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Salient points – 1Care

By DrNGSC

  1. The government plans to introduce a new healthcare system called 1-Care. It includes an insurance system to fund for healthcare.
     

  2. The National Healthcare Financing Authority will be in charge of 1Care – and it is likely to be turned into a GLC.
     

  3. Based on available information, every household will be made to pay up to 9.4% of gross household income for social health insurance. The payers will be the individual, the employer and the government via taxes, exact proportion still being worked out)
     

  4. There shall be no choice. Everyone has to pay. There is no opting out. We have to pay upfront. It will no longer be fee-for-service; it is fee-before- service.
     

  5. There has been no information on exactly how this payment will have to be made or how the government will collect from self-employed people.
     

  6. The government will be expected to contribute to the insurance premiums of government pensioners, civil servants and five dependants.
     

  7. But the problem is: 1Care does not cover all your medical expenses. Only for a prescribed basic list of what “you can have” healthcare items. Anything more than basic you will have to pay your own.
     

  8. Your long-serving independent family doctor will have to join the system or will not be allowed to see you under the 1Care scheme. The robust, cost- effective independent clinics serving the country will be replaced by 1Care clinics.

  9. You cannot pick your own doctor. 1Care will allocate a doctor to you.
     

  10. If you want to see a doctor of your choice, you’ll need to pay for that from your own pocket. Your allocated doctor will decide when and which specialist you can see if the need arises (a process called gate-keeping).
     

  11. The NHFA will pay GPs RM60 (present proposal) for each patient as consultation fees. It does not include medicine. Compare this with presently, for cough and cold visit, the GP would charge RM20-RM30 for consultation and medicine. With 1Care: consultation for GP visit is RM60 and this does not include medicine.

  12. You cannot see your doctor as and when you feel the need arises. There will be a rationing system in place as well. There will also be rationing for specialist care with the GP as the gate-keeper. Likewise if you wish to see the specialist of your choice or go to a hospital of your choice, unless referred by your allocated doctor, you will also have to pay out of your pocket. 
     

  13. Even if you only see the doctor once in a year, you will not get a refund from 1Care. Your medical costs are prepaid in advance irrespective of whether you become sick or not.
    You are also expected to make an additional co-payment for your visit. This is to discourage you from seeing doctors too often.
     

  14. You will be prescribed only medicines from a standardised list of not-the- original medicines in keeping with WHO List of essential Medications.. This will save cost for 1Care and maximise profit for the insurance companies. Insurance companies will have major say in the price and the range of this standardise medicine list. It will likely to be the cheapest medicine.
     

  15. The doctor will only give you injections. You’ll need to get all other medicines from a pharmacist, even if it means hauling three sick children with high fever along a hot, dusty busy street looking for the nearest pharmacy.
     

  16. If you do not like what is given to you, you can get alternative care by paying out of your own pocket. 
     

The Big Picture 

  • Each year, we all pay a total of RM44.24 billion a year for healthcare – now called National Healthcare Hospitals and clinics ( an integration of public hospitals and clinics, private hospitals and private GPs. which in essence is a privatisation of public and nationalisation of private healthcare facilities)

  • All this will now go under 1Care.

  • This means 1Care will get almost RM45 billion a year.

  • The administrative cost is likely to be 10% or about RM 4.5 billion

The poor
Who will then care for the poor and the marginalised population when the private and public healthcare corporatize and turned into independent commercial entities each competing with the other for business and profits?

  • Public hospitals and clinics are service-driven will become corporatize/privatise and have to be profit-driven

  • So who will serve the people in remote places?

  • Who will serve the very poor people?

Situations

What happens when the government introduces 1Care?
 
The whole system of independent one-stop GPs will be restructured and converted into 1Care clinics like the UK NHS general practitioner system.
 
Before:  
Ali has always having skin rashes for many years. He has to see his doctor once a month to get treatment. That would mean he will have to see his doctor 12 times a year just for this illness. What if he has other illnesses?
 
