Sep 27, 2012

Pilo's 5 ideas for Healthcare Budget

below are excerpts from Page 45-47 of PR's Shadow Budget for 2013.

Improving healthcare services
Pakatan Rakyat affirms that healthcare is a basic fundamental human right. It is the condition for our pursuit of happiness. And yet the Barisan Nasional government spends little in healthcare, at the same rate as authoritarian Laos and China.

In terms of delivery, public healthcare personnel are stretched. Although the public sector provides for up to 85% of the population, it is served by only 25-30% of specialists and 45-60% of all registered doctors.

Pakatan Rakyat will strengthen the shape of Malaysian healthcare in the future. Improvements will include:
- The scope of public healthcare and the means of financing this public good;
- Pay and job conditions for medical personnel;
- Ways to improve health indicators for the Orang Asli and Bumiputras living in Sabah and Sarawak and increased allocations to reflect the costs involved in providing services to these communities in hard to reach rural areas. Amounts allocated per household to Sabah and Sarawak are presently smaller than in Perlis and Terengganu despite their much larger geographic areas5;
- Better meeting the needs of senior citizens and patients requiring long-term care. Increase the number of health care professionals specially trained to look after the needs of senior citizens and of those requiring long-term out-patient care and monitoring and hospitals with facilities and infrastructure for geriatric services and long term out-patient health care will also be considered6; and
- Adopting new models of community and home-based care for patients not needing hospitalisation but who have difficulties getting to a clinic or hospital for health care due to age, injury or illness. Such measures would promote injury and illness prevention and reduce unnecessary admissions into hospitals, which would provide significant savings to Malaysian health system.

The availability of public healthcare services that provide good and wide ranging treatments allows for greater number of economically disadvantaged groups to seek treatment at government hospitals. This reduces the tendencies (stemming from resignation or fear of waiting list, unavailability of services etc.) of patients from the poorer segments of the society to go to private clinics to seek treatment.
At the point of this entry, the Balisan's Budget for Healthcare have yet to be unveiled and tightly kept in the black briefcase of Najip.

One thing for sure to be anticipated from Balisan's Budget is drop out of the much anticipated 1Care. The conception of this idea from the start is a shameless ploy to nick the rakyat's money by masquerading as the national health insurance scheme. Their main selling point of this idea was it is the way forward as it is adopted by developed countries such as Japan, Taiwan and UK. They managed to fool less educated people, but not people who better understood how many cans of worms those systems had opened by adopting such system. Plus, the many ways monetary funds may be easily be siphoned off with 1Care is way too obvious, even for any half-wit Malaysians.

Nope, this entry is not for bashing the almost toned-down 1Care.
Possibly the biggest disappointment with PR's Budget and the Balisan's Budget (to be unveiled tomorrow) is that all their Strategy or Budget are simply hot-air Promises.

Malaysians do not need another Election Budget.

PR's Healthcare budget focussed more on the Orang Asli Health Services, Geriatric Services and Community Health Services. Possibly, a good way to go, as they are harping good votes from elderly citizen as the young voters are already in their 'fixed deposit'.

As simplified as it is, budget is simply a calculation on how much we want to spend (or allocation of spending) and making sure what we spent on is worthy of its value or more.

I had thoughts about how our healthcare budget should be.

Perhaps it may be too ideal or downright infantile as I am afterall a health-management idiot, but I just want to share what I think our Healthcare Budget should be.

1. Focus on the primary care and prevention

Healthcare has always been grossly misunderstood as the provision of secondary care, where posh doctors, specialists or Consultants in Clinics or Hospital providing the medication or surgery. The real burden in healthcare is indeed for this tier of care.

Nevertheless, the burden of disease actually comes from the failure of our Primary Care. Primary Care leaders of the country may be cursing me right now, because of my disrespectful comment. Yet, many Primary Care doctors on the ground would agree with me that many activities - all the speeches, all the courses, programmes, thematic works and etc were actually being carried out, but possibly only a minority shown real results. Real results.

The biggest threat to our national security is not terrorism, but the burden of non-communicable disease. We need to sit down and focus on reducing Obesity and Smokers, because those 2 conditions by themselves can spawn a whole shebang of diseases - Diabetes, Hypertension, Renal diseases, Cardiac diseases, Cancers, Eye diseases, Skin diseases, Depression and the list goes on.

Obesity should be tackled in two ways. Encourage healthy diet and increase opportunity for exercise.

Policy-makers should take bold move to introduce Perfect Weight Incentive, a small portion of extra bonus or monthly incentive for those with normal BMI, starting with the public sectors. Hospitals and clinics should start charging more if the patients is of higher BMI.

