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ACCORDING to the second series of the 2014 Auditor General’s (AG) Report, the Health Ministry had written off RM30.47 million in unpaid medical fees between 2012 and last year. A seemingly hefty sum in the way of money reflecting the just as hefty number of Malaysians who are too often sick; sick enough to incur hospital bills they cannot afford. But, treat them the hospitals must, because these are government-run hospitals and if they do not treat the people, who will? Hence, the logical decision to write off the unpaid bills rather than collect them. This then raises two issues, long a point of discussion that has found no real resolution. Firstly, some scheme should be devised to raise money so that healthcare at the point of service delivery can be free for all who opt for treatment in public hospitals. Secondly, preventive healthcare, which is the cheaper option.

Once upon a time, there was in Britain a free healthcare system for all who resided in the country. Money is raised through the National Health Insurance (NHI). A nominal sum, deducted at source, is paid by every worker as a weekly or monthly contribution, as the case may be. While the individual may contribute a small fraction of his or her salary, the total collection is a sizeable amount given the number of workers in the country’s labour force. For this contribution, everyone is entitled to a family doctor whose surgery is probably round the corner in urban areas. Referrals to specialists are made by the family doctor and treatment was then completely free, inclusive of medicines. Over the years, this has changed for the worse. Nevertheless, Britain’s National Health Service remains one the world’s most patient-friendly healthcare systems. If, then, money is the AG’s concern, some version of the NHI should be introduced.

But, curing is, indisputably, more expensive than preventing illnesses, which is making preventive medicine more popular. Malaysia should adopt an aggressive approach where pervasive public health education is the main thrust. Public hygiene takes precedence. A sustained clean environment should be the basis upon which the country’s healthcare rests. Rural clinics should spearhead a “healthy Malaysia” campaign and the community mobilised in the war against diseases. In vulnerable communities, the free milk programme in schools should be extended to include children from birth. District nurses should emulate the foot doctors of rural China, going out to the patients instead of waiting for them. In short, if the healthcare system had been more proactive, the country’s economically disadvantaged would not be victims of wanting standards of hygiene and unhealthy diets; healthy Malaysians would mean less need to write off treatment costs. Complement this with an NHI scheme and the already commendable level of modern healthcare that has put the country among the top 10 in the world can be easily affordable. There would then be no need for the AG to censure what is in effect an act of altruism by the Health Ministry. For, providing healthcare to the poor is not wasteful.

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