Now:  
But now, Ali’s doctor has allocated only a budget equivalent to six visits a year. Regardless of how many time Ali would need for his yearly treatment. What happens then? A rationing system will kick in. If the doctor sees Ali too many time, his “P4P” (Pay for Performance) profile will be poor and he will be paid less.
 
To start with, Ali will probably cannot just walk in and expect to be treated. He will have to make an appointment. There will be a long waiting list. What if Ali needs to be treated for fever or some painful joints? He will also have to wait for his appointment. If he cannot wait and wants immediate treatment from another doctor he will have to pay on his own. This is what the NHS UK system is offering its patients.
 
Lim has an appointment to see his doctor over a knee ache. Just before his appointment, he has an ingrown toe nail that has become painful. At the clinic, after his doctor treats him for his knee ache, he asks his doctor if he could look into his ingrown nail. His doctor says “No, the system does not allow me to do that. You must make another appointment. This visit I can only treat and bill for your knee ache. 1Care will accuse me of over-servicing my patients. I have no discretion here, all is by SOPs” This is what the NHS UK system is like today. 
 
Mutu lives in a remote rubber estate. One day he had chest pain and went to the nearby 1Care clinic..He has blood pressure problems since young and has had fits. A hospital assistant saw him. Because of a change of his medications to the cheapest not-the-original medications, his blood pressure went out of control and his seizures returned. He developed a fatal stroke and died This is already what is happening when essential original medications are replaced with the cheapest .The cheapest medications is not necessarily the best for the patient and certainly not the safest.
 
 Every salary man must get a 5-9% deduction from his salary to fund this scheme. This money is taken and gone for good even if you don’t see a doctor.

13 Replies to “Salient points – 1Care”

  1. Inviting all friends for change

    ” Selangor / KL Healthcare Public Forum”
    Why pay more for less?

    Do you want
    More taxes, less care
    More cost, less choice
    More restriction, less freedom

    TAK NAK. TAK NAK

    Come join us on 12th Feb. 2012 4-6pm, at Global Business and convention center, PJ section 19.

    We need to change the tenant at Putrajaya. GE 13 is coming soon, is our best chance. Failure is not an option. We must succeed. Please let us all get out of our comfort zone and work very very hard. Time for change.

  3. ///You cannot pick your own doctor. 1Care will allocate a doctor to you.///–the author

    The administrative cost for doing that will cost a quarter of the budget. 1-care will employ more ‘civil servants’ that the current Health Ministry.

    If the citizens are required to pay ‘insurance tax’ to buy basic health care, isn’t it more cost effective for them to purchase it directly from insurance company. There will be no need for the overhead cost to match patient to doctor.

    The government should have a 1-health insurance scheme for those who either have no income with proof, or those who are happy to join. Government hospitals will then entertain only those who have 1-health insurance for free medical services. Others will have to pay for treatment in government hospital, at a reasonable rate compared to private clinics.

    But 1-care is motivated for the creation of a GLC. It is using government regulation to force citizens to pay into their pockets.

  4. The government has been stringing the people along all these
    decades by declaring that healthcare will not be privatised.
    Looks like this is PRIVATIZATION!
    Plain and simple.
    This is another of those 1this and 1that scam.
    So, we all know who will be the real beneficiaries!!!
    Looks like every scam is being worked to milk the people BEFORE
    their downfall.
    So, spread the word to all and sundry, especially those in the
    hinterland as well as Sabah & Sarawak that a new tenant MUST take
    over in Putrajaya.
    No ifs and no buts!!!
    And all the scams perpetrated on the people must be reversed
    immediately a new government is formed.

  5. ///The whole system of independent one-stop GPs will be restructured and converted into 1Care clinics like the UK NHS general practitioner system.///–the author

    The UK government collects only 1% of the taxable income for NHS. The suggestion of 5-9% of salary equals 15-20 times that collected for NHS in UK.

    That indicates that health cost of 1-care in Malaysia would be 10 times more expensive than the UK based on purchasing power, and it means that with 1-care the people will have less to spend for nutritional meals to maintain their health.

