Fixing Our Healthcare System

By: Natalie Shobana Ambrose

theSun, Malaysia (pg 13)

February 9th, 2012
http://www.thesundaily.my/news/303201

http://www.thesundaily.my/node/86955

“When you're older, this is where you spend all your money," said the couple next to me as they compared my one purchase at the pharmacy to their bags of medication and vitamins.

I'm inclined to believe them especially after my cousin pointed out that the conversations at family get-togethers in recent times revolve around what medication the senior relatives are on which is usually followed by a brief assessment of our healthcare system, cost, efficiency and which doctors, clinics, hospitals are knowledgeable, affordable and have shorter queues.

There has been plenty of talk about healthcare around the world which has inevitably triggered us to think about our healthcare system. Not so long ago, the United States was debating Medicare reforms nicknamed "ObamaCare" and it seemed like a long, painful reform with many criticisms.

Downing Street is trying to reform its National Health Service (NHS) which has drawn widespread criticism especially since Prime Minister David Cameron is insistent on going ahead with the restructuring efforts.

All this is a constant reminder that healthcare is a prickly subject. And a prickly subject for everyone not just certain governments.

Here on our shores the healthcare debate has been heightened by a loose statement which abruptly introduced most Malaysians to 1Care – the proposed name for Malaysia's healthcare reforms. It drew a lot of speculation and concern from the public with little concrete information and is now seen as another running bad news story for the government.

The reality is that publicly subsidised healthcare is expensive for the government and reforms are inevitable in this economic climate especially with healthcare costs projected to escalate. Even though some statistics confirm that Malaysia's healthcare is 40% cheaper than that of Singapore it does not mean that it is affordable for every Malaysian.

Many Malaysians would agree that healthcare reform is necessary. Perhaps the current system is not sustainable and the truth is every system has room for improvement. The question is how should 1Care, the proposed new healthcare system be structured and funded?

It has been indicated that 1Care is being modelled after the NHS whose founding principles state "health care for all, free at the point of use, unrelated to the ability to pay". Though an altruistic slogan, logically it is one that is almost impossible to be carried out in a sustainable manner in the long run hence why Britain is now needing more NHS reforms.

Selling it as a cheaper alternative ensuring universal healthcare coverage for all Malaysians then comes across as election-speak and brushing aside questions of the impact it has on taxpayers increases fears and speculation especially in a time when the government is reducing subsidies.

What needs to be done is for the public to be briefed and given tangible information on the cost and options. If the proposed system acts as does the Employees Provident Fund (EPF), what happens to dependants, retirees and the unemployed who cannot afford to contribute?

What also happens to unskilled illegal migrant workers, or those living in remote places with little access to healthcare or even international students? Who pays because we cannot and should not neglect them?

We can say that this 1Care system is only for Malaysians but even as a student in London, I used the services of the NHS, paying for medication but not consultation and was entitled to other free services such as hospital treatment in Accident and Emergency, hospital treatment (if the doctor recommends it) and family planning services.

If 1Care is modelled after Britain's NHS, then these too are legitimate pressing questions that need to be addressed and the information disseminated to the public.

We have excellent medical staff but our facilities leave much to be desired. Last year an exposé on the maternity ward of the Kuala Lumpur Hospital not having hot water shower facilities, questionable hygiene and inadequate toilets caused an uproar. Of course, the government had allocated RM300 million for upgrading services in the last Budget. However the reality is there are many more cracks in the system that have not been highlighted or addressed.

At the core, what Malaysians want is access to good health services and will be willing to contribute if mechanisms are in place to safeguard the system ensuring that if implemented the 1Care fund will not be the go-to fund for unrelated projects. Neither should the fund be streamed into the accounts of political parties. With the track-record of government initiatives becoming liabilities it is only fitting that healthcare reforms be negotiated in a transparent manner with the different stakeholders to ensure the best interest of the rakyat is the priority.

Natalie wonders if 1Care will actually care for the people.

Comments: letters@thesundaily.com

Growing Grey: Who Will Care For Our Old?

By: Natalie Shobana Ambrose

theSun, Malaysia (pg 13)

February 9th, 2012

http://www.thesundaily.my/news/289751

“I’m four years old and seven months,” she blurted. Funny how at that age, you know exactly how old you are and every additional month counts. Once gravity hits, things change. Rarely do you hear someone say I’m 35 and a half. On the other hand, I know of a few people who have the power to stop the clock claiming to be 59 for many years, citing “Age is just a number ... mind over matter”. As the saying continues, “if you don’t mind, it doesn’t matter!”, though sometimes your knees remind you of how old you are.

When the United Nations Population Fund christened the seventh billionth person, the figure was repeatedly drawn on as a shock-warning statement by various well-meaning factions. While most policymakers focused on the issue of over-population and the burden on resources, highlighting issues such as access to food, housing, education, jobs and impact on the environment, one main concern continued to remain on the back bench – an ageing population.

Indeed the world’s population is increasing. However the issue has shifted. In many parts of the world, a demographic transition has taken place. Population growth has recorded a decline in birth rates and an increase in longevity, pointing to a rapidly growing greying population – and only some are noticing.

In the developing world, most government policies are concentrated on issues of development and target the younger generation – understandably, especially since the general philosophy is that the young are the future of the nation. However, if a country is faced with a rapidly growing aging population and does not have the foresight to provide adequate infrastructure, healthcare benefits and sufficiently address welfare issues, this shift in demography will detrimentally affect and impact the nation’s workforce and economy.

When we in the developing world think about aging societies, we think of them as a predicament of wealthier, more developed countries, citing the examples of Japan and England. Our understanding of the issue is framed against the backdrop of aging being a rich country’s problem. If only it were.

Perhaps it is for this reason that the developed world has better provisions for the aged. That is because it became rich before it became old, while the developing world became old before it became rich. But this does not omit the fact that Asia and Malaysia have a growing aging population with needs that have yet to be addressed.

Our changing cultural norms have led to a decrease in birth rates and a growing older population. To add, it was reported as at 2011 that one in three elderly people in Malaysia are abandoned.How are we going to cope when we are already in the third stage of the demographic transition according to Unescap with the projection of over 3.4 million older persons by 2020?

Fundamentally the issue of a greying Asia and Malaysia cannot be put on hold until we reach a percentage knighting us a geriatric society. The issues need to be addressed now so as to avoid a danger-zone era of hyperaging and the consequences of it.

Thankfully in Malaysia we do not have too much of a skewed sex ratio caused by selective abortions or a “4-2-1” society where a one-child policy leads to a child providing for two parents, caring for four grandparents and himself. However we are not out of the red as we do not have adequate healthcare facilities, well-equipped aged-care homes, elderly-friendly housing and public spaces that cater to the elderly.

Furthermore, we have become trapped in a sedentary lifestyle which means not only are the aged needing more and better healthcare, so are the younger generation. Then the question remains – who will look after the aged in a society that values filial piety but has inadequate provision especially in a changing society where families are smaller, salaries are insufficient and the setback of brain drain runs deep.

The reality is that we are all getting older – if you’re still counting months, perhaps you don’t feel it, but our parents and grandparents do. An aging population inevitably affects us politically, economically and even militarily, according to American demographer Phillip Longman.

This century is touted as the Asian Century, but what many Asian countries are neglecting is the very real issue of a spiralling aging population and the reality that a neglected greying population reads trouble on so many levels.

Natalie feels her knees too often and hopes our government puts into action its slogan of “people first” and not “pockets first” in assessing healthcare reforms and policies for a greying society.                                                                      
Comments: letters@thesundaily.com