1CARE – FAQs

Q: What is 1Care for 1Malaysia? A: 1Care will merge private and public sectors into one system. Everyone pays private sector prices. There will be no more government healthcare for the 75% of the rakyat who can't afford the private sector. It will be a fully privatised, SHI-based system.

Q: What is 1Care's Social Health Insurance (SHI)? A: An insurance scheme that every working adult must buy. This SHI pays for your healthcare. But international studies show that SHI systems INCREASE costs and do NOTHING to improve healthcare!

Q: How much do I have to pay? A: The government estimates they need 9.5% of your income to maintain 1Care. They are also exploring sliding scale deductions, where the poorer pay less and the richer pay more. So you could be paying much more than the 9.5%!

Q: Do employers still provide healthcare benefits? A: The 9.5% is supposed to be shared between employer, employee and government. But it's actually ALL paid by you:

(1) Your portion is deducted from your salary. (2) Government's portion is paid with your tax money (3) Employers will eventually pass the cost back to you

Q: What healthcare do I get in return? A: According to the 1Care Concept Paper, your 10% will pay for about 6 clinic visits or 1 specialist visit a year, or 1 hospital stay in 11 years. And you will STILL need to pay when you see the doctor!

Q: What is a Primary Healthcare Providers (PHCP)? A: PHCPs are 1Care-certified GPs. Everyone must register with a 1Care PHCP. If you don't like your PHCP, you can pay extra to see another one.

Q:Why do I need to register with a PHCP? A: 1Care tracks your health records through the PHCP. If you use “too much” of 1Care's healthcare budget, you may get only limited or even no healthcare until a new budget is approved. Unless you pay extra to get your own doctor.

Q: What is Gatekeeping? A: You can't go to any hospital or specialist without your PHCP's referral. If you don't like the specialist or hospital he refers you to, 1Care gives you the “choice” to pay extra to see your own.

Q: How is the PHCP paid? A: 1Care pays PHCPs a flat rate for every patient. There's no reward for better care, so doctors have no incentive to improve. They also have a fixed budget. If they see too many patients, they won't get paid. So your PHCP may not see you if he's out of budget. You'll have to pay extra to see another doctor.

Q: Can I change my doctor? A: Yes, You can apply to the authorities, submit the paperwork, wait for approval, etc. If you don't want the hassle or long waits, you can pay extra to see your own doctor.

Q: Do I have to pay for hospitalisation or surgery? A: 1Care will never fully reveal what they provide. But the 1Care Concept paper shows that if you get serious diseases like cancer, heart or kidney disease – you pay your own. Other needs are subject to 1Care's budget limitations.

Q: Do I still have to buy medical insurance? A: 1Care has very limited coverage, so you need insurance or lots of cash.

Q: Can I get my money back when I retire or if I never use the system? A: You will never get your money back.

Q:What if I am poor? A: If you are a family of four earning below RM500, the government pays the SHI for you.

Q: When will this scheme start? A: It already has. 1Care is currently in Phase 1 & 2 of a 4 phase implementation process. This is confirmed by the Health Ministry's Deputy Director-General, Datuk Dr Noor Hisham Abdullah. The process is expected to be completed within the next 2 to 5 years.

Q: Why do we need this 1Care reform? A: The government claims it can't afford to pay for healthcare. The Health Ministry's 2011-2015 Plan proposes cost-cutting measures to make government hospitals "abandon acute care" and "more strictly limit services" to the rakyat. But they willingly give out BILLION-RINGGIT contracts for services that don't improve healthcare!

THE RAKYAT DEMANDS OUR RIGHTS!The UN Universal Declaration of Human Rights states:

"everyone has the right to a standard of living adequate for the health and well-being of oneself

and one's family, including medical care."

As a signatory to this declaration, the Malaysian government must uphold its dignity and not impose any policy that restricts the rights of the people to affordable and quailty healthcare – either in public ot private sector.

It is the government's responsibility provide enough quality and affordable healthcare for all the health needs

of everyone in Malaysia, without any discrimination.

A moral and caring government will not force people to choose between disease or financial ruin.

A moral and caring government would not treat its citizens' health as a commodity to be traded, manipulated

and negotiated for profit.

