Medical Insurance for All Malaysian?

During a seminar on health care reform held recently in Kuala Lumpur, Malaysian Health Minister Liow Tiong Lai mentioned that the government would refer to the healthcare model in Taiwan (one type of social insurance, i.e. National Health Insurance (NHI)) as one of the bases to reform Malaysian health care system. The government will develop the National Health Financing Authority (NHFA) to manage the fund under the National 1Care Health Scheme (1Care) - which is expected to be funded by government, private sector, employers and the people.

Theoretically, it is a good idea to have a structured healthcare system that can provide healthcare services to all citizens in the country. In my view, expensive medical cost is one of the key financial risks that everyone should really concern on - almost everyday we can read news about unfortunate folks with serious illnesses begging the public to fund for the expensive medical costs. According to Liow, starting from 2004, the medical expenditure for private hospitals exceeds government hospital. Frankly, the main factor attributes to this trend is the government hospitals are unable to deliver the healthcare services promptly and efficiently - I believe some of you may experience the frustration in government hospital, such as spending hours of waiting or getting doctor appointments scheduled after many months. However, we have to admit that government hospitals still have the most complete range of equipments.

However, practically, it is extremely difficult to implement social healthcare insurance model as adopted in Taiwan. There are too many factors that directly affect the implementation of social healthcare insurance - you can find out many weakness in Taiwanese model from Wikipedia article I refer below (sorry I only managed to find out the Chinese Language version). Let me quickly quote a few examples:

• Difficult to increase insurance premium, despite the high medical inflation (have political consideration)
• High volume of abuse by "insured" (due to public's attitude)
• Overstatement of medical costs by hospitals

The responsible government agency needs to have a very stringent controls on all aspects of the healthcare, if they want to make this healthcare reform successful. It will be really a massive work to be done, furthermore on regular basis. Many expertises are needed to close monitor the "claim experience", from incidence rate, average claim paid, average length of stay up to loss ratio - many insurance companies have done a lot of controls on their medical claims but unfortunately quite a number of them the medical insurance is not a really profit making business. The agency should be granted sufficient authority to take actions on the hospitals if necessary (without political influence). Well, you may want to ask the the problem: "Where can we get the relevant expertises?"

We still have long way to go in healthcare reform. By the way, just wondering if the healthcare reform will also cover the delivery efficiency as well?


Reference:

• "Liow: Public Healthcare to Refer Taiwanese Model; Poor for Free, Rich Pays More" (Sin Chew Jit Poh, 21 August 2011, Chinese Language)
• "Mechanism to be Devised under NHFA to Manage 1Care Fund" (Bernama, 15 March 2011, English Language)
• "Nation Health Insurance" (Wikipedia, Chinese Language)