Should Malaysia’s RM11 billion health service be privatized?

by YELVERTON

And so the Aussies have ventured to set right our stone-aged health care system to see if we can kill less people. Looks like Malaysians cannot do anything right for themselves these days. Certainly any proposal has to be better then anything our clueless Ministry of Health officials can come up with but unfortunately the Aussies have failed to emphasize on one main factor… who holds the money? And is the MOH, currently so inefficient that ambulances run out of petrol midway to an accident scene, willing to take their fingers off the pies of equipment purchases, bloated IT budgets and crumbling hospital buildings.

When Thatcher ruled and decided the NHS needs new directions she became hopelessly unpopular to the glee of Labour. But Blair didn’t do a good job either. He stuffed down doctor’s throats MMC’s (Modernizing Medical Careers) without their consent not unlike Malaysia’s notorious Private Healthcare, Facilities and Services Act immediately alienating doctors provoking them to march in mass protests in London and Glasgow in March this year. This was followed by the resignations of Professor Alan Crockard as national director of Modernizing Medical Careers, Alex Liakos as adviser to the MMC and Professor Shelley Heard as MMC National Clinical Advisor prompting the Health Secretary Patricia Hewitt to apologize both in public and parliament.

The BMA (British Medical Association) unlike our muted MMA (Malaysian Medical Association) rightly pointed out that apologies were not enough as the entire training system has been put into jeopardy as changes have clearly not been thought through, throwing the futures of doctors and consequently healthcare into disarray. Till this day if you walk into any NHS hospital you will find notices advising doctors not to cooperate in the MMC. This move has also seen British doctors flying off to Australia and New Zealand for a “better rounded training”. Clearly Labour had forgotten the guile of Aneurin Bevan, the Guru who was instrumental in the successful initial implementation of the NHS.

Today the NHS is a shadow of Clement Attlee’s Labour government’s creation following the aftermath of World War 2. When William Beveridge floated this principle of a “cradle to grave” philosophy in 1948, the idea was if full employment can be ensured in Britain, then the cumulative taxation collected could help fund the NHS. Health was deemed a social need not to be compromised and in tandem with Britain’s inert principles of being a caring society. However Attlee soon ran into serious trouble when funding from the US stopped after Japan was defeated. But Attlee had an advantage in Aneurin Bevan, his newly appointed Health Minister. Bevan quickly analyzed that he has to first win the doctors over to his side for he reasoned correctly that without doctors, there would be no health service. He offered consultants lucrative payment structures and later stated, “I stuffed their mouths with gold.”

Britain at that time was like Malaysia today. Millions who could not afford private healthcare had to put up with third rate services at state run hospitals. Now, every single person had access to quality health care that is financed through progressive taxation. Till this day, Labour considers the creation of the National Health Service its proudest achievement. Thatcher introduced General Managers into the system and her government subsequently defined the populace as an “internal market”. Health Authorities ceased to run hospitals but “purchased” care and services. GPs became “fund holders” and were able to purchase care for their patients. The “providers” were termed independent trusts.

Despite Blair’s promise to reverse Thatcher’s “privatization” of the NHS, he in fact with Gordon Brown, strengthened it. It suddenly dawned on Labour that healthcare was not cheap. This included the rising costs of medical technology and medicines, the desire to increase standards and an ageing population. Instead they renamed their reforms with terminologies such as detailed service standards, strict financial budgeting, revised job specifications, practice-based commissioning (fundholding again in reality), closure of surplus facilities and emphasis on rigorous clinical and corporate governance including restructuring medical training.

Furthermore Blair’s Government, whilst leaving services free at point of use, has encouraged outsourcing of medical services and support to the private sector. Under the Private Finance Initiative, an increasing number of hospitals have been built by private sector consortia. But Blair and Brown failed to see Bevan’s logic as to what happens to doctors if the system is privatised. The most famously quoted study is the one by a consultancy company which works for the Department of Health that showed that for every £200 million spent on a privately financed hospital results in the loss of 1000 doctors and nurses.

Oops… ..the erstwhile creator of one of Britain’s biggest asset and icons has got itself tangled so badly that at last call orders were out by the Labour government that the ultimate and if possible speedy target should be that the trusts or authorities or whatever term you would like them called — should be absolutely independent. Labour doesn’t want its baby anymore. It’s an unbelievable headache. And what of its consequences if you want to be paid. Waiting lists cannot exceed six months. So doctors just post their patients to private hospitals where the same surgeons get them done and get the NHS to pay for it which will lead to… ..you guessed it… hospitals and trusts running a financial deficit and getting into debt.

Government’s, especially in the West, can rise or fall only on the issue of healthcare. So will privatization of the healthcare system work in Malaysia work or will it, like how the British and US governments have discovered, be the beginning of a very slippery road to rising premiums, increasing budget allocations and ultimately insolvency? Should we wait for time to tell or should we just go ahead with the privatization and let the next generation worry about it? Or maybe we should let the government proceed with the privatization and let the electorate decide at the next election.