The rakyat elects governments to protect our interests! Taxes must be used for the rakyat's benefit, including to provide quality healthcare and other essential services.

Therefore, the rakyat states clearly:

TAK NAK 1CARE!Instead, the rakyat demands:

1. DE-PRIVATISE PUBLIC HEALTHCARE2. STOP CORRUPTION, WASTAGES, LEAKAGES

3. INCREASE FUNDING FOR PUBLIC HEALTHCARE4. REGULATE PRIVATE HEALTHCARE CHARGES

5. MAINTAIN THE PRESENT 2-TIER SYSTEM

1CARE – WHAT IT'S REALLY ABOUT

According the the Ministry of Health:

Slide 27 from presentation: “MALAYSIAN HEALTHCARE SYSTEM TOWARDS ACHIEVING BETTER HEALTHCARE FOR MALAYSIA” by Dr. Abd. Rahim bin Mohamad, MOH Planning and Development Division. Briefing given in Putrajaya, 28 September 2010

BIG WORDS DISGUISE THE REAL INTENTIONSThe government uses nice-sounding words to give people a positive impression of 1Care, but the meaning of the words could be very different from what most people think.

Here are the real meanings of some words we need to remember when discussing 1Care:

INTEGRATE:1Care will merge private and public healthcare sectors to create a single system. All government facilities will function like independent “private entities” [1] and charge private sector rates. 1Care will completely privatise healthcare.

UNIVERSAL COVERAGE:The concept of EVERYBODY being able to get ALL the healthcare they need. Malaysia already has universal coverage. The government uses taxes to provide all levels of healthcare and has clinics and hospitals everywhere. Malaysia also has a thriving private healthcare sector for people who don't want to use government services.

SOLIDARITY AND EQUITY:The concept where the richer pays to support the poorer to get equal quality of healthcare. Malaysia already has equity because 10% of the population pays taxes to make public healthcare available for the other 90% who are too poor to pay taxes. Most richer citizens also use private healthcare so that the poorer can use public healthcare.

CHOICE OF QUALITY:Malaysians already have choice – people can choose the more expensive private sector with shorter waiting times and better environment, or the cheaper public sector with better expertise and facilities.

Clearly, the objectives of 1Care “reforms” are already being met by the healthcare system we have now. And many of the problems in our healthcare system can be easily solved without a total revamp. So why is government so very keen to implement 1Care “reforms”?

PRIVATISATION AND PROFITSThese slides are from a January 2009 presentation by the Ministry of Health entitled: “FUTURE OF HEALTH CARE FINANCING IN MALAYSIA” by Dr Abd Rahim Mohamad, MOH Planning & Development Division.

In the first 20 slides, Dr Abd Rahim lists the problems with Malaysia's healthcare system. Then he presents two reform options – introduce a NHI [2] and more privatisation, or improve the current system:

Slide 22: “FUTURE OF HEALTHCARE FINANCING IN MALAYSIA” - Dr Abd Rahim bin Mohamad, 18 January 2009

A right-thinking person would have chosen the second option. It is more efficient and costs less for the rakyat. But in the next slide, Dr Abd Rahim proposes the FIRST option:

Slide 23: “FUTURE OF HEALTHCARE FINANCING IN MALAYSIA” - Dr Abd Rahim bin Mohamad, 18 January 2009

[1] A Malaysian Pharmaceutical Society (MPS) report quotes a “Dr Nordin” from the MOH as saying “the current Govt Hospitals and Health Clinics will be given autonomy and will operate like private entities”. This was during a briefing about 1Care to MPS by senior MOH officials held on 15th Jan 2012. View the report here: http://on.fb.me/wD0utH[2] NHI: National Health Insurance, another name for Social Healthcare Insurance (SHI), a compulsory nationwide medical insurance scheme

1CARE – PRIVATISATION IN DISGUISE

Behind all the big words and macro economic mumbo-jumbo, 1Care is really just about money – a lot of money.

The government has been trying to privatise healthcare ever since Dr Mahathir's time. In 1991, the Privatisation Master Plan officially listed healthcare to be privatised. In 1996, the 7th Malaysia Plan stated “privatisation of health facilities and services will also be an important aspect”. Since then, many segments of public healthcare have been privatised.