All working offices should also provides simple gym room, sport or recreational area for all employees and make allowance for 30mins of exercises from their working hour (430-5pm). All housing areas should have properly maintained Parks for home makers.

Guidelines on fighting obesity already been started but has it been properly followed through. Malaysia | UK.

Main blame for weight gain among ladies are pregnancies, therefore a proper diet guidance during pregnancy is important.

It is every human rights to have the freedom to smoke. However, it is costly, if the secondhand smokes affect the greater proportion of the people. Thus, banning of smoking in public area should be implemented nationwide and strict law-enforcing is essential. What's the point of putting up a big notice board of 'Fine on Smoking' in the hospital ground and the members of hospital puffing away below that notice. Proper smoking area should be allocated for smokers, to allow the auto-destruction of these sub-population. Smokers who attend public health services should be confirmed of their status by blood or urine nicotine tests and be charged more.

2. Family building

Family planning is family building. Pregnancies should be planned and properly executed. Our country's pick up on contraception is very appalling. This had lead to many teenage pregnancies and various problems associated with pregnancies due to unplanned pregnancy. Unplanned pregnancies at extreme of ages have relatively poorer outcome in the conception leading to less healthy babies with various health implications in their adulthood. Furthermore, various medical illnesses worsen during pregnancy and some to irreversible stage.

The cost of using effective contraception is small compared to the massive cost of handling various medical problems in the mother during pregnancy and future diseases associated with the children.

Having the proper number of children can build a happy, strong family with strong family ties. Family support in time of need can ease a lot of health burdens especially for the people of geriatric age group.

3. Competency-based and provide job satisfaction

All medical personnel should be strictly monitor of their duties and competencies by their own superiors and be counter-checked by another independent body. This is to promote fairness and justice as much as possible.

There are few medical assistants in operation theatre who gets to sit idle in their resting lounge while the doctors pushed the patient in themselves. There are medical assistants in the health clinics that come to work only once a week, yet pushed the medical officers around. There are medical officers in the Health Clinics who do not conform to the working clinic rotation requirements because of certain connection to certain Datuk.

If certain people do not work competently or their contribution is unnecessary, perhaps we can really cut cost by reducing those positions. I have heard of Consultants in Australia pushing in their own patients for Ultrasound.

And, please, do not speak of medical doctors or medical personnel as money-faced people. Although we appreciate a big paycheck but we appreciate more a good working condition where we do not get fxxked by people of same rank or below, just because they are senior or with big cable.

The recent overhaul of HRMIS for the public servants, medical personnel included, is a clearly amusing. As a medical officers, my Sasaran Kerja Tahunan (SKT) or Annual Work Target is similar to the house officers in the department. As I read the 'Template' for the SKT, it was a very ideal SKT, but I doubt all those targets had been achieved completely.

Spending a small amount of money on monitoring competency and good working environment beats wastage of money due to incompetency and outflow of medical personnel to the private healthcare.

4. Medical registry and data

One of the weaknesses in our country is our pending success to create and maintain a good registry.

Currently, various of registries had been initiated and the registry that I had known since I started service as a houseman is COTDS, which supposed to record all operations done in Public Hospitals.

COTDS is Computerised Operating Theatre Documentation System. Sadly, few months back, COTDS was being replaced by COTDS2 but COTDS2 was plaqued with various problems. And now, I was told the Ministry had pulled the plug on COTDS and COTDS2 because of payment problem.

Frankly-speaking, with the registry and data, various analysis and population-based study can be undertaken. With proper supervision and guidance, I guess it is no harm in propelling our massive number of young budding house officers to do simple analysis and study of the data.

At some point of time, recognition of treatment or management to conditions or diseases specific to our region can help better usage of our healthcare allocation for treatment.

5. Private participation in health care

Give out tax rebate for private healthcare centres or private companies who organize health-related events and campaigns that shown impact in reducing health problems. Get them to build more parks, gyms or recreation areas.

Private healthcare practitioners/specialists/consultants should be made compulsory or be enticed with personal tax rebates to serve in public hospital in rotation for small amount of time, perhaps once a month or once in two months. And perhaps if they are willing to serve in public healthcare centers in the Borneo side, they can be given bonus holiday package of 'Cuti-Cuti Malaysia' there.

It is a win-win situation. The public healthcare can get expertise from private healthcare practitioners. And in return, they can rekindle their interest by seeing different spectrum of diseases in public healthcare, plus a relaxing get-away from the routine.

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