAY FOR? The government insists that the rakyat doesn't pay the whole 10%. It's supposed to be shared between the employee, employer and government. They are only telling you half a lie. The truth is that the 10% is ALL paid by you. How? 1. Your portion is deducted from your salary. 2. Government's portion is paid with your tax money 3. Employers pay their portion, but will eventually pass the cost back to you quietly This last point is confirmed by Dr William Hsiao, who is helping the MOH develop the 1Care implementation plan. 2009 1Care Concept Paper shows those who don't need to pay for the SHI. “ the burden of (SHI) on The government says they will take care of the poor by paying employers was actually for their SHI. Who are these “poor” people? The PM says families that earn RM3000 a month find it hard to make ends borne by employees ” meet. This is about 60-70% of the population (about 17-20 million people). But this table shows the government pays for only 187,172 Dr William Hsiao poor people (0.7% of the population). These are only the hardcore poor – defined as a family of four who earns less In one of his consultant reports, Dr Hsiao explained that, than RM500 a month! [8] So if a family of four earns only “(SHI payments) imposed on employers were passed back RM501/month, they have to to pay the 10%! to employees over time in the form of lower wages or lower pensions and other fringe benefits.” Hsiao says, “In This table also shows that the largest group that the other words, the burden of payroll tax on employers was government pays for are not poor or needy cases at all! actually borne by employees.” [7] [6] All these points are contained in the 1Care Concept Paper. You can read it at: http://taknak1care.weebly.com/1care-documents.html [7] You can read the interview with Dr Hsiao here: http://bit.ly/ze89ea [8] For statistics on Malaysia's poverty levels, visit these sites: http://bit.ly/wahNEk, http://bit.ly/k4Y3S,
  • 6. 1CARE – SOCIAL HEALTH INSURANCE (SHI) PAYING MORE BUT GETTING LESS HEALTHCARE! SHI SYSTEMS PROVEN: THEY DON'T WORK! CASE MIX / CASE BASED: The government says our world-renowned health system is A very complex method to budget for the number of patients unsustainable. They claim 1Care's SHI will make healthcare needing different types of care. For example, Hospital A has a cheaper and better. But international studies show that SHI budget for 3 heart attacks, 7 broken arms, and 5 fevers a systems don't work! TWO World Bank studies conclude: week. If more cases come in, the SHI won't pay for them. “ There is no evidence that SHI countries enjoy CO-PAYMENT: Even after paying 10% a month for 1Care's SHI, you STILL better quality health care than countries with tax- need to pay when you see the doctor! financed health systems ” [9] BENEFITS PACKAGE: “ SHI systems...more expensive than tax-financed A list of what the SHI pays for [12]. No one knows exactly what 1Care's package is. But the Ministry's 1Care Concept Paper systems, do no better in terms of most health estimates that your 10% deduction is only enough to pay for outcomes...may do worse ” [10] about 6 clinic visits a year, or 1 specialist visit a year, or 1 hospital stay in 11 years. [12] It doesn't work because a SHI system is only concerned with money, not people's lives! This creates many problems. The SHI won't cover the most serious and expensive healthcare needs such as cancer, kidney disease, heart disease and AIDS. [12] You have to pay on your own if you have these diseases. And treatment for any one of these could easily cost well over RM200,000! This is unacceptable, because the government knows: - 25% of the population gets cancer by age 75, - 10% suffer from kidney disease, and - the No.1 Killer in Malaysia is heart disease 1Care makes you pay so much yet gives so little in return and abandons you when you need it the most. And the government is doing this on purpose! WILL 1CARE REALLY RATION HEALTHCARE? Yes! Like all insurance, 1Care's main focus is to pay out as little as possible so that money stays in the fund. And 1Care needs a lot of cash to maintain its many, many NEW support Slide 14: “TOWARDS PUBLIC PRIVATE INTEGRATION: ASPIRATION FOR organisations and their activities. [12] 1CARE” by Dr. Azilina Abu Bakar, MOH The rakyat will never fully know how much they are being IT'S ALL ABOUT THE MONEY denied healthcare. But Dr Rozita Halina Tun Hussein, Deputy With 1Care, the rakyat pays the SHI. The SHI then pays the DG of the Health Ministry, confirms that there will be rationing: doctors and hospitals when we use their services. The government says this way, we all get healthcare but don't have to worry about paying the expensive