Just a few examples of government privatisation:

1992: Institut Jantung Negara corporatised (due to be privatised with impending Sime Darby buy over)

1994: The Government Medical Store is privatised. Now, Pharmaniaga monopolises manufacturing, purchasing, storage and distribution of all drugs and medical products. Prices went up 3.3 times.

1996: Hospital support services privatised to three UMNO-linked companies. Costs rose from RM143 mil in 1996 to over RM1 bil in 2009

2011: Radiology services in public hospitals privatised

FINISHING THE JOB1Care will be the final piece in the process to completely privatise Malaysia's public healthcare system. According to a MOH briefing to the Malaysian Pharmaceutical Society, “Govt Hospitals and Health Clinics will be given autonomy and will operate like private entities” and “1 Care transformation proposals are now in the final stages.” [3]

Slide 48: “MALAYSIAN HEALTHCARE SYSTEM TOWARDS ACHIEVING BETTER HEALTHCARE FOR MALAYSIA” - Dr Abd Rahim bin Mohamad

As this slide shows, the government wants to liberalise, then capitalise on the lucrative healthcare industry. 1Care “reforms” will make this possible. Merging the public and private sectors lets the government charge private sector fees. 1Care also guarantees the government a captive market of full-paying patients, because the entire population must be registered under 1Care.

WHO BENEFITS MOST FROM 1CARE?The Economic Transformation Programme (ETP) report [4] enthusiastically promotes "health as an economic commodity". The report declares Malaysia should make:

“ healthcare as an engine of economic growth ”

The ETP report calls for the government to “use its infrastructure capabilities, domestic consumption base and diverse population to create an economic growth agenda for healthcare.” (In other words, the government should use its facilities to make money from the rakyat.)

The ETP report also identifies medical tourism as an “attractive sector” and explains that “with 1.9 beds per thousand and 0.8 doctors per thousand as of 2008, Malaysia has a solid foundation to build on.” (pg 557)

These numbers include both private and government doctors / hospitals! So with 1Care, the government is positioning themselves to reap huge profits from the health tourism boom, together with the private sector. Meanwhile, the rakyat is forced to subsidise the government's business through a compulsory SHI [5]!

As if this is not bad enough, the ETP further proposes that Malaysia should be internationally promoted as a “R&D and clinical trial destination for the pharmaceutical and med tech industries” as our country has a “high incidence of lifestyle diseases”.

The government is not only forcing the rakyat to subsidise their healthcare business, they will also offer the rakyat up to be the world's lab rats!

[3] MPS report on MOH Seminar on 1Care Health Transformation held on 15th Jan 2012, http://on.fb.me/wD0utH[4] You can view the ETP Healthcare Report (Chapter 16) from here: http://scr.bi/w2deN2 (the ETP has removed it from its own website)[5] SHI: Social Health Insurance. 1Care forces everyone by law to pay up to 9.5% of their monthly income for a compulsory insurance

1CARE – HOW DOES IT WORK?

1. INTEGRATION:1Care will merge the private and public healthcare sectors. There will be no more government subsidised system. All healthcare services will charge private sector prices. This will leave the 75% of the rakyat who depend on public healthcare with inadequate healthcare.

Slide 19 from presentation entitled “TOWARDS PUBLIC PRIVATE INTEGRATION: ASPIRATION FOR 1CARE” by Dr. Azilina Abu Bakar, MOH National Health Financing Planning and Development Division

To disguise the high costs of 1Care's privatised system, the government will force everyone to buy a compulsory Social Health Insurance (SHI). The government says that you don't need to pay to see a doctor if you have this 1Care SHI.

This is a big lie because the rakyat are forced to pay up to 9.5% of their income every month for this SHI. And as this MOH slide proves, 1Care's SHI only covers some services. Anything more, you pay out of your own pocket.

Slide 9: “1CARE FOR 1MALAYSIA: PRIMARY HEALTHCARE” by Dr Safurah Jaafar, Director, Family Health Development Division, MOH.

1Care also DOESN'T pay for cases where your disease is so serious that you need very expensive long term treatment or very expensive immediate treatment. 1Care expects you to have your own cash or insurance for that.

But all the SHI premiums that you have paid in your entire lifetime will NOT be refunded to you. Ever.

