by Dr Jeyakumar Devaraj
Aliran Monthly Vol 24 (2004): Issue 11/12

	Looks like the struggle against the neo-liberal agenda might have to start with the defence of the public healthcare system. We need to mobilize! Dr Jeyakumar Devaraj

In his briefing to the press on 23/12/04, after receiving the memorandum endorsed by 81 organisations calling upon the government not to privatize the dispensaries in Government hospitals, Datuk Dr Chua Soi Lek stressed that there was no real issue. According to Dr Chua, the whole event was orchestrated by opposition parties for political mileage. The Malaysian healthcare system is one of the best in existence, and the BN government has been doing a good job managing the health care sector.

The two-tier healthcare system

The fact that out-patients only need to pay RM 1 to register and get treatment should not blind us to the fact that the BN's mismanagement of the health care sector over the past 25 years has led to the de facto existence of a 2-tier system in Malaysia. Maybe a concrete example will help!

Let's take the case of a 40-year-old Ipoh resident who has just suffered a heart attack. If he is a government servant or the spouse of one, then he will be referred to the IJN or to University Hospital within a month where he will be assessed, put up for angiography and further treatment if that is found necessary, and all this will be for free – the government will pick up the bill.

If he is not a government servant, but has an income in excess of RM10,000 a month, or a comprehensive health insurance cover, he has the option of seeing one of the 4 interventional cardiologists in the private sector in Ipoh where the going rate for coronary angiography is RM4000, angio-plasty is RM8000, angioplasty with stenting is about RM15,000, and by-pass surgery is in the region of RM30,000.

However the majority of people in Perak are not government servants, and do not earn in excess of RM10,000 per month. The percentage with comprehensive health insurance cover is small – and don’t forget these policies are not cheap. So what happens to these patients? Ten years ago we could send them to the Cardiology units in GH-KL, University Hospital or in UKM. However in the interim some idiot has corporatised all these institutions, so these avenues are closed to the non-government servant.

At present the only avenue for a recent heart attack patient who is not wealthy nor a government servant is the Cardiology Unit at the Penang GH. Unfortunately this is the only cardiology center in the government sector for the whole of north Malaya, and they are inundated with many genuine cases. The doctors there work valiantly, but they are grossly overloaded. I called last week to try and get an appointment for a patient who in my opinion needed an early assessment – within 10 days I would have thought. I was told that the earliest appointment would be June 2005! And this is just for checking, not any intervention!

The evolution of a two-tier healthcare system

The Malaysian healthcare system that was built up in the first 20 years after Merdeka was quite equitable. Patients, even the poorest, had the chance of being seen by the senior specialists if their condition warranted it – at that time almost all the specialists were in government service.

However, the Thatcherite revolution in the West found a strong adherent in Dr Mahathir who, with his policies of “Malaysia Incorporated” and “Public – Private Partnership”, allowed the widespread development of private hospitals. These private hospitals led to a massive brain-drain from the public sector, for incomes for private specialists were five to ten times higher than those of government sector specialists. Over 20 years, this had led to a situation where 75 per cent of the specialists in the country are in the private sector catering to about the 25 per cent of the in-patient population. (Up till now 75 per cent of all admissions are still to government hospitals) Meanwhile the heavy work-loads in the government hospitals – the 75 per cent of the inpatient population as well as the training of house-officers, other junior doctor and aspiring specialists is shouldered by 25 per cent of specialists in the country. (What a pathetic deployment of skilled manpower!)

This situation has been made even worse with the corporatisation of the Cardiology Department of GH KL as the current IJN as well as the corporatisation of the University Hospitals which have a high concentration of government sector specialists.

A lack of honesty and insight

In the course of his discussion with us, Dr Chua kept saying – “do not bring that up, it was before my time. I am only responsible for what has taken place since March 2004.” What a cop-out! It is the BN government’s management of the health care system that has led to the present 2-tier system, and civil society has more than adequate reasons to view any further manipulations of the healthcare sector with suspicion and trepidation – given the BN’s track record!

Incidentally, the deterioration of the health care system to a 2-tier system is not the only problem with our healthcare system. The other major problem is the series of privatization exercises that have led to inflated costs and bulging coffers for the lucky corporations involved – but we will not go into that for now.

Anyone who does counselling will tell you – the most important factor for a successful outcome is the client’s acceptance that something is wrong, and that solutions need be found. Our exposure to the honourable Minister on 23 Dec gave us the disturbing feeling that the BN leadership remains quite oblivious to the amount of damage it has wrought upon the healthcare system in this country, and appears intent on inflicting more of the same in the near future.

Looks like the struggle against the neo-liberal agenda might have to start with the defence of the public healthcare system. We need to mobilize!

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Dr Jeyakumar Devaraj is a Central Committee Member of Parti Sosialis Malaysia and an Aliran member.

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