Asia Times: Doctors buck privatization of health care



	June 19, 1999	atimes.com

Southeast Asia

Doctors buck privatization of health care
By Anil Netto

PENANG, Malaysia - A landmark initiative by doctors to protest impending moves to privatize Malaysia's healthcare system is fast gaining steam, even as government officials remain mum about the matter. An anti-privatization letter written by doctors at a state-run generalhospital in Ipoh city, 170 kilometers south of Penang, now has more than 150signatures from several areas across the nation.

At the same time, the Malaysian Medical Association (MMA), whosemembers make up 80 percent of the country's doctors, has also called for amoratorium on ''corporatization.'' The MMA thus joins the Malayan Nurses' Union, representing government service nurses, and the Estates Hospital Assistants Association ofMalaysia in openly declaring skepticism and apprehension toward theprivatization of health care.

''These are highly significant developments, coming from front-linehealth care workers with direct experience in patient care and servicedelivery,'' says Chan Chee Khoon, an epidemiologist who spearheads theCitizens' Health Initiative (CHI), which has endorsed a manifesto thatstresses accessibility to affordable health care.

Such protest moves may not have come a moment too soon. Inside sources suggest that the corporatization scheme is set to be launched in January of next year, despite steadfast official silence. The secrecy is not surprising given that any move leading to higher patient fees at general hospitals is likely to become an explosive election issue - should the public get wind of it. The country is gearingup for a general poll that must be held by mid-2000.

Activists are trying to increase public awareness about the plan for thepublic health care system and are determined to make it a key issue in theupcoming elections. First on the agenda is to distribute the doctors' letter of concern toas many Malaysians and non-government organizations as possible. As Chan noted, ''The intention is to mobilize the public and to have hundreds of thousands of signatures arriving at the health minister's office."

The World Health Organization has acknowledged Malaysia's public healthcare system as second only to Cuba's in terms of geographical distributionand access to primary health care. Malaysia's infant mortality rate is approaching that of the United States, a remarkable achievement considering the country spends only about2.5 percent of its gross domestic product on publicly-funded health care.

Activists want to protect and preserve the health care system, especiallyfor low-income Malaysians. In recent years, more and more patients havebeen put off by the high fees imposed by the dozens of private hospitalsaround the nation. As a result, state-run general hospitals have faced longer queues ofpatients, many of them from the low-income group and the middle class, whoare also feeling the pinch of the recession. In response, the government has actually allocated more funds for health spending. That should have made the critics, who have long argued thatstate-run hospitals need a marginal funding hike rather than privatizationto achieve significant improvements, happy.

But activists are unsure if the increased funding is being usedeffectively. ''My concern is that a good chunk is being used to pay forprivatized hospital support services [at state-run hospitals],'' saidChan. He estimates that the cost of these services has gone up by four tofive times following their privatization.

Indeed, that has been the government's strategy: a quiet step-by-stepapproach to privatization that has angered activists and left the public inthe dark. First, the government medical store that supplies drugs to all thestate-run hospitals and clinics was privatized. The cost of drugs shot upimmediately. That was followed by the privatization of various support services at thegeneral hospitals: laundry, cleaning, biomedical engineering maintenance,facilities maintenance, and clinical waste disposal. All these services were privatized to a small, select group of firms, including one linked to the prime minister's son. The results of all this privatization have not been encouraging. Patient fees have increased and there have been instances when patients were asked to buy their own medical supplies such as surgical plates and screws before treatment could proceed.

Activists are also fuming over the lack of information about a parallelnational health care financing scheme, which the government had promisedwould accompany the corporatization of government hospitals. Such a scheme would be crucial in safeguarding continued access to health care for poorer patients. It would also need to include visitors to the country, illegal immigrants, the unemployed, indigenous people in the forests, and the elderly in its scope. In addition, campaigners are worried that corporatization will be linked to consultation and possible joint ventures with overseas health care entrepreneurs that do not seem to have proven track records.

The activists want the government to conduct an impartial cost-benefitanalysis of the health care support services that have been privatized thus far. They have also urged Kuala Lumpur to study the impact of the corporatization ofthe National Heart Institute and of the University Hospital near thecapital - among the first hospitals to be privatized - on efficiency,costs and patient fees.

For now, though, many doctors and activists remain skeptical andcritical, especially over the lack of transparency and consultation. ''Ithink they are going to make a mess of it,'' worried a doctor who signed the Ipoh letter. He concedes that the scheme may help to stem the exodus of doctors to theprivate sector by offering them higher salaries. ''But,'' noted the doctor, ''corporatization in this country has never been for the public good. If you look at the way it is done, one haslegitimate reason to be worried."

(Inter Press Service)

back to the top

©1999 Asia Times Online Co., Ltd.

Southeast Asia Sex News | Asian Sex Gazette