Slide 33: “MALAYSIAN HEALTHCARE SYSTEM TOWARDS ACHIEVING BETTER HEALTHCARE FOR MALAYSIA” - Dr. Abd. Rahim bin Mohamad

2. PHCPs – DOCTOR JAGA PINTUAll GPs will have to register as 1Care Primary Healthcare Providers (PHCP). But their Medical Degrees won't be good enough. They must go for additional 1Care training. PHCPs will also not be allowed to dispense medicines. You will have to get it from a pharmacy after you see your doctor.

Some other important issues about PHCPs are:

REGISTERING PATIENTS:Everybody must register with a 1Care PHCP. If you don't like this doctor, you can pay extra to see another one. If you want a second opinion, you also pay extra. But your SHI premiums will not be reduced or refunded.

Registration also lets 1Care track your health records. If you use “too much” of their healthcare budget, you may be limited or denied healthcare in future. Unless you pay extra.

GATEKEEPING:1Care PHCPs will act as Gatekeepers - no one goes to a hospital or a specialist without their PHCP's referral. For example, you cannot simply see your own gynae or pediatrician anymore. You must first see your PHCP. If he thinks you need a specialist, he will refer you to one that HE is registered with. If you don't like that specialist, you have a “choice” of paying extra to see your own.

PREVENT DISEASE:1Care PHCPs have to ensure their patients stay healthy. This is because 1Care limits how many patients can be referred to specialists / hospitals. If too many patients are referred, 1Care may penalise the PHCP. 1Care may also put you on a waiting list until its budget allows you to go to a specialist / hospital. If you can't wait, you can pay extra to get immediate service.

CLAIMS:PHCPs earn by claiming money from the SHI for patients they see. But they are given a fixed budget. So they can't see “too many” patients or they won't get paid. They may even be penalised. So your PHCP may not see you if he's out of budget. You'll have to pay extra to see another doctor.

NOTE: All these points are contained in the 1Care Concept Paper. You can read it at: http://taknak1care.weebly.com/1care-documents.html

1CARE – SOCIAL HEALTH INSURANCE (SHI)HOW MUCH, WHO PAYS AND WHO DOESN'T? [6]

Table from the 2009 1Care Concept Paper [6] showing the Health Ministry's estimate of how much the new 1Care system will cost the rakyat.

IS THE 10% PAY DEDUCTION TRUE?The government strongly denies these figures are real. They insist that they put some meaningless numbers in their proposal to the Prime Minister. But we can calculate how the Ministry got their figures, based on official government statistics.

RM44.23b (total health expenditure)divide by 28.3m M'sians = RM1,562 RM972 (annual SHI per person) multiply 4.3 people per household = RM4181.50

We can also see that the Ministry's 9.5% estimate is the average amount needed to sustain 1Care - based on 2009 conditions. This will increase. According to Dr Hsiao (Harvard economist and 1Care consultant), “In every country, health care costs are increasing faster than wages. When that happens, the premium has to go up.”

The Ministry is also exploring sliding scale deductions, where the poorer pay less and the richer pay more. So you could end up paying much more than the proposed 9.5%!

WHO REALLY PAYS THE 10%?The government insists that the rakyat doesn't pay the whole 10%. It's supposed to be shared between the employee, employer and government. They are only telling you half a lie.

The truth is that the 10% is ALL paid by you. How?

1. Your portion is deducted from your salary.2. Government's portion is paid with your tax money 3. Employers pay their portion, but will eventually pass the cost back to you quietly

This last point is confirmed by Dr William Hsiao, who is helping the MOH develop the 1Care implementation plan.

“ the burden of (SHI) on employers was actually borne by employees ”

Dr William Hsiao

In one of his consultant reports, Dr Hsiao explained that, “(SHI payments) imposed on employers were passed back to employees over time in the form of lower wages or lower pensions and other fringe benefits.” Hsiao says, “In other words, the burden of payroll tax on employers was actually borne by employees.” [7]

WHO DOES THE GOVERNMENT PAY FOR?

2009 1Care Concept Paper shows those who don't need to pay for the SHI.

The government says they will take care of the poor by paying for their SHI. Who are these “poor” people? The PM says families that earn RM3000 a month find it hard to make ends meet. This is about 60-70% of the population (about 17-20 million people).

