Former Health DG speaks out

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Former Director-General of Health Tan Sri Dato' Dr Abdul Khalid bin Sahan has spoken out on why the free market does not work for health care. He also touched on some of the negative effects of the rapid growth in the number of private hospitals.

On why the free market does not work for health care:

This is because health care is quite unlike other services:

  • Health care is universally accepted as a basic right of all citizens. Everyone has a right to receive it, irrespective of ability to pay or place of residence. When it comes to health care, financial or geographic barriers are unacceptable.
  • Illness and thus the need and demand for health care is uneven and unpredictable. There should be protection against such uncertainties.
  • Consumers are generally ignorant about medicine. The choice and cost of health care are determined by providers who have professional dominance and who vary in competency and integrity. There should be mechanisms to contain cost and ensure quality services.
  • The benefit of health care goes beyond the individual recipient to the family and society. Investment in health is indirect investment in the economy of the country and should therefore be given serious attention.

These distinctive features of health care have resulted in market failure and forced many countries to move away from a completely free market towards a more integrative, controlled financing, payment mechanism and health care delivery model. The objective is to have an efficient scheme which can satisfy the basic right to everyone, where and when necessary and at affordable cost.

On the impact of the government’s lack of a cohesive action plan in spite of the numerous studies that have been carried out in the past two decades:

That we have fallen short of the central strategic challenges can be concluded from the following examples:

  • continuing prevalence or resurgence of preventable diseases;
  • mismatch in resource allocation and utilisation of national resources for health;
  • inequitable geographic and financial accessibility to health care;
  • continuing public-private sector dichotomy and public to private sector exodus of trained staff;
  • cost escalation in the private sector;
  • long waiting times and less than patient-friendly care in the government sector;
  • inadequate communication between practitioners and their patients, congested and uncomfortable wards and waiting areas, and delays in attending to emergencies;
  • inefficient and ineffective health care;
  • the absence of a national health policy.

On some of the negative effects of the rapid growth of private sector hospitals:

The private sector is developed and operated with private capital and paid for by fee-for-service by consumers, their employers or an insurance company. The private sector is only accessible to those who can pay directly or indirectly….

…the last two decades saw the unprecedented growth of the private sector, with large, ultramodern, and lavishly equipped private hospitals developed and run by companies. Concentrated in large urban centres, they would have involved large amounts of capital outlay. Their uncoordinated development has resulted in overcapacity, duplication and under-staffing…

….the growth of the private sector has continued to encourage the exodus of doctors, specialists and other professionals from the government to the more lucrative private sector. A much larger government sector is now run by a much smaller number of lower paid staff. This imbalance obviously does not contribute towards building good morale, efficiency and quality of service……

On why an independent body is needed to produce the National Health Policy:

A definitive health policy is long overdue. Expertise and interest to formulate such a policy, and the information base required span across government agencies, the private sector and NGOs. It is therefore suggested that the government commission a body of people with the relevant terms of reference and adequate authority to undertake the exercise. Such a body should be headed by a person with credibility. A period of two years should be adequate to prepare the policy for submission to the government…….

In view of the complexity of the exercise as described above, it is best undertaken by an independent body external to the Ministry of Health. It should be a supra-ministerial body responsible to the Cabinet. Its membership should comprise people with considerable relevant knowledge, skills and experience to add credibility. It should be led by someone with easy access to the government and to the political leadership….

In view of its importance, urgency and far-reaching consequence, it would be a mistake to allow the exercise to be undertaken in-house as another one of the activities of the Health Ministry. Two decades after the first study in 1984/85, and several years after subsequent related studies, we are still no closer to a national health policy.

 

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