Affordable quality healthcare: Benchmark of a developed society

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A cubicle crammed with beds in a 'third class' ward at the Penang General Hospital. Where is the moral outrage?

The government could use GST revenue to fund a Malaysian version of the UK National Health Service, suggests Benedict Lopez.

As we move towards the status of a developed and high-income nation, it is important we ensure that the many public services offered to our people are on par with any developed country.

If we fall short in any one area, then our vision of a developed country will be blurred, to say the least. Among the critical services that should be a yardstick in determining Malaysia’s status as a developed nation is the quality and provision of health and medical services to the people.

The conditions of our third-class wards in some of our public hospitals are just deplorable – humid and cramped. I shake my head in disbelief at such appalling conditions even in this day and age!

Despite the overall increase in the budget for health and medical services over the years, more improvements need to be made and shortcomings rectified. Malaysia now has a doctor to population ratio of 1:633. The target for the country is to achieve a 1:400 ratio by 2020.

Many public hospitals now face a shortage of medical officers and specialists due to the poor salary scales and working conditions. As a measure to prevent further resignations from the public sector, the salary structure of medical officers and specialists must be completely revised.

Officers in the Administrative and Diplomatic Service (PTD) very often equate the salary structure of doctors with themselves, not taking into account the nature and hours of work of these doctors and specialists.

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Doctors deserve to be treated as a special group, similar to members of the judiciary and the armed forces. Granted, the remuneration for public sector doctors cannot be compared with that of their counterparts in the private sector. Still, the gap should at least be considerably reduced.

Compounding this predicament, most doctors in our public hospitals are overworked and have to be on call based on their roster. When their allowances and overtime pay is a paltry sum, then this affects both their morale and motivation in discharging their duties. So, the natural tendency for them is to seek greener pastures in the private sector.

Malaysia should emulate developed nations like the United Kingdom and introduce a National Health Service (NHS) to sustain a high standard of health and medical services. The architect of the UKs NHS was the then Labour government’s compassionate and far-sighted Health Secretary, Aneurin Bevan, who said, “No society can call itself civilised if a sick person is denied medical aid just because of the lack of means.”

The NHS was launched on 5 July 1948. On that day, doctors, nurses, pharmacists, opticians, dentists and hospitals came together for the first time as one giant UK-wide organisation. Now after more than 69 years since the inception of the NHS, its original character remains unbroken.

Prior to the NHS, patients had to pay for a visit to the doctor or if they were hospitalised – driving many families into debt. Free healthcare for all solved this major problem confronting the people, particularly the working class.

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Bevan was a passionate advocate for the NHS being free of charge for all citizens. It was precisely for this reason that he resigned from the cabinet in 1951, when it voted to impose charges for dental care, spectacles and
prescriptions.

In his resignation letter to then Prime Minister Clement Attlee, he wrote: “It is the beginning of the destruction of those social services in which Labour has taken a special pride and which were giving to Britain the moral leadership of the world.”

Malaysia seems to be moving retrogressively as far as public healthcare is concerned. Some public hospitals are now embarking on partial privatisation by differentiating between paying and non-paying patients. A move in this direction is deeply disturbing as medical treatment may vary between fortunate and less fortunate patients. Definitely not in line with our move towards a caring society.

Skyrocketing medical insurance premiums for private medical care in Malaysia further reinforce the need for the government to introduce an NHS. The price of private medical insurance premiums is fast rising beyond the reach of many in the middle class here. For those unable to afford such premiums but are forced to turn to private hospitals for urgent medical intervention, imagine the heavy burden of having to stump out cash to pay hefty hospital bills.

Revenue earned from GST could be channelled towards a Malaysian version of the NHS. After all, GST is a non-discriminatory tax paid by the rich and the poor; so all Malaysians should in some way benefit from the GST they are paying. A Malaysian version of the NHS is not an unachievable goal if there is a concerted effort and the political will to introduce it.

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Good medical treatment should be the privilege of all Malaysians – not the prerogative of a minority.

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Benedict Lopez
Benedict Lopez was director of the Malaysian Investment Development Authority in Stockholm and economics counsellor at the Malaysian embassy there in 2010-2014. During the course of his work, he covered all five Nordic countries. An eternal optimist and now an Aliran member, he believes Malaysia can provide its citizens with the same benefits and privileges found in the Nordic countries - not a far-fetched dream but one that he hopes will be realised in his lifetime.

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