But this table shows the government pays for only 187,172 poor people (0.7% of the population). These are only the hardcore poor – defined as a family of four who earns less than RM500 a month! [8] So if a family of four earns only RM501/month, they have to to pay the 10%!

This table also shows that the largest group that the government pays for are not poor or needy cases at all!

[6] All these points are contained in the 1Care Concept Paper. You can read it at: http://taknak1care.weebly.com/1care-documents.html[7] You can read the interview with Dr Hsiao here: http://bit.ly/ze89ea[8] For statistics on Malaysia's poverty levels, visit these sites: http://bit.ly/wahNEk, http://bit.ly/k4Y3S,

1CARE – SOCIAL HEALTH INSURANCE (SHI)PAYING MORE BUT GETTING LESS HEALTHCARE!

SHI SYSTEMS PROVEN: THEY DON'T WORK!The government says our world-renowned health system is unsustainable. They claim 1Care's SHI will make healthcare cheaper and better. But international studies show that SHI systems don't work! TWO World Bank studies conclude:

“ There is no evidence that SHI countries enjoy better quality health care than countries with tax-

financed health systems ” [9]

“ SHI systems...more expensive than tax-financed systems, do no better in terms of most health

outcomes...may do worse ” [10]

It doesn't work because a SHI system is only concerned with money, not people's lives! This creates many problems.

Slide 14: “TOWARDS PUBLIC PRIVATE INTEGRATION: ASPIRATION FOR 1CARE” by Dr. Azilina Abu Bakar, MOH

IT'S ALL ABOUT THE MONEYWith 1Care, the rakyat pays the SHI. The SHI then pays the doctors and hospitals when we use their services. The government says this way, we all get healthcare but don't have to worry about paying the expensive bills. [11] Not true.

Again, we have to re-look at some of the big words in the slide above to understand what they really mean.

GLOBAL BUDGET : It simply means “fixed budget”. Doctors / hospitals are given a fixed amount, and they can only use that much and no more. This ALWAYS leads to “rationing” - healthcare providers will try to give as little service, materials, drugs, etc as possible so that they won't run out of money.

CAPITATION:A fixed fee. 1Care pays PHCPs a flat rate for every patient, no matter what service they give There's no reward for better care or penalty for poor service. So doctors have no incentive to improve their care towards their patients.

CASE MIX / CASE BASED:A very complex method to budget for the number of patients needing different types of care. For example, Hospital A has a budget for 3 heart attacks, 7 broken arms, and 5 fevers a week. If more cases come in, the SHI won't pay for them.

CO-PAYMENT:Even after paying 10% a month for 1Care's SHI, you STILL need to pay when you see the doctor!

BENEFITS PACKAGE:A list of what the SHI pays for [12]. No one knows exactly what 1Care's package is. But the Ministry's 1Care Concept Paper estimates that your 10% deduction is only enough to pay for about 6 clinic visits a year, or 1 specialist visit a year, or 1 hospital stay in 11 years. [12]

The SHI won't cover the most serious and expensive healthcare needs such as cancer, kidney disease, heart disease and AIDS. [12] You have to pay on your own if you have these diseases. And treatment for any one of these could easily cost well over RM200,000!

This is unacceptable, because the government knows: - 25% of the population gets cancer by age 75, - 10% suffer from kidney disease, and - the No.1 Killer in Malaysia is heart disease

1Care makes you pay so much yet gives so little in return and abandons you when you need it the most. And the government is doing this on purpose!

WILL 1CARE REALLY RATION HEALTHCARE?Yes! Like all insurance, 1Care's main focus is to pay out as little as possible so that money stays in the fund. And 1Care needs a lot of cash to maintain its many, many NEW support organisations and their activities. [12]

The rakyat will never fully know how much they are being denied healthcare. But Dr Rozita Halina Tun Hussein, Deputy DG of the Health Ministry, confirms that there will be rationing:

Slide from: “IMPLICIT & EXPLICIT BENEFIT PACKAGE: PROS & CONS” presented by Dr Rozita at the Prince Mahidol Award Conference, Thailand, January 2012. ('Implicit' - only top officials know which services 1Care excludes. 'Explicit' - PHCPs know too. But patients won't ever know.)

