1Care monopoly

PETALING JAYA: The 1Care national healthcare scheme (1Care for 1Malaysia) will see “preferred” pharmacies appointed to dispense medicine.

Under the proposed scheme, general practitioners will prescribe medication and patients will have to buy them from accredited pharmacies.

The Malay Mail understands that a pharmaceutical chain and a multi-level marketing giant are in talks to obtain what critics say is a monopoly on the dispensation of prescription drugs, which may lead to costlier medications.

According to the policy, concept paper prepared by the Health Ministry, a Primary Health Care Trust (PHCT) will acquire healthcare services from pharmacies and dentists, among others.

“They oversee and purchase healthcare services from independent contractors (primary care providers/contractors), dentists and pharmacies.

“They also commission services from secondary or tertiary care providers such as hospital services, emergency services, etc,” according to the concept paper.

The PHCT is an autonomous agency accountable to the Malay sian Healthcare Delivery System (MHDS), and will be the key agency to purchase primary healthcare services and other levels of services for the region.

Dr Ng Swee Choon, who sits on the panel that drafted the concept paper, and is a committee member of the Federation of Private Medical Practitioners’ Associations Malaysia, said the policy will lead to a monopoly on the provision of healthcare services.

“Prices of drugs will increase when privatisation occurs. This is also due to the monopoly because only certain pharmacies can dispense medication to patients under the policy,” he said.

The concept paper also proposed a mandatory, publicly administered social health insurance (SHI), whereby “the whole population of Malaysia has to subscribe to SHI with no avenue to opt out from the system”.

Two options in funding contribution were proposed:

• Two-thirds employer and onethird employee participation; and

• 50:50 contribution. The concept paper also stated “other possible sources of fundraising may include Employees Provident Fund (EPF) dividends, EPF contributions and Social Security Organisation funds.

“In line with other government plans to look at contributory pension schemes (pencen bercarum) for civil servants, it is conceivable that civil servants will also contribute towards their own SHI premiums as per private employers.

“If the programme is adopted, another possible source of funds may come from the Kumpulan Wang Amanah Pencen.”

The financial requirements of the restructuring of the current healthcare system also raise a question on the need for it. As the concept paper stated, the restructuring will reduce government subsidy from an estimated 17.9 per cent of total health expenditure in 2007 to 15.6 per cent, which accounts for almost RM1 billion.

Policy will not be implemented if unsuitable, says Tiong Lai

However, government spending for health will increase from 2.11 per cent of GDP in 2007 to an estimated 2.85 per cent of GDP or RM13.6 billion to RM23.4 billion in 2007.

“We have a healthcare system that is not heavily privatised, but Malaysians are still recording good health statistics going by global ratings,” Ng said.

The government has argued that the 1Care system will be able to offer more equitable healthcare services across all levels of society, particularly the poor, and reduce leakage of public funds.

However, the implementation of a mandatory tax under the proposed policy was heavily criticised.

Health Minister Datuk Seri Liow Tiong Lai had said nothing has been cast in stone, as the ministry was still studying the proposal, and the policy will not be implemented if found unsuitable.

However, documents made available to The Malay Mail show that health officials presenting working papers abroad have been promoting this particular scheme which, say the papers, is mandatory.