The Place of Public Health Insurance in Malaysia The Consumer Viewpoint
Text of a talk by Anwar Fazal, Regional Director, Asia and the Pacific, International Organization of Consumers Unions (IOCU) at a public forum organised by the Malaysian Medical Association (MMA) in conjunction with its 15th Annual Meeting on 12 April 1975 in Johor Baru, Malaysia.
1. This year is the year when many Malaysians are thinking about the year 2001. Workshops are being held in many different parts of Malaysia about what kind of Malaysia will there be in the year 2001, and I was thinking about myself in that year – old, perhaps sickly, in my bed, unable to speak, with my children and grandchildren around me, reading my health insurance policy and debating whether they should lose their “no claim bonus” by bringing me to hospital. I hope they decided wisely – and I hope I got a better deal than many motorcars do!
2. Consumer organisations throughout the world have a special interest in health matters and rate that issue high on their priority list. Many of then also have done a great deal of research on the subject of insurance.
3. The consumer point of view regarding health insurance is this: the best public health insurance scheme for Malaysia would be one which encourages and ensures a healthy mind, a healthy body and a healthy environment.
4. This scheme should be reflected by a universal health care system, the essential ingredients of which will be:
· a concerted programme of comprehensive health education in schools and in the community;
· priority for preventive health measures, and a new breed of public health community workers being developed;
· a national system of curative services that meets the real needs of the people for efficient and sensitive health care;
· far greater attention paid to safety – we have a bad and worsening record in both industrial and road safety (in the case if the latter, four times worse than even many developed countries);
· the destruction and poisoning of our environment is now causing greater concern than before and urgent action is called for;
· much more work needs to be done in the area of the control of foods and drugs especially their importation, manufacture, and advertising (the latter brought forth wanton and misguided self medication and in the case of infant foods, caused what is described as “commerciogenic malnutrition” – malnutrition caused by commercial firms through their advertising practices.
5. Those then are some of the fundamental health issues facing Malaysia. While we have set a pattern that appears to be in the right direction, so much more needs to be done – and undone. It is on these kinds of issues that the MMA must come up strongly and with courage and give expression to constructive forthright viewpoints.
6. Who pays for such a scheme? The consumer view is that health care is basically a public service, it is a necessity, it is a right and therefore is best paid for by an equitable tax system.
7. This does not mean of course that within the free enterprise system, the mixed economy system that we have, we cannot have a parallel health delivery system operating within society. To give the consumer various options is normally a good thing but in the case of basic health, these should be in addition to, supplementary to, the presence of a universally developed public health system in the country out of public funds.
8. We are also not against insurance; we think insurance is a good thing. We think that people
must prepare themselves for certain types of eventualities.
9. In the case of medical and health insurance, consumer studies in many parts of the world have indicated serious problems and if such a scheme is encouraged, or introduced in this country, or develops out of SOCSO, or if MMA gets itself involved in such a scheme, I would urge a great deal of caution, I would urge a great deal of heart-searching, I would like to think in terms of whether really it is meant to serve the people – the consumer, the final client, or patient if you prefer that particular term. Is it really meant to do that, or is it a convenient system by which people who deliver the service can rake in the money. Sometimes such schemes are disguised by being called “non-profit making” but still within it have a built-in system of profit. I think these are some of the issues which you have to consider and this is the type of heart searching that you will have to do.
10. What are some of the types of issues which consumers will be concerned with if you set up such a scheme? There are basically six consumer yardsticks that are important and we hope that whoever introduces the scheme will keep this in mind.
· Need – think you have to be very careful to make sure that the insurance is sold to people who need it, that it is not sold to people who don’t need it, because in a country where 50 percent of the wage earners may earn less than RM200, you don’t want them to waste money through any compulsory system or even any voluntary system or private system imposed upon them by virtue of their employment.
· Choice – you must be concerned that they get choices of policies. We know that in many places, people have no choice in the type of policies that they get. The present system is such that it is very difficult for consumers to even compare policies not just medical policies, even life insurance policies. Guidance and advice centers can be established.
· Clear Policy Implications – Consumers, we have found, are not aware of the implications of many clauses hidden in small print. We need simpler language and simpler documents.
· Education of Consumers – There is hardly any education of consumers in the insurance field. It is an area where doubts, a large number of doubts, prevail. It is an area where it is difficult to get competent and impartial advice. It is an area where consumers, well meaning, have been let down through legal loopholes. It is an area where it is a jungle, in which consumers merely hit and miss, where many can be persuaded to buy insurance policies that they do not need.
· Adequate After Sales Service – I think if such policies are introduced, there must be very clear guidelines about how these policies are to be serviced. We have found insurance policies in different fields, including health, which are very difficult to implement and cause more problems than solve.
· Redress and Protection – We think that there must be proper and efficient machinery established for redress where consumers have complaints. This is an area where the Insurance Department perhaps can strengthen insurance law in this country to give greater protection for the individual consumer. Perhaps a consumer consultative panel can be established.
11. These then are some of the considerations that consumers will be interested in, which you yourselves, personally as consumers, if not as medical people responsible for health care, must take into account if a health insurance scheme is to be introduced in this country.
12. We do not want to see in Malaysia the extremes of a two-class system develop as it has developed in several countries, where private hospitals and modern technology, personalised care for the rich and the insured are available while government hospitals, understaffed, with beds in the corridors, and crowded wooden benches in the clinics are for everyone else. None of us want to see a situation where health care becomes a scarce commodity, to be sold at a profit. We don’t want a system of privilege which is based on greed and not on need, where, as one angry person said, “a system that only benefits fat doctors, fat hospitals, and fat insurance companies”, where exploitation of a sellers’ market would prevail.
These then are some of the issues that bother us as people who represent the consumers and I hope that the MMA and responsible authorities in Malaysia will give due consideration to the final person, the consumer, who is supposed to be the ultimate beneficiary of this. We are not against insurance, we think it is an essential element in our economic system but we think that there should be greater safeguards, there should be greater protection and greater education, but fundamentally, we believe, as I said at the beginning, that the best health insurance scheme for this country must be a good public health system universally applied out of public funds.Back to Speeches