[9] “SOCIAL HEALTH INSURANCE REEXAMINED” by Adam Wagstaff, Development Research Group, World Bank. http://bit.ly/w8aMoo[10] “SHI VS. TAX-FINANCED HEALTH SYSTEMS-EVIDENCE FROM THE OECD” by Adam Wagstaff http://bit.ly/wuaQnl[11] “Better healthcare for all” - 7th para, The Star, 3 DECEMBER 2011 http://bit.ly/wJYVsE[12] Point No 46 & 55, Annex 6: 1Care Concept Paper, http://taknak1care.weebly.com/1care-documents.html

1CARE – IS IT CONFIRMED OR NOT?

FACTS SPEAK FOR THEMSELVESThis is Dr Rozita's profile printed in the Prince Mahidol Award Conference 2012 programme book. It clearly states that:

“ 1Care for 1Malaysiahas been accepted by the Government of Malaysia ”

This is an international conference, jointly organised by the WHO and World Bank. It was attended by over seven hundred senior healthcare policymakers from around the world.

The government tells the rakyat that “nothing has been decided” and they are still “looking at which concept to adopt.” But they told the whole world that 1Care has been accepted and they are working to implement it!

Can we trust ANYTHING they tell us about 1Care if they can lie to its citizens so shamelessly like this?

The government thinks we are all fools who will believe anything!

HOW CLOSE ARE WE TO COMPLETE PRIVATISATION?

1CARE

1994 - Privatised:Government Medical Store.Pharmaniaga monopolises

manufacture, purchase,storage and distribution of alldrugs and medical products

1996 - Outsourced:clinical wastemanagement,

facility maintenance,laundry services,

biomedical maintenance,janitorial services

Privatised:Selected healthcare services.Private practitioners allowedto practise in public hospitals

1992 - Corporatised:Institut Jantung Negara

(to be privatised with

Outsourced:ICT systems developmentand support – HMIS, THIS

Acquisition:Buying private hospitals –

Sabah and Sarawak

Outsourced:Transgenic mosquitoes for

Dengue control

Outsourced:radiotherapy, urology,

dialysis, radiology

Concession:Private build & maintain.MOH rent then transfer

ownership to government –Women and Child Hospital

Land Swap:MOH institutions on prizedcommercial land, private

sector to build newcomplexes on private or MOH

land – 1NIH research

Facilitating:Hospital Information System,

Teleprimary Care and OralHealth Information System

Integration:Training schools –

John Hopkins with Perdana

Methadone programme- Authorise GPs and latercommunity pharmacists.

- Govt gives methadone FOC- patients pay GPs

Facilitating:Mandatory private health

Integration:Locum arrangements -

public doctors in private

Facilitating:Patient’s purchase of

implants and prosthesis- have shops in hospitals

- public providers introduce

Policy:The 1991 PrivatisationMaster Plan officially

listed healthcare to be

Outsourced:Catering services

patients to sales reps

Policy:In 1996, the 7th Malaysia Planstated that “corporatisationand privatisation of healthfacilities and services will

Facilitating:FOMEMA - mandatory

medical check ups for all

Integration:Training schools –

John Hopkins with Perdana

Semi-privatised:UMMC, HUKM,

Hospital Selayang,Hospital Putrajaya

Privatised:Monitoring of privatised

services and consultancycontracted to SIHAT

INFO SOURCES:“PUBLIC-PRIVATE INTEGRATION

IN HEALTHCARE DELIVERY -PAST AND PRESENT”

Dr Rozita Halina Tun Hussein, MOH

“REVISITING PRIVATISATION INMALAYSIA: THE IMPORTANCE OF

INSTITUTIONAL PROCESS”by Shankaran Nambiar, Malaysian

Institute of Economic Researchhttp://bit.ly/w54z2A

“OWNERSHIP AND HEALTHCARESERVICES IN MALAYSIA:

CRITICAL ISSUES”by Raja Rasiah, Makmor Tumin,

Nik Rosnah Abdullah, Uni. Malayahttp://bit.ly/ydynRC

And various other news sources

insurance for foreign workers

1CARE – WHAT WILL HAPPEN WHEN IT STARTS?