bills. [11] Not true. Again, we have to re-look at some of the big words in the slide above to understand what they really mean. GLOBAL BUDGET : It simply means “fixed budget”. Doctors / hospitals are given a fixed amount, and they can only use that much and no more. This ALWAYS leads to “rationing” - healthcare providers will try to give as little service, materials, drugs, etc as possible so that they won't run out of money. CAPITATION: A fixed fee. 1Care pays PHCPs a flat rate for every patient, no matter what service they give There's no reward for better care Slide from: “IMPLICIT & EXPLICIT BENEFIT PACKAGE: PROS & CONS” presented by Dr Rozita at the Prince Mahidol Award Conference, Thailand, or penalty for poor service. So doctors have no incentive to January 2012. ('Implicit' - only top officials know which services 1Care improve their care towards their patients. excludes. 'Explicit' - PHCPs know too. But patients won't ever know.) [9] “SOCIAL HEALTH INSURANCE REEXAMINED” by Adam Wagstaff, Development Research Group, World Bank. http://bit.ly/w8aMoo [10] “SHI VS. TAX-FINANCED HEALTH SYSTEMS-EVIDENCE FROM THE OECD” by Adam Wagstaff http://bit.ly/wuaQnl [11] “Better healthcare for all” - 7th para, The Star, 3 DECEMBER 2011 http://bit.ly/wJYVsE [12] Point No 46 & 55, Annex 6: 1Care Concept Paper, http://taknak1care.weebly.com/1care-documents.html
  • 7. 1CARE – IS IT CONFIRMED OR NOT? FACTS SPEAK FOR THEMSELVES This is Dr Rozita's profile printed in the Prince Mahidol Award Conference 2012 programme book. It clearly states that: “ 1Care for 1Malaysia has been accepted by the Government of Malaysia ” This is an international conference, jointly organised by the WHO and World Bank. It was attended by over seven hundred senior healthcare policymakers from around the world. The government tells the rakyat that “nothing has been decided” and they are still “looking at which concept to adopt.” But they told the whole world that 1Care has been accepted and they are working to implement it! Can we trust ANYTHING they tell us about 1Care if they can lie to its citizens so shamelessly like this? The government thinks we are all fools who will believe anything! HOW CLOSE ARE WE TO COMPLETE PRIVATISATION? Policy: Privatised: Facilitating: Facilitating: Facilitating: The 1991 Privatisation Selected healthcare services. Hospital Information System, Patient’s purchase of Mandatory private health Private practitioners allowed Teleprimary Care and Oral implants and prosthesis insurance for foreign workers Master Plan officially to practise in public hospitals Health Information System - have shops in hospitals listed healthcare to be - public providers introduce patients to sales reps Integration: Outsourced: Integration: Locum arrangements - 1992 - Corporatised: ICT systems development Training schools – public doctors in private Institut Jantung Negara Outsourced: (to be privatised with and support – HMIS, THIS John Hopkins with Perdana Catering services Facilitating: Acquisition: FOMEMA - mandatory 1994 - Privatised: Buying private hospitals – Outsourced: medical check ups for all Government Medical Store. Sabah and Sarawak radiotherapy, urology, Pharmaniaga monopolises dialysis, radiology manufacture, purchase, 1CARE storage and distribution of all INFO SOURCES: drugs and medical products Outsourced: “PUBLIC-PRIVATE INTEGRATION Transgenic mosquitoes for IN HEALTHCARE DELIVERY - Dengue control PAST AND PRESENT” Policy: Dr Rozita Halina Tun Hussein, MOH In 1996, the 7th Malaysia Plan stated that “corporatisation “REVISITING PRIVATISATION IN and privatisation of health Concession: Methadone programme Private build & maintain. MALAYSIA: THE IMPORTANCE OF facilities and services will - Authorise GPs and later INSTITUTIONAL PROCESS” MOH rent then transfer community pharmacists. ownership to government – by Shankaran Nambiar, Malaysian - Govt gives methadone FOC Institute of Economic Research 1996 - Outsourced: Women and Child Hospital - patients pay GPs Integration: Training schools – http://bit.ly/w54z2A clinical waste management, John Hopkins with Perdana “OWNERSHIP AND HEALTHCARE facility maintenance, Land Swap: Semi-privatised: SERVICES IN MALAYSIA: laundry services, MOH institutions on prized UMMC, HUKM, CRITICAL ISSUES” commercial land, private Privatised: biomedical maintenance, Hospital Selayang, by Raja Rasiah, Makmor Tumin, sector to build new Monitoring of privatised janitorial services Hospital Putrajaya Nik Rosnah Abdullah, Uni. Malaya complexes on private or MOH services and consultancy http://bit.ly/ydynRC land – 1NIH research contracted to SIHAT And various other news sources
  • 8. 1CARE – WHAT WILL HAPPEN WHEN IT STARTS?