    The government should just stick to its old ways of providing health services rather than making people less healthy with less disposable income. Only Malaysian government allows plans to create tycoons at the expense of the citizens. People who chose to misuse their power to make life miserable for millions of the citizens are not fit to live.

  6. Then what is the meaning of morals and ethics ? It will be something like if you pay RM 100, you can this package of treatment for your headache. If you pay RM 1000, you can another package of treatment for the same headache. Instead of do no harm, it will be do harm. Hippocrates will be turning and tossing in his grave. No doubt medicine is expensive. But there should be some leeway for conscientious care. If the day should come when we have to pay for government’s health care, then NGOs should come in. Traditional treatment should be legalised and should be made into an education component so that whoever who study this kind of treatment will be legalised to practise openly. Afterall, our ancestors went to see this traditional doctors and got healed long before there are any western treatment. Traditional treatment is more varied than western treatment. At least the patient can have second opinions.

  9. In government hospitals and clinics, now you are seen by Dr 1. The next second you are seen by Dr 2. You don’t have any choice. If you know the Dr, you know who to pick. If you don’t know, be prepared to be a guinea pig. Not much different with we will allocate a doctor for you. Doctors should go private. That way they will give the best treatment in order to secure their business and their patients are happy paying the doctor they know will give them what they want. Actually it is just a vicious same cycle.

  10. They care only how to fill their pockets with our money only.
    This scheme is one way to steal billions from Malaysians without Malaysians knowing that.
    It’s a “People First” care scheme….” I help you….you help me”

  12. Personally said, i dont agree with this 1care plan but i need to brief the public something about the so call not original medication. First of all, this not original medication is actually call generic medicine. However it is not to said it not genuine medications. It is the same in term of of the active ingredients and it work the same as the original. So it is suppose to work the same as the original with at least 90% bioequivalent. There is no wrong in changing from original to generic medication as it can help to reduce the health budget and also the burden of the patient as well. A developed county like Australia also promoting the use of generic medication so it is wise to do so. There are too many irresponsible people had been abusing our health care system by requesting all original medication without any strong reasons. So please dont miss use the term “not original medication”. However I still against this 1care scheme personally.

  13. The question we should ask is why does the government propose to create 1-care?

    1. Is it to save government funds, or reduce expenditure on health services. If so, is it because the government cannot afford it?

    If affordability is the question has the government consider other solutions?

    (a) Should not the government cut down on other non-health expenditures? It can reduce the number of overseas scholarships given to undergraduates. That saves at least a billion ringgit a year.

    (b) It can reduce military equipment purchase, the six patrol boats are not needed. That saves nine billion ringgit.

    (c) It can sell APs on tender. That will take in a billion ringgit a year. Only some cronies from Mamak days would stop becoming richer by the day.

    (d) Government hospitals might charge their patients who are able to pay at a rate lower than private hospitals.

    2. Is it to improve on health services?

    By all means make studies on how the current system can be improved. Taiwan is said to have a model better than USA which is based mainly on insurance scheme. But Americans are against mandatory participation in health insurance scheme of the so-called Obama care towards which 1-Care is approaching.

    3. 1-Care is said to follow NHS. Does the government consider NHS superior to the current health services system in the country? In NHS, the patients are not assigned doctors; the patients have a right to choose doctor. NHS covered all sickness unlike the proposed 1-care. Private doctors do not receive fees from NHS; the patients pay. NHS is entirely financed by the government, possibly supplemented by funds collected from the 1% taxable income paid towards national insurance; it is a direct tax. But 1-care talks about collecting 5-9 % gross income.

    4. If 1-care models after NHS why are the details so different?

    5. 1-care serves to create a GLC and it benefits only those in position to enrich themselves. Well, 1-care would create 10% employment for non-health related activities, and cost the government or the persons who pay health insurance that much more. 1-Care utilizes the brand name NHS but it produce a different animal.

    6. 1-